WORLD CANCER DAY 2019

The theme for 2019 is “I am and I will” – all about your story and your commitment. Whoever you are, you have the power to reduce the impact of cancer for yourself, the people you love and for the world. It’s time to make a personal commitment.

CANCER

• • Generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasm.
  • One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, which can then invade adjoining parts of the body and spread to other organs. This process is referred to as METASTASIS. Metastases are the major cause of death from cancer.
  • It is a leading cause of death worldwide and accounting for 7.6 million deaths

The main types of Cancer are: lung, stomach, liver, colorectal and breast.
About 70% of all cancer deaths occurred in low and middle income countries

WHAT CAUSES CANCER?
Cancers arise from one single cell and the transformation from a normal cell into a tumour cell is a multistage process. These changes are the result of the interaction between a person’s genetic factors and three categories of external agents which are:
1. Physical Agents: ultraviolet and ionizing radiation.
2. Chemical Agents: asbestos, components of tobacco smoke.
3. Biological Agents: infections from certain viruses, bacteria and parasites.
Age is another fundamental factor for development of cancer.

RISK FACTOR FOR CANCERS
Tobacco use, alcohol use, unhealthy diet and chronic infections from Hepatitis B (HBV), Hepatitis C (HCV) and some types of Human Papilloma Virus (HPV).

HOW CAN THE BURDEN OF CANCER BE REDUCED?
Cancer can be reduced by a) Prevention b) Early detection c) Management of patients with cancer.

a) Prevention (30-40% of cancer can be prevented)

• • Increase avoidance of risk factors
  • Vaccinate against human papilloma virus implicated in cancer of the cervix and Hepatitis B virus (HBV)
  •  Control occupational hazards.
  • Reduce exposure to sunlight.

b) Early detection (30% can be cured through early diagnosis and treatment)
Deaths from cancer can be reduced if cases are detected and treated early. There are two components of early
detection

i. Early Diagnosis
The awareness of early signs and symptoms in order to facilitate diagnosis and treatment before diseases become advanced.
ii. Screening
Systematic application of screening test in the population. It aims to identify individuals with abnormalities suggestive of a specific cancer and refer them promptly for diagnosis and treatment.
For example – Mammogram for Cancer of the breast, PAP Smear for Cancer of the Cervix

c) Management of a patient with cancer
It is the series of interventions including surgery, radiotherapy, chemotherapy and psychosocial support that is aimed at cutting the disease or considerably prolonging life while improving the patient’s quality of life.

 

WHAT IS DIABETES MELLITUS?

It is a chronic condition (it lasts a lifetime) associated with abnormally high levels of sugar (glucose) in the blood.
It occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.
Hyperglycaemia, or raised blood sugar is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s system especially the nerves and blood vessels

WHAT ARE THE DIFFERENT TYPES OF DIABETES?
There are 2 major types called Type 1 & Type 2.
Type 1 is characterized by deficient insulin production and requires daily administration of insulin.
Symptoms include excessive excretion of urine, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.

Type 2 comprises 90% of people with diabetes resulting from the body’s ineffective use of insulin and is largely due to excess body weight and physical inactivity.
Symptoms may be similar to those of Type 1, but are often less marked as a result; the disease may be diagnosed several years after onset.

Other types are:
• Gestational diabetes which is hyperglycaemia with onset or first recognition during pregnancy.
• Secondary diabetes – refers to elevated blood sugar levels from another medical condition, certain medications such as prednisone and drugs used in treatment of HIV infection.

WHAT ARE THE RISK FACTORS?
• Anyone can develop diabetes but it is common in:
• Overweight/Obese people
• People who are physically inactive

• Blacks, Indians and Hispanics
• Older persons
• People with a family history of diabetes.

HOW CAN THE BURDEN OF DIABETES BE REDUCED OR AVOIDED?
Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of Type 2 diabetes. To help prevent Type 2 diabetes and its complication, people should:

• Achieve and maintain healthy body weight
• Be physically active – at least 30minutes of regular, moderate – intensity activity daily.
• Eat a healthy diet of between three and five servings of fruits and vegetables a day and reduce sugar and saturated fats intake.
• Avoid tobacco use.

MANAGEMENT & TREATMENT OF DIABETES MELLITES
Early diagnosis can be done through relatively inexpensive blood testing.
Diabetes cannot be cured and treatment involves lowering blood glucose with diet, exercise and use of appropriate medications (insulin, oral medications).
Other interventions that are both cost saving and feasible include:

• Blood pressure control
• Foot care
• Screening for retinopathy (which causes blindness)
• Blood lipid control (to regulate cholesterol level)
• Screening for early signs of diabetes – related kidney disease.

Monkey pox is an infectious disease caused by monkeypox virus. The disease was first identified in laboratory monkeys, hence its name, but in its natural state it seems to infect rodents.

It is a rare disease, that occurs primarily in remote parts of Central and West Africa, near tropical rainforests, Human Monkeypox was first identified in humans in 1970 in the Democratic Republic of Congo (ZAIRE).

 

Monkeypox is a viral Zoonosis (a virus transmitted to humans from animals).

 

TRANSMISSION

Infection of index cases results from direct contact with the blood, bodily fluids, cutaneous or mucosal lesions of infected animals – infected monkeys, giant rats and squirrels.  Eating inadequately cooked meat of infected animals is a possible risk factor. It can also occur via an animal bite.

Secondary or human to human transmission can result from close contact with infected respiratory tract. Secretions, skin lesions of an infected person or objects contaminated by patient fluids or lesion materials.

 

SIGN AND SYMPTOMS

The incubation period (interval from infection to onset of symptoms) is usually from 6 to 16 days but can range from 5 to 21 days.

The infection can be divided into 2 periods.

1. The invasion period (0 – 5 days) characterized by fever, intense headache, swelling of the lymph rode, back pain, muscle ache and lack of energy.
2. The skin eruption period (within 1-3 days after appearance of fever) where the various stages of rash appears.

 

The face (95% of cases) and palms of hands and soles of the feet (75%) are most affected.

 

Monkeypox is usually a self-limited disease! Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and severity of complications.

 

DIAGNOSIS

Monkeypox has symptoms in human similar to those seen in the past in small pox patients although less severe. Smallpox was eradicated in 1980.

 

It can only be diagnosed definitively in the laboratory where the virus can be identified by a number of different tests.

 

TREATMENT AND VACCINE

There is no specific treatment or vaccines available for monkeypox infection.

Vaccination against smallpox has been proven to be 85% effective in preventing monkeypox in the past but the vaccine is no longer available after it was discontinued following global smallpox eradication. Nevertheless prior smallpox vaccination will likely result in a milder disease course, Cidofovir, an antiviral drug is suggested for patients with severe, life-threatening symptoms.

 

PREVENTION

1. Reducing the risk of infection in people

• During human monkey outbreaks, close contact with other patients is the most significant risk factor, therefore close physical contact with monkeypox infected people should be avoided. Gloves and protective equipment should be worn when taking care of ill people.
• Regular hand washing should be carried out after caring or visiting sick people.
• Cooking all animal products before eating.
• Protective clothing and gloves should be worn while handling animals during slaughtering procedures.

 

1. Controlling infection in healthcare settings

• Implementation of standard infection control in hospitals.

 

1. Preventing monkeypox expansion through restrictions on animal trade.

Restrictions or banning the movement of small African mammals and monkeys may be effective in slowing the expansion of the virus