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Cancer Prevention 預防癌症

Cancer Prevention 預防癌症. 講者: 山度士醫生 - 公共健康博士 健康推廣部主管 Dr. Dos Santos – Assistant Professor – Loma Linda University School of Public Health. What is Cancer 甚麼是癌症 ?.

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Cancer Prevention 預防癌症

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  1. Cancer Prevention 預防癌症 講者: 山度士醫生 - 公共健康博士 健康推廣部主管 Dr. Dos Santos – Assistant Professor – Loma Linda University School of Public Health

  2. What is Cancer甚麼是癌症? “A proliferation of cells whose unique trait – loss of normal controls- results in unregulated growth, lack of differentiation, local tissue invasion, and metastasis.” The Merck Manual 細胞增生,不受控制, 結果: 不正常生長,不能辨別, 入侵其他組織及擴散

  3. Treatment 治療? Good mostly if cancer is detected at an early stage 預早治療才有效. Important重要的 : Early Symptoms/Diagnosis 早的徵狀及診斷 Chemotherapy, Radiotherapy, and Surgery

  4. Cell replication 細胞復製

  5. Cell replication 細胞復製

  6. Oncogenes至癌基因 What activates oncogenes? Smoking Radiation Virus Mutated genes that activate cell growth. For example: RAS gene 25% of cancer cells have RAS gene. Others: C-myc, N-myc - Lung cancer N-myL – Neuroblastoma 神經細胞 C-erb-B2 – Breast cancer

  7. Suppressor genes抑制基因 • Normal cells have genes that suppress cell growth. Those genes are affected in cancer cells. • Example: p53 – prevents replication of damaged DNA and promotes cell death in cells with abnormal DNA.

  8. Hereditary Influences遺傳基因的影響力 Some cancers are related to hereditary genetic alterations. Some forms of Leukemia白血病 Breast Cancer 乳癌 Colon Cancer結腸癌

  9. Regarding the most common diseases, Dr. Lamont Murdoch of Loma Linda University School of Medicine has put it aptly: “faulty genetics loads the gun, . . . lifestyle pulls the trigger.”

  10. Environmental factors環境的因素 Virus病毒 • HPV人類乳頭狀瘤病毒 – cervical cancer 子宮頸癌 • Cytomegalovirus – Kaposi’s sarcoma (AIDS) 巨細胞病毒 - 多發出血性血管瘤 • Epstein-Barr - Burkitt’s lymphoma (AIDS) 伯基特淋巴瘤病毒 - Burkitt 淋巴瘤 (NPC) • HB virus HB病毒– liver cancer 肝癌 • Human retro virus - lymphomas 人類逆轉錄病毒 - 淋巴瘤

  11. Kaposi Sarcoma - AIDS多發出血性血管瘤

  12. Environmental factors - chemicals環境的因素 -化學藥品

  13. Radiation 輻射 • Ultra violet – squamous carcinoma/melanoma skin • X Rays – leukemia, lymphomas, melanoma, myeloma, thyroid cancer, lung cancer Immunity免疫 • Transplant drugs – various cancers, lymphoma • AIDS – Kaposi’s sarcoma

  14. Early Diagnosis - Screening 早的診斷 - 檢查 Breast Cancer Breast self-examination, Medical examination, Mammography Uterus cancer Pap smear Uterus, ovarian Pelvic examination Lung Cancer X-ray, sputum cytology Prostate Cancer Rectal examination, PSA Rectal & Colon Occult blood in stool, Rectal examination, Sigmoidoscopy

  15. Cancer markers腫瘤標誌物 • AFPα胎甲球蛋白 - Liver 肝臟 • CA 125 - Ovary 卵巢 • CA 15.3 - Breast • CA 19.9 - Pancreas胰臟 • CA 72.4 - Stomach, Ovary, Colon胃,卵巢,結腸 • CEA - Colorectal 結腸,直腸 • EBV - Nasopharynx 鼻咽

  16. Early Symptoms 早的症狀 • Fatigue 疲勞 • Weight loss 體重減輕 • Fevers 發燒 • Night sweats 夜間出汗 • Cough 咳嗽 • Hemoptysis 咳血 • Hematemesis 嘔血 • Pain 疼痛 • Change in bowel habits 排便的習慣改變

