This document discusses early detection of cancer, with a focus on breast cancer. It notes that early detection is important as one third of cancers could be cured if detected early and treated adequately. It emphasizes the need for public health education so patients can get screened and diagnosed at earlier stages when conservation treatments are possible and long-term survival chances are higher. Locally advanced disease is common in Pakistan, presenting challenges for treatment. The document promotes efforts like breast self-exams, clinical exams, and mammography to enable earlier detection when options are more favorable.

1. Early Detection of Cancer Breast Prof. Muhammad Arshad Cheema FRCS Chairman Department of Surgery King Edward Medical University Chief Division of Surgery Mayo Hospital Lahore Consultant Cancer Surgery

2. 5 common causes of deaths in Pakistan Injuries Cancer Cardiovascular Diseases TB, Hepatitis and other Communicable Diseases Diarrhea & Malnutrition

3. Cancer has become the no 1 killer of people worldwide WHO 2010

4. Major Surgical Disease Burden in Pakistan Trauma Tumors Infections like TB, Typhoid, Peritonitis

5. What is World Cancer declaration?

6. What is World Cancer declaration?

8. Surgical Oncology Society Pakistan (SOS-PK) Association for advancement of cancer surgery in Pakistan www.cancersurgerypk.org

9. Four components of cancer control Prevention, Early detection A third of cancers could be cured if detected early and treated adequately Diagnosis & treatment Palliative care All patients in need of pain relief could be helped if current knowledge about pain control and palliative care were applied.

10. Can we Prevent Cancer?

12. Cancer Prevention Avoid exposure to known carcinogens Modify risk factors

13. Cancer Prevention 40% of cancer could be prevented, mainly by not using tobacco, having a healthy diet, being physically active and preventing infections that may cause cancer.

14. Tobacco use is the single largest preventable cause of cancer in the world

15. Carcinogen Vendor

16. Oral Cancer from Tobacco use

17. Is there any advantage in early detection?

18. One fifth of all cancers worldwide are caused by a chronic infection, for example human papillomavirus (HPV) causes cervical cancer and hepatitis B virus (HBV) causes liver cancer

19. Chances of survival are increased if diagnosis is made at an early stage and prompt therapy is instituted

20. How can we detect cancer early

22. Development of a lump which grows rapidly

23. A mole which starts to bleed or develops a halo

25. Mammography detection

26. Who should get screening?

27. What is the biggest problem faced by this nation?

28. What can we do as society in this regard?

29. Health Education of Community – a neglected field in our country

30. Early vs late presentation

31. How common is Breast Cancer here?

33. Four have advanced 3b disease

35. Lump in breast Lymph nodes in axilla 8 cm lump above nipple

36. TIME SPAN OF DELAY

37. CLINICAL PRESENTATIONS OF PATIENTS

38. Cancer frequently presents at an advanced stage in this country

39. Fungating tumor is a distressing site

40. Locally advanced CA

41. Locally advanced CA

42. Locally advanced CA

44. How common is locally advanced and metastatic Ca Breast At least 2/3 in our country

45. What are the factors which influence survival?

46. Survival Depends on Stage at diagnosis Axillary LN involvement Other Prognostic factors Tumor grade Estrogen & Progestin Receptors Her 2 nue

47. Early Diagnosis Breast Self Examination & Education Breast Clinical Examination Mammography Genetic Screening?

48. First Issue in Oncology is of the tissue – 4 ways of getting tissue Fine needle aspiration cytology Core needle biopsy Incisional biopsy Excision biopsy

49. Surgery Conservative (NSABP trial B06) Lumpectomy + Radiotherapy Mastectomy Radical (Halsted) Modified radical (Patey) Spares pecmaj muscle

50. In the late 20th century, breast-conserving surgery (BCS) was introduced as an alternative to mastectomy Although no differences in overall survival were found between these two surgical procedures, BCS was associated with a significantly increased risk of local recurrence if radiotherapy was omitted.

51. To Conserve or not? The choice between mastectomy or BCS is influenced by various factors, including Age at diagnosis tumor size / breast size Geographical residence / access to healthcare facilities / ability to follow up Patient’s or physician’s preference,

52. Conservative Surgery Invasive ca < 4 cm Axillary Dissection & Radiation Disease free survival similar to mastectomy Needs careful follow up

54. Majority of breast cancer presents as locally advanced disease

55. Raw smelly wound

56. Real Life Scenarios

57. Patient with bilateral tumourLeft tumour bleeding 200-300 ml /day

59. Wound closure with LD Flap

60. Outcome of the mastectomy wound

61. Recipient and Donor site Closure after LD Flap

62. Tumour in the Right Breast

65. Donor and Recipient area after Bilateral LD Flap

66. Histopathology Invasive ductal carcinoma 8/20 lymph nodes involved ER -ve PR -ve

67. 26 months post-operative She received post op radiation to chest 6 cycles of CMF On follow up remains tumor free 26 months after surgery

68. Submandibular Gland tumor

69. Submandibular Gland tumor managed by excision and Pec major flap

70. October is celebrated asBreast Cancer Awareness Monththe pink ribbon campaign

71. There is urgent need for public health education so that patients can be diagnosed at early stage when conservation is possible with chances of long term survival

72. Summary Early detection maximizes chances of cure Pay heed to warning signs – See a doctor Get screened if you are among high risk population

73. You are welcome to 3rd National Cancer Surgery Conference Feb 2-5, 2011 Organized by Surgical Oncology Society Pakistan (SOS-PK) www.cancersurgerypk.org

74. Dr. Muhammad Arshad Cheema FRCS President Surgical Oncology Society Pakistan Professor & Chairman Department of Surgery King Edward Medical University