 Hello everybody. Hello all the doctors from Manipal Hospital. Hello. Hello, ma'am. Yeah, this is Professor Damansaluja speaking to you guys. I am Vedant Cabra. I am head of cancer surgery and my colleague Dr. Anushil Munshi. He is head of radiation oncology and a couple of other colleagues would be joining very soon. Whenever you are ready, we can start actually. We are ready to start. So I can see 45 participants already on logged in. And so, Shivani, whenever you want, shall we? Because normally we open the link about 10 minutes earlier. So because this was opened exactly at 3, maybe it will take 5 minutes for people to log in. You can wait for 5 minutes, not a problem. Good afternoon, Nan. Good afternoon, Havan. Good afternoon, Sir. I think ma'am, let's wait for some time, little time because the ink has initiated at 3 only. So maybe people are joining. Yeah, I can see that number is increasing every minute. So already 50 people have joined. So a lot of people are logging in. Yeah, we will wait for 5 minutes. Good afternoon to everybody. This is Dr. Neha from Bhadkaracharya College. Good afternoon, ma'am. Good afternoon, Neha. Namaskar, ma'am. I am Dr. Geeta Mungya from Movement Development Cell. And good afternoon to doctors present here. Hello, Dr. Geeta. Namaskar, ma'am. Just now I said a few things and I realized I was on mute. Yeah, no problem. We will start in another 2-3 minutes because a lot of students are, people are still joining. And then we can start. We had a registration around 150 for the program. I see. You know, expect more participation. I am sure. It's a very important area, actually. Ma'am, should I just shoot one meal again so that people can join? If you say so. As you wish. Yeah, sure. People might have waited and gone maybe. Yeah. Actually we had requested our principal sir also but he was busy with some important meeting with the university authority. So I think it will be difficult for him to join here right now. Okay. So I must share by the time we start ma'am that we have been associated with Manipal Hospital from last 3 years. And consecutively every year we are doing some program of awareness. That's very nice. So it is a social awareness to all the participants and our Movement Development Cell is very actively involved in all these activities. So we keep doing such programs. Yeah, I think cancer is important to awareness is very important in cancer. Yes, because now it is getting so common I can say that you never know at any stage. What I have realized is that sometime you get so casual that you come to know at the very late stage about the disease. So I recently came to know about some cases. I mean they got to know when it was at the fourth stage. So I don't know at that point of time how much like it can be cured and how it can be. I mean doctors will be there to brief us about it. It is to catch early as early as possible. That means we must do regular checkups should be done. That's my opinion. Yes, yes. I'm sure all of these people on the on the board today are going to emphasize on that and early diagnosis and you know routine checkups and screening. All this is very, very important and I am sure you know all the oncologist would be talking about that. Yes ma'am so that is very very rightly said because these are the topics that we are going to cover. Yes, I will actually start with cancer prevention, especially lifestyle modifications. Then my colleague Dr. Munshi will speak about cancer screening, which is to detect them early. And as you said Dr. Mongia, this was stage 4 cancer and at stage 4 cure becomes nearly impossible for most cancers. So screening our endeavor is to catch them a little early so that they can be treated well. They can be treated with minimum kind of modalities, less intensive treatment and best care rates can be obtained. Then Dr. Vajpayee who is a medical oncologist would be talking about early science and symptoms. And finally Dr. Sunny again our medical oncology colleague would talk about the recent advances that have taken place in cancer treatment in general. Largely we will be covering about awareness and prevention. Yeah that's very actually that's the important crux. Once somebody is diagnosed then it is the treatment which you have to do anyway and as a society as a general public we can't do much. But at least we can contribute in prevention and going at an early stage to the hospital so that we make the life of the doctors little easier. Otherwise the patient is going at the later stages and they are expecting miracles from the doctor. Exactly. At that point of time I think it become more difficult to... It's very difficult right. Yes ma'am with your permission shall we start ma'am? Yeah I think we can start people will keep joining as and when because classes are also going on online. So maybe people will join after their class in 5-10 minutes. Because you know these people are very busy and tight for time so I think we should not make them beat too much. Yeah a very good afternoon to all of you. I quote you beat cancer by how you live, why you live and the manner which you live. Unquote. Brightly said an American sportscaster Stuart Scott who died at the age of 49 years falling a long battle with cancer. I'm your host for the occasion Dr. Shivani Jeevarmani from Department of Biomedical Sciences. Bhaskaracharya College of Applied Sciences. A very warm welcome to all of you present here. This is yet another episode rather a reminder call in our endeavor to create awareness of diseases and further the possibility of creating health and happiness for everyone. Welcome to the webinar on cancer awareness for women being organized by Department of Biomedical Sciences and women development cell of Bhaskaracharya College of Applied Sciences and Dr. B. R. Ambedkar Center for Biomedical Research University of Delhi and our knowledge partners Manipal Hospital Dwarka. We are all here to create awareness and be aware on the topic which is considered to be the need of the hour that is cancer especially in women the main pillar of our society. The incidence of cancer may be cervical breast cancer etc is increasing at an alarming rate. Thus it is vital to step up cancer literacy and knowledge amongst the population. We hope that this humble effort of ours will help you all to understand the importance of screening early detection and preventive strategies like lifestyle modification. We thank the panel of our eminent doctors from Manipal Hospital who have taken out their valuable time and joined hands with us in our mission to spread awareness. So now I request my colleague Dr. Shwetambri to say a few words of wisdom in Hindi. May I request Dr. Shwetambri? Namaskar ma'am. I am Dr. Shwetambri from Bhaskaracharya College. Am I audible? Yes you are audible. Thank you. Komal hai kamzoon nahi, shakti ka naam hi nari hai, jakko jeevan dene wali modh pithun se hari hai. Nari wasam me utsaha se paripun jeevan ki tal hai, mata ka maan hai aur pita ka samman hai. Nari wasam me jeevan ko paribhashit karta niband hai, nari hi purush ke vishwas aur utsaha ka adhar hai. Manushe apne hi utsaha se swasth aur aswasth anwav karta hai. Param Adhaniya Acharya Avam Nideshak, Dr. Daman Saluja, Shikshak Gan, Doctors, Avam Priya Vidhyarthi ho. Namaskar. Aaj hum cancer ke prati jagrupta ki taraf kadam utha rahe hai. Cancer hone ki suchna vastam me bahut hi dukhad hoti hai. Prantu hum apne vishwas aur sahas se issa sambandit jattil samasyao se uber sakte hai. Apni gati Vidhyo chahe wo pareyavaran ka vidhvans ho, covid-19 yaafir cancer. Hum sab ke liye swayam hi uttar dahi hai. Hum chand par pahonche antatika ko ron daala aur ozoon me chhet kara hai. Aaj humne vidhin prakara ke rasaino aur keet naashko ka istimalkar ko shetro me kamiya bhi praap ki hai. Wahi dusri aur cancer jyasi jeevan ghatak bimariyon ko janam bhi diya hai. Har saal cancer se sambandit shod par arbo rp kharj karne ke baat bhi, bahut sankhya me log iss bimari se piddit ho rahe hai. Dusri aur doktor ke prayosa se hume cancer se uberne me bahut sahayog mil raha hai. Vishwasni hai ki cancer se bachaaf hum hai. To aaye, sambon atm vishwas ke saath iss dhisha me cancer ke prati jagrutta ke liye kadam badaat. Dhanne baat. Thank you Dr. Shwet Ambri. I now request Dr. Geeta Mongia who is the convener of Women Development Cell of Bhaskaracharya College to enlighten the audience on the mission of Women Development Cell. Thank you Shivani. Thank you Dr. Shivani. And I first of all welcome all the esteemed guests of the day and all my participants who have taken out time for this program. I just wanted to have a brief introduction of our cell. The Women Development Cell at Bhaskaracharya College of Applied Sciences is a very vibrant cell and which keeps on working on the reforms towards women, whether it is of physical health, whether it is mental health, whether it is social awareness. So we keep organizing the various programs throughout the year for the women of our society and we definitely believe in the empowerment of the women. We look towards Nari Shakti Avyaan. We want them to be at nirbhar. We want them to be mentally and physically strong. Towards that we keep organizing self-defense programs from Delhi Police. And since this year it was a bit difficult because of the pandemic situation, but otherwise we do it as an outreach activity for the society also along with the students of our college. Then for the mental health, we keep organizing with the doctors for the benefit of the women. And I'm very much happy to tell everyone that we are associated with the Manipal Hospital and the doctors are, we are privileged to have such a nice doctor that who have been taking out time and briefing us and our students about the various aspects, medical aspects. Then for the social reforms, we keep organizing various activities, whether it is National Commission for Women, we keep organizing lecture from there, then about the cyber security. So there are a numerous amount of programs that is being done throughout the year. And we have further programs also in pipeline, but this is one of the activities that is being catered by the women development cell along with the biomedical department. And I'm very happy to tell every participant that we have Professor Daman Saluja with us. And it is our honor to have her here and brief us about the knowledge about this. And I would also like to enlighten our audience and esteemed guests that we have done this program in our non-teaching staff. So it will be a very nice gesture and part of all of you if you can add some information or you add Hindi in your speech and your program so that whatever interaction will be easy for everyone and it will become a little more interactive session. So with these words, I thank you everyone. Thank you Gita ma'am. I request our mentor, Honorable Professor Daman Saluja, Director, Dr. B. R. Ambedkar Center for Biomedical Research to address the audience and bless the occasion. Thank you so much ma'am for keeping all the patients for the late starter. Over to you ma'am. Thank you Shivani and I first of all want to welcome all the doctors, panelists from Manipal Hospital. It's one of the premium hospitals with well known for its care for the patients. And I'm really glad that they have spared time out of their such busy schedule to address the audience on this very important issue of cancer and especially cancer awareness and prevention. Because that is what is very, very important as part of our responsibility, the audience that we are talking about. Prevention and risk can be reduced. The treatment is not done by the doctor. But how can we prevent it? What work should we do to prevent cancer? These are the doctors that we will talk about in our lecture. So as we all are aware, if everybody switches off their microphones, that will be good. Yeah, I request all to keep your mic muted so that we can hear ma'am. So there is some whistling coming from the background. So cancer is actually globally, if we look at it's a second major killer. And India is no less in India also the number are increasing rampantly and some of the major cancers that are common in India are women related health issues such as breast cancer and cervical cancer. And the other are fine both in males and female both are common like oral cancer and lung cancer stomach and colorectal cancer. But the number has increased in India during the past one decade like anything. So therefore it is imperative that people are aware of ways to prevent cancer. By providing the correct information and healthcare in time, we can reduce not only the global impact of cancer, but also in India. In fact, February is a national cancer prevention awareness month in several countries. And in India, of course, we don't have like that as February as a prevention and awareness month in many countries it is celebrated as a, so a lot of such activities are conducted all over. But you know, awareness is not enough. Awareness should be followed by taking action on that awareness. Today, if we don't take action on what the doctors tell you, then we are not going to benefit from it. This is what we have heard and removed from the other ear. So today, all these people who are experts in this field, whoever tells us that we shouldn't eat this, shouldn't do this, we have to take action in our daily life. This is very important. And therefore it is like, you know, when cancer occurs, the life of the patient changes, the life of the family changes. Because there is always a fear that it can happen again. I don't know if it will be right or not. And of course the treatment is expensive. So it is better that we keep our health like this so that it doesn't happen. We should treat ourselves with such things that can prevent us from getting cancer. And there are now, there are diagnostic systems which we call screening methods where we can have very early detection. And this early detection will tell us that, okay, we have this type of cancer and we must see the doctor immediately so that the treatment can start at an early stage of the cancer. And therefore it will be more recoverable and curable. So that is very, very important. Although I can say that there is no definite or certain way of preventing cancer, but there are several risk factors which increase the likelihood of getting cancer. And if we are able to take care of those risk factors, we can, you know, lower the risk and we can improve our health so that we don't get into these. You will have heard a lot of factors. Cigarette smoking, tobacco smoking and then, like cervical cancer, we all know, infection, human papilloma virus. And now there is a vaccine for it. So we should apply that vaccine to children, especially girls. Radiation exposure, obesity, environmental factors, alcohol, lung cancer and oral cancer, tobacco, food, chewing, tobacco. So these are all things that I think in detail these doctors will tell us. And that's why to reduce, they will also tell us how we can, what actions we should take to reduce our risk. And I like, for example, there is a lot of emphasis these days that health, keep your weight under control, don't smoke. And immunization, as I just said, has come for HPV. There are a lot of things that these learned professors and doctors will tell us. And I'm sure today's speaker will highlight many of these important points and we should follow them. That is what is our responsibility so that we bring it down and so that they can cure the patient at an early stage. With these few words, I would once again welcome all the speakers and the audience for making it a special seminar. I'm sure you will all be benefited. We all will be benefited from the wise words of the speakers of today. And thank you, Shivani and all other from your college for organizing this webinar by coordinating with doctors at Manipal Hospital. Over to you Shivani. Thanks Damanman for enlightening us with your word for wisdom. I totally agree with you. February is the month when Cancer Day is celebrated all over the world. So with this in mind, we actually conceptualize this program. And I totally agree with you that prevention is better than cure. Our future depends on our present actions. Now I would request Dr. Neha saying my colleague to introduce our imminent speakers and initiate the proceedings of the webinar. Over to you Dr. Neha. Dr. Neha, are you there, dear? Dr. Neha, you may unmute yourself. I think her mic is not working. Just few minutes back, she talked to me. She was here only. I think she was here only. I think let's wait for one minute. Let me see if I can reach her. Dr. Shivani, I think she has some issues at her intellect. Can you take up and proceed further? So I take the opportunity of welcoming our imminent panel of doctors. Dr. Vedant Cabra, whose HOD surgical oncology. Dr. Piyush Bajpay, whose HOD and consultant in medical oncology sciences. Dr. Anushil Munshi, whose HOD consultant radiation oncology sciences. And Dr. Sunny, who's a consultant in medical oncology. Sir, may I now welcome you all to start the proceedings. Thank you, ma'am. I'm Vedant Cabra. I'll be starting first. Thank you. I'll just share the screen and then in a minute we'll start. So as everybody has said, prevention is better than cure. So let us start with prevention first. And is it possible that cancer can be prevented? We'll see. And it is possible. It may not be possible in every 100% situation. But in many people, prevention is possible. If you see, in the US, in the 19th century, about 120 to 120 years ago, the lifestyle contribution in deaths there was very little. 60% deaths were caused by infection. But 100 years later, in 2000, 60% deaths were caused by lifestyle diseases. The red one on the right side of the pie chart is the lifestyle. And the important component in lifestyle is cancer. Similarly, in Australia, in the UK, 60% deaths are caused by lifestyle diseases. In India, ICMR study was conducted in 2017 in which we found out that 60% deaths are caused by lifestyle diseases. If we look at the cancers, there are many diseases in the UK and in the US in which we found out that 45% cancer is caused by lifestyle. So you can imagine that we can prevent almost half of the cancers if we have a proper lifestyle. And in India, I suspect this percentage is going to be even more than 50%. Why is that? Because the Global Adult Tobacco Survey, which is called CATS, in the last CATS survey, it said that adults, 15 years and above Indian people are using almost 29% tobacco. And this percentage, in western countries, in the US, is very low, 20% or even less. I hope that because of our lifestyle, especially because of tobacco, the cancers have increased in the UK, the US and other countries. So these are some things that I will talk about. Tobacco, alcohol, obesity, Madam Saluja has also told me about some of them. I would like to say first about tobacco because 40 to 50% cancer is caused by tobacco. If you look at it from the bottom, if you look at it from the top, there is no such organ, there is no such organ left where cancer cannot be caused because of tobacco. We all know that mouth cancer is very common in our country because it is very common to eat tobacco. And because of this, India is called the Oral Cancer Capital of the World. In the same way, the voice box, the throat, blood cancer, liver cancer, stomach cancer, and cervical cancer, which Madam has talked about, in all these cancers, tobacco has a very important role in making these cancers. Now, whether tobacco is taken as a paan, whether it is a bee, whether it is a jaggery, it is a cigarette, because in our country, if we look at alcohol with it, then in alcohol, the Oral Cancer, from the top to the bottom, there are cancers because of alcohol. And these are some important cancers, which are more important cancers because of alcohol. And in this, the pink color circles, the bigger the circle, the more the effect of alcohol is for these cancers. This is the study of the UK, alcohol and tobacco are two such things, which are gradually increasing, which is very bad. For tobacco, the average age in our country is 8 to 10 years, 12 years of age. And here, the teachers have a very important role, because many college students come to college for the first time and use tobacco there. And it is very important to curb it. And our role is also very important. Maybe it is more important than us. And if the combination of tobacco and alcohol is done, like it is said, it is 1 plus 1, 2, not 1 plus 1, 11. So if someone has a chance to get cancer because of tobacco and they start taking alcohol, then it increases and increases a lot. The second number is obesity. How can obesity be? One is lack of exercise and the other is the problem of our diet. High fatty diet or low fiber diet. And this combination also causes all kinds of cancers in the body. If we look at it in a prominent way, breast cancer, intestinal cancer and uterus cancer, which is found in fat people and in cancer, fat is a very important contribution. The type of diet that I told you in the beginning that low fiber, high fat is one thing that we should eat more fresh fruits and vegetables, freshly cooked fruits, seasonal fruits and vegetables and locally available. According to that season, the part in which you live should be consumed most of the time. We are getting all kinds of food, it is good for your health but freshly prepared, locally available and seasonal food material is the best. I would also like to say that our Indian tradition, the ancient way of cooking, has been told that if we follow this type of food during the rains, it can give us a very balanced and healthy, nutritious diet. If we look at the difference between vegetarian and non-vegetarian diets, it is seen that vegetarians have less cancer and the main reason for that is that processed meat and red meat increase the cancer a lot. Not only is there more cancer but if you look at life expectancy then compared to non-vegetarians if all other things are equal then it is more than 7-8 years. Vegetarian lifestyle is a better lifestyle as compared to non-veg especially if you are consuming red meat, processed meat and it is not for processed meat it is any kind of processed food. Nowadays, food is less available at home, and it is very easy to make packets with preservatives, processed food junk food, pizza, burgers, biscuits, cookies, all these things, you should at least use them. Infections are something that can cause cancer. Not only cancer but other diseases too. So a common infection which is very age, hepatitis B what does that liver do? It causes disease, damages and repairs and it reaches chronic hepatitis, from acute stage to chronic stage. And when it continues to damage continuously for years then it develops cirrhosis. And the nodules of cirrhosis become lumps then there is cancer and you can see the red color on the bottom left this is cancer. The reason for cancer is hepatitis B alcohol is also a very common reason for liver cancer. It follows this cycle, cirrhosis and then it gets cancer. Its vaccine is available similarly there is another virus human papillomavirus. Dr. Saluja told that cervical cancer is caused by it. So I would like to tell more that only cervical cancer has many types of cancers which can be caused by human papillomavirus. And in this area your sexual organs in Jannango and rectal area in anal canal in vagina, these types of cancers can be received by HPV virus. And there is a very good way to save from these two viruses that are vaccines. Hepatitis B vaccine is included in Indian Academy of Pediatrics of our Government of India and it is also given in this. It is a little different in children and adults of immunization schedule. Likewise HPV vaccine is also included in Indian Academy of Pediatrics as an optional vaccine and it is also recommended to the Government of India to include it in mandatory vaccine. In our country today it is also recommended for girls as it is given by HPV as it is in New Zealand. It is because in boys there is also Penile Oral Cancer and it is available. If the person who needs it is 14 years old then only two doses are sufficient and after that you have to take three doses in this vaccine. As I said in the beginning it is a life of running and stress. The immune system gets worse and the bad cells in the body which should be removed they cannot be removed. So they change in cancer and then they increase. The stress of life, the stress of work and not only work is stress but also outside is stress. It is increasing and our immune system is also getting weaker. After that when social media gets eaten then the social interaction in which you sit and make your mind light those interactions are completely over. So for cancer prevention finally I would like to tell you to modify your lifestyle in such a way that your overall well-being physical, mental and spiritual and in that intellectual, social all these are very important balance should be balanced. So physical well-being from your good diet, exercise mental well-being if you are happy do some yoga and spiritual well-being, meditation and yoga can be done by them. So I would like to say cigarette or tobacco stay away from any form of tobacco and alcohol consume more fresh fruits at least every day we should take 3-4 fruits a big bowl of salad and fresh food is also good. Physical exercise watch your weight I would like to tell especially for women breast cancer if your child gets pregnancy early in the early age and if the child is given more milk for more than a year the protective factor works for breast cancer in the long term so the breast feeding should be promoted there are women who have a problem that they cannot do a lot of feeding but they should try to take the crash if they can do it near the workplace or keep the night time feeding if they can do it in daytime and overall a holistic well-being if you stay you can prevent cancer thank you and I would like to invite Dr. Anushil Munshi to talk to you about cancer screening good afternoon everyone I hope I am audible yes sir you are audible ok so first of all I would like to thank you all for taking some time for your health it is very important and especially when it comes to cancer I think that we need time to listen to this to know about it it is very important to take this time and in the future as Dr. Vedant Kabra has told that prevention is one thing and the second thing is screening so that we can detect cancer early so I would like to talk to you in a few minutes about cancer screening as you can see on this slide our purpose our aim is to detect cancer as soon as possible because of cancer the mortality is reduced the expenses of cancer if you see that in early stage the expenses are reduced side effects are reduced the patient's discomfort is reduced and the quality of life is better if we detect cancer early and the things about this which we need to know and when I will try to give which screening modality should be used which frequency should be used how many times should be used which age should be started which age should not be needed should be closed guidelines and can there be any damage due to cancer screening so we will talk about these things in the next slide first let's talk about breast cancer so what are the methods and which age should be started I have divided this in three categories in three parts traditional which are going on for a long time in which mammography sonography which is also called ultrasound breast self examination breast self examination which examine your own breast so it is called breast self examination clinical breast examination then then there are some modern tools which have digital mammograms MRI tomosynthesis another investigation and with contrast there is another modality and in the future there will be some other modalities which will have artificial intelligence based systems which will give some extra inputs about this so one question is when should we start so as far as breast self examination is concerned so women can start breast self examination at the age of 20 years but in some cases they can start earlier now how can breast self examination be done and how it is important to know so once a month after two or three or four days of periods breast self examination but there are two or four things important to know as I told you once a month two to three days after periods breast and armpit should be examined with the arm raised on that side and the second thing is it is important not to examine finger tips but the pads which are shown here the pads these parts you have to examine from the flat surface and at that time when you have applied some oil or shower gel then you can easily examine it there are many ways many directions you can examine it from breast this technique which is shown in this figure you can do up and down technique from the middle to one side there are many ways you can slowly take big circles out you can examine the third way is to take a hand in each direction taking it out and examine the whole breast but you have to see from the hand you can also see in the mirror whether you can see something like a bump or something like a lump or something like a dimpling the color of the skin has not changed and that is why I am saying you should examine in that phase because the softness of the breast varies according to the duration according to your duration so keep a fixed duration like after 4 days then after 4 days you have to examine so that you always have a comparative assessment in your mind this is about breast self-examination now a more important and commonly available is called Memogram in which the breast is kind of put between two plates and after that an X-ray unit is captured with a camera the film plate is captured and it is called Memogram and typically two views are taken one is called Cremio-cordyl and the other is called Mediolatal Oblique two views are taken and the breast is seen in this 100% accurate there is no technique but this technique is very beