Transcript 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.

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?
“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
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
Cell replication 細胞復製
Cell replication 細胞復製
Oncogenes 至癌基因
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
What activates
oncogenes?
Smoking
Radiation
Virus
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.
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
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.”
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
Kaposi Sarcoma - AIDS 多發出血性血管瘤
Environmental factors - chemicals
環境的因素 -化學藥品
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
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
Cancer markers
腫瘤標誌物
•
•
•
•
•
AFPα胎甲球蛋白
CA 125
CA 15.3
CA 19.9
CA 72.4
• CEA
• EBV
- Liver 肝臟
- Ovary 卵巢
- Breast
- Pancreas胰臟
- Stomach, Ovary,
Colon胃,卵巢,結腸
- Colorectal 結腸,直腸
- Nasopharynx 鼻咽
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
HONG KONG
Main Causes of
Death - 1998
Hong Kong – Most Common Cancers - 1998
1998 年 - 香港最常見的癌症
Main Cancers in Females
女性患的主要癌症
Main Cancers in Males
男性患的主要癌症
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
Colorectal cancer 結腸癌
(3rd in men, 2nd in women)
Type 類型:
Adenoma
腺瘤
+
Polyps
息肉
Proportion of Cancer Deaths Attributable to
Different Factors – Doll and Peto - 1981
癌症的比率與死亡因素
Ge ophysical - 地理生理
3%
Infe ction - 感染
M e dical - 1%
10%
醫療
Tobacco Che micals 1%
化學
30%
Pollution - 2%
煙
污染
Occupation
4%職業
Alcohol - 3%
性別 Se x - 7%
酒
Food
additiv e s Die t - 35%
1%
飲食
食物添加劑
Tobacco
Alcohol
Diet
Food additives
Sex
Occupation
Pollution
Industrial chemicals
Medical procedures
Geophysical
Infection
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
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.
Liver cancer 肝癌
•
•
•
•
•
•
•
•
•
Type: Hepatocellular carcinoma
Hepatitis B/C
Cirrhosis of the liver - alcohol
Aflatoxin
Vinyl chloride
Thorium dioxide
Anabolic steroids
Arsenic
Tobacco
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
Helicobacter pylori
Ulcers
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
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
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
Cervix Uteri 子宮
•
•
•
•
•
•
Sex intercourse before 18 yrs
Multiple partners
Husband with multiple partners
Human Papilloma Virus, Herpes Virus
Smoking
Vitamin A deficiency
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
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
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)
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
Broccoli Florets 西蘭花
Red Bell Peppers 紅燈籠椒
Oranges 橙
Red Grapes 紅提子
Beets 紅菜頭
Cherries 櫻桃
Onions 洋蔥
Corn 栗米
Eggplant 茄子
890
840
750
739
710
670
450
400
390
Studies Vegetable-Fruits and Cancer
蔬菜-水果與癌症的研究
Cancer Site 位置
Block et al, 1992
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
Adventist Health Study
34,200 whites in California –
food frequency questionnaire X mortality
Cancer type癌症
Protective 保護
Hazardous 危險
Colon 大腸
Meat, animal fat
肉,動物性脂肪
Lung 肺
Legumes (beans,
peas豆類
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
Prostate 前列腺
Legumes, tomatoes, nuts,
dried fruits 豆,蕃茄,果仁,
乾果
Meat 肉
魚及肉Fish, meat
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
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.
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
Age-adjusted Per 10,000 Person - Years
10,000人之中每年的歲數調整
25
Cancer Death Rates According to Fitness
Status根據體格情況而定的癌症死亡率
Men 男性
20.3
20
Women 女性
16.3
15
10
9.7
7.3
5
4.7
1
0
Poor Fitness
不良的體格
Average Fitness
普通的體格
Good Fitness
好的體格
Cancer death rates were substantially higher in low-fit subjects compared to
those with moderate or good fitness.
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