  17. HONG KONG Main Causes of Death - 1998

  18. Hong Kong – Most Common Cancers - 1998 1998 年 - 香港最常見的癌症

  19. Main Cancers in Females 女性患的主要癌症

  20. Main Cancers in Males男性患的主要癌症

  21. Cancers Linked to Tobacco 與吸煙有關的癌症 • Lung 肺 • Lip 唇 • Mouth (oral cavity)口 • Throat (NPC) 喉 • Voice box (larynx) 咽 • Trachea (wind pipe)氣管 • Esophagus 食 • Stomach子胃 • Liver 肝 • Pancreas 胰臟 • Bladder 膀胱 • Kidney 腎 • Cervix 子宮頸 • Leukemia 白血病 • Colon 腸 • Skin 皮膚 • Penis 陰莖

  22. Colorectal cancer 結腸癌(3rd in men, 2nd in women) Type 類型: Adenoma 腺瘤 + Polyps 息肉

  23. Proportion of Cancer Deaths Attributable to Different Factors – Doll and Peto - 1981癌症的比率與死亡因素 地理生理 感染 醫療 化學 煙 污染 職業 性別 酒 飲食 食物添加劑

  24. Lung Cancer 肺癌 • Smoking – 85-90% of all lung cancers • 吸煙 - 所有肺癌的85-90% • Radon 氡 (鐳射氣) • Asbestos, Vinyl Chloride, Nickel Crhomates, Coal 石棉、乙烯基塑料、鎳、碳 • Second-hand smoking 二手煙 Women – 1.5 – 2 fold greater risk to develop lung cancer than men

  25. Colorectal cancer – Risk factors 結腸癌 - 危機因素 • Age 年齡– mostly over 50 yrs • Intestinal Inflammation腸道發炎 – Crohn’s disease, ulcerative colitis • Family 家庭 • Low fiber diet低纖食物 – or low fruit, vegetables, and whole grains • High fat diet高脂食物 – red meat, butter, dairy • Smoking and alcohol 吸煙和酒精 • Sedentary lifestyle – regular exercise can cut risk in ½ (colon) • 久坐不動的生活方式 Drinking 6 - 8 cups of water a day might be another preventive factor.

  26. Liver cancer 肝癌 • Type: Hepatocellular carcinoma • Hepatitis B/C • Cirrhosis of the liver - alcohol • Aflatoxin • Vinyl chloride • Thorium dioxide • Anabolic steroids • Arsenic • Tobacco

  27. Stomach cancer胃癌(4th in men & 5th i9n women) • Helicobacter pylori • Smoked, dried, salted, pickled foods (Nitrates) • Low fresh fruits, vegetables, and whole grains • Lack of refrigeration • Smoking and alcohol • Previous stomach surgery • Family • Ulcers Helicobacter pylori

  28. Breast cancer 乳癌 3rd in women • Women over 50 yrs. • Late pregnancy and breast feeding • Early menarche and late menopause • Hormones – menopause, contraceptives • Overweight – fat tissues produces estrogen • Sedentarism • Alcohol – 4 drinks a day – 30-40% more risk • Low fruits and vegetables • Smoking

  29. Nasopharynx cancer 鼻咽癌 • Smoking 吸煙– 90% of the cases • Alcohol 酒精 - 75 – 80% of the cases • Vitamin A deficiency 缺乏維他 A ? • Epstein-Barr Virus • Smoked meats-fish

  30. Oesophagus Cancer 食道癌 • Related to alcohol and smoking 和飲酒及吸煙有關 • Very hot drinks 很熱的飲品 - cereals, mate • Intake of fruits and vegetables decrease risk 吃水果和蔬菜會減低危機 • Carotene foods and vitamin C - probably decrease risk too 含胡蘿葡素及維他命C的食物會減低危機

  31. Cervix Uteri 子宮 • Sex intercourse before 18 yrs • Multiple partners • Husband with multiple partners • Human Papilloma Virus, Herpes Virus • Smoking • Vitamin A deficiency

  32. Pancreas Cancer 胰臟癌 • Smoking tobacco 吸煙 • High energy intake - probably 高熱量食物 • Cholesterol - probably 膽固醇 • Meat - probably肉類 • High intake of fruits and vegetables, fibre and vitamic C - protective against 多吃水果和蔬菜,纖維素及維他命C - 有保護性

  33. Ovary Cancer • Smoking tobacco 吸煙 • Family History • High energy intake - probably 高熱量食物 • Female Hormone - Estradiol • Contraceptives seem to protect • Exercise (6h/week) • Women who never had children • High intake of fruits and vegetables - protective against 多吃水果和蔬菜 -有保護性

