Cancer PreventionCancer Prevention預防癌症預防癌症

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 CancerWhat is Cancer甚麼是癌症甚麼是癌症 ??

““A A proliferation of cellsproliferation of cells whose unique whose unique trait – loss of normal controls- results in trait – loss of normal controls- results in

unregulated growthunregulated growth, lack of , lack of differentiationdifferentiation, local tissue i, local tissue invasionnvasion, and , and

metastasismetastasis.”.”The Merck ManualThe Merck Manual

細胞增生細胞增生 ,, 不受控制不受控制 ,,

結果結果 : : 不正常生長不正常生長 ,, 不能辨別不能辨別 ,,

入侵其他組織及擴散入侵其他組織及擴散

Treatment Treatment 治療治療 ??

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 Cell replication 細胞復製細胞復製

Cell replication Cell replication 細胞復製細胞復製

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

OncogenesOncogenes 至癌基因至癌基因

Suppressor genesSuppressor genes抑制基因抑制基因

• 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 InfluencesHereditary Influences 遺傳基因的影響力遺傳基因的影響力

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 factorsEnvironmental factors環境的因素環境的因素

VirusVirus 病毒病毒• 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 - AIDSKaposi Sarcoma - AIDS 多發出血性血管瘤多發出血性血管瘤

Environmental factors - chemicalsEnvironmental factors - chemicals環境的因素 環境的因素 -- 化學藥品化學藥品

Radiation Radiation 輻射輻射 Ultra violet – squamous

carcinoma/melanoma skin

X Rays – leukemia, lymphomas, melanoma, myeloma, thyroid cancer, lung cancer

ImmunityImmunity 免疫免疫

Transplant drugs – various cancers, lymphoma

AIDS – Kaposi’s sarcoma

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

Early Diagnosis - ScreeningEarly Diagnosis - Screening早的診斷 早的診斷 - - 檢查檢查

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

Early Symptoms Early Symptoms 早的症狀早的症狀• 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 - 1998Hong Kong – Most Common Cancers - 19981998 1998 年 年 - - 香港最常見的癌症香港最常見的癌症

Main Cancers in FemalesMain Cancers in Females女性患的主要癌症女性患的主要癌症

Main Cancers in MalesMain Cancers in Males男性患的主要癌症男性患的主要癌症

• 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

Cancers Linked to TobaccoCancers Linked to Tobacco與吸煙有關的癌症與吸煙有關的癌症

Colorectal cancer Colorectal cancer 結腸癌結腸癌(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

Medical - 1%

Pollution - 2%

Food additives -

1%

Sex - 7%

Occupation 4%

Tobacco - 30%

Alcohol - 3%

Diet - 35%

Infection - 10%

Geophysical - 3%

Chemicals 1%

Tobacco

Alcohol

Diet

Food additives

Sex

Occupation

Pollution

Industrial chemicals

Medical procedures

Geophysical

Infection

煙

酒

飲食食物添加劑

感染

醫療

化學

污染

職業

性別

地理生理

Lung Cancer Lung Cancer 肺癌肺癌• 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 factorsColorectal cancer – Risk factors結腸癌 結腸癌 - - 危機因素危機因素

• 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.

• Type: Hepatocellular carcinomaType: Hepatocellular carcinoma• Hepatitis B/CHepatitis B/C• Cirrhosis of the liver - alcoholCirrhosis of the liver - alcohol• AflatoxinAflatoxin• Vinyl chlorideVinyl chloride• Thorium dioxideThorium dioxide• Anabolic steroidsAnabolic steroids• ArsenicArsenic• TobaccoTobacco

Liver cancer Liver cancer 肝癌肝癌

Stomach cancerStomach cancer 胃癌胃癌(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 pyloriHelicobacter pylori

Breast cancer Breast cancer 乳癌乳癌3rd in women

• Women over 50 yrs.Women over 50 yrs.

• Late pregnancy and breast feedingLate pregnancy and breast feeding

• Early menarche and late menopauseEarly menarche and late menopause

• Hormones – menopause, contraceptivesHormones – menopause, contraceptives

• Overweight – fat tissues produces estrogenOverweight – fat tissues produces estrogen

• SedentarismSedentarism

• Alcohol – 4 drinks a day – 30-40% more riskAlcohol – 4 drinks a day – 30-40% more risk

• Low fruits and vegetablesLow fruits and vegetables

• SmokingSmoking

Nasopharynx cancer Nasopharynx cancer 鼻咽癌鼻咽癌

• 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 Oesophagus Cancer 食道癌食道癌

• Related to alcohol and smoking Related to alcohol and smoking 和飲酒及吸煙和飲酒及吸煙有關有關

• Very hot drinks Very hot drinks 很熱的飲品 很熱的飲品 - - cereals, matecereals, mate

• Intake of fruits and vegetables decrease riskIntake of fruits and vegetables decrease risk

吃水果和蔬菜會減低危機吃水果和蔬菜會減低危機• Carotene foods and vitamin C - probably Carotene foods and vitamin C - probably

decrease risk too decrease risk too 含含胡蘿葡素及維他命胡蘿葡素及維他命 CC 的食的食物物會減低危機會減低危機

Cervix Uteri Cervix Uteri 子宮 子宮

• Sex intercourse before 18 yrs

• Multiple partners

• Husband with multiple partners

• Human Papilloma Virus, Herpes Virus

• Smoking

• Vitamin A deficiency

Pancreas Cancer Pancreas Cancer 胰臟癌胰臟癌

• Smoking tobacco Smoking tobacco 吸煙吸煙• High energy intake - probably High energy intake - probably 高熱量食物高熱量食物• Cholesterol - probably Cholesterol - probably 膽固醇膽固醇• Meat - probablyMeat - probably 肉類肉類• High intake of fruits and vegetables, fibre High intake of fruits and vegetables, fibre

and vitamic C - protective againstand vitamic C - protective against

多吃水果和蔬菜多吃水果和蔬菜 ,, 纖維素及維他命纖維素及維他命 C - C - 有有保護性保護性

Ovary CancerOvary 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 1999Foods 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 5770Raisins 提子 2830Blueberries 藍草梅 2400Blackberries 黑梅 2036Kale 1770Strawberries 士多啤利 1540Spinach 菠菜 1260Brussel Sprouts 1260Raspberries 1220Plums 李 949Alfafa Sprouts 930

Broccoli Florets 西蘭花 890Red Bell Peppers 紅燈籠椒 840Oranges 橙 750Red Grapes 紅提子 739Beets 紅菜頭 710Cherries 櫻桃 670Onions 洋蔥 450Corn 栗米 400Eggplant 茄子 390

Studies Vegetable-Fruits and Cancer Studies Vegetable-Fruits and Cancer 蔬菜蔬菜 -- 水果與癌症的研究水果與癌症的研究

Block et al, 1992Block et al, 1992

132/170All sites 所有部位6/8Miscelaneous 其他9/9Oral cavity 口腔3/5Bladder 膀胱4/14Prostate 前列腺3/4Ovary 卵巢7/8Cervix 子宮頸8/14Breast 胸24/25Lung 肺4/4Larynx 咽喉9/11Pancreas 胰臟20/27Colon-rectum 腸17/19Stomach 胃15/16Esophagus 食道

Studies reporting inverse relationship/total number of studies

Cancer Site 位置

Adventist Health StudyAdventist Health Study 34,200 whites in California –

food frequency questionnaire X mortality

魚及肉 Fish, meat Legumes, tomatoes, nuts, dried fruits 豆 , 蕃茄 , 果仁 , 乾果

Prostate 前列腺Meat 肉Bladder 膀胱

Legumes, vegetable proteins, dried fruits 豆 ,菜蛋白質及乾果

Pancreas 胰臟Fruits 水果Stomach 胃Fruits 水果Lung 肺

Meat, animal fat

肉 , 動物性脂肪Legumes (beans, peas 豆類

Colon 大腸

Hazardous 危險Protective 保護Cancer type 癌症

• 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

Phytochemicals Against CancerPhytochemicals Against Cancer

Terpenoids Terpenoids 食物天然色素食物天然色素• Stimulate activity of GST (glutathione S-transferase – neutralizes

dangerous and cancer products making them more water-soluble, easy to be excreted from the body.

Angelica, caraway, coriander, fennel, juniper berry

Alpha-pinene

Cherries 車梨子 , spearmintPerillyl

Peppermint 薄荷Menthol 薄荷腦

Caraway, citrus, mints 薄荷 , cardamom, celery 西芹 , coriander fennel, dill 時蘿

Limonene 果酸

Lemon grass 香芧Farnesol

Lemon grass 香芧 , coriander, melissaGeraniol

Caraway, spearmint, dill 時蘿Carvone

Food or herb containing the terpenoidTerpenoid

Cancer Death Rates According to Fitness Cancer Death Rates According to Fitness StatusStatus 根據體格情況而定的癌症死亡率根據體格情況而定的癌症死亡率

Men Men 男性男性

Women Women 女性女性2020

1515

1010

55

00

20.320.3

16.316.3

7.37.39.79.7

4.74.711

Poor FitnessPoor Fitness不良的體格不良的體格

Good FitnessGood Fitness好的體格好的體格

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2525

Average FitnessAverage Fitness普通的體格普通的體格

Cancer death rates were substantially higher in low-fit subjects compared to Cancer death rates were substantially higher in low-fit subjects compared to those with moderate or good fitness.those with moderate or good fitness.

• 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

Elements of a Cancer-Protective LifestyleElements of a Cancer-Protective Lifestyle一個抗癌的生活模式一個抗癌的生活模式