  34. ANTIOXIDANT FOODS (rated by oxygen radical absorbancy) 抗氧化食物 Issue: July 1999 Foods that score high in an antioxidant assay called ORAC (Oxygen Radical Absorbance Capacity) may protect cells and their components from damage by oxygen radicals. Studies show that eating fruits and vegetables that are high in ORAC levels may be particularly beneficial. Top Antioxidenta Foods (ORAC unites per 100g) Broccoli Florets 西蘭花 890 Red Bell Peppers 紅燈籠椒 840 Oranges 橙 750 Red Grapes 紅提子 739 Beets 紅菜頭 710 Cherries 櫻桃 670 Onions 洋蔥 450 Corn 栗米 400 Eggplant 茄子 390 Prunes 西梅 5770 Raisins 提子 2830 Blueberries 藍草梅 2400 Blackberries 黑梅 2036 Kale 1770 Strawberries士多啤利 1540 Spinach菠菜 1260 Brussel Sprouts 1260 Raspberries 1220 Plums 李 949 Alfafa Sprouts 930

  35. Studies Vegetable-Fruits and Cancer 蔬菜-水果與癌症的研究Block et al, 1992 Cancer Site 位置 Studies reporting inverse relationship/total number of studies Esophagus 食道 15/16 Stomach 胃 17/19 Colon-rectum 腸 20/27 Pancreas 胰臟 9/11 Larynx 咽喉 4/4 Lung 肺 24/25 Breast 胸 8/14 Cervix 子宮頸 7/8 Ovary 卵巢 3/4 Prostate 前列腺 4/14 Bladder 膀胱 3/5 Oral cavity 口腔 9/9 Miscelaneous 其他 6/8 All sites 所有部位 132/170

  36. Cancer type癌症 Protective 保護 Hazardous 危險 Colon 大腸 Legumes (beans, peas豆類 Meat, animal fat 肉,動物性脂肪 Lung 肺 Fruits 水果 Stomach 胃 Fruits 水果 Pancreas 胰臟 Legumes, vegetable proteins, dried fruits 豆,菜蛋白質及乾果 Bladder 膀胱 Meat 肉 Prostate 前列腺 Legumes, tomatoes, nuts, dried fruits 豆,蕃茄,果仁,乾果 魚及肉Fish, meat Adventist Health Study34,200 whites in California – food frequency questionnaire X mortality

  37. Phytochemicals Against Cancer • Citrus fruits – Limonene – may help dispose of carcinogens. • 維他命C豐富的水果: 排出致癌物 • Garlic, onions, leeks and chives – Allyl sulfides - increase production of glutathione S-tranferase (anti-free radical). • 蒜頭、洋蔥、露荀及芫茜: 增加酵素的產生(防止自由機的產生) • Broccoli – Dithiolthiones – protects against DNA damage. • 西蘭花: 防止DNA受損害 • Grapes – Ellagic acid – protects DNA. • 提子: 保護DNA

  38. Terpenoid Food or herb containing the terpenoid Carvone Caraway, spearmint, dill 時蘿 Geraniol Lemon grass 香芧, coriander, melissa Farnesol Lemon grass 香芧 Limonene 果酸 Caraway, citrus, mints薄荷, cardamom, celery西芹, coriander fennel, dill 時蘿 Menthol 薄荷腦 Peppermint 薄荷 Perillyl Cherries 車梨子, spearmint Alpha-pinene Angelica, caraway, coriander, fennel, juniper berry Terpenoids 食物天然色素 • Stimulate activity of GST (glutathione S-transferase – neutralizes dangerous and cancer products making them more water-soluble, easy to be excreted from the body.

  39. Cancer Death Rates According to Fitness Status根據體格情況而定的癌症死亡率 25 Men 男性 20.3 20 Women 女性 16.3 15 Age-adjusted Per 10,000 Person - Years 10,000人之中每年的歲數調整 10 9.7 7.3 5 1 4.7 0 Average Fitness 普通的體格 Good Fitness 好的體格 Poor Fitness 不良的體格 Cancer death rates were substantially higher in low-fit subjects compared to those with moderate or good fitness.

  40. Elements of a Cancer-Protective Lifestyle 一個抗癌的生活模式 • Proper Diet 正常的飲食 • Fruits 水果 • Vegetables 蔬菜 • Maintain Proper Weight • 保持正常的體重 • Drinking plenty of water 多喝水 • Avoid smoking & alcohol 遠離香煙及酒精 • Follow a plant-based diet • Regular Meals with no Snacks 吃正餐、不吃零食 • Avoid molded food遠離發霉的食物 • Avoid fat, barbecued, charred, smoked meats遠離脂肪、燒烤和煙熏的食物 • Regular Aerobic Exercise • 定時的帶氧運動 • Sunlight in Moderation • 適度的陽光 • Use herbal seasonings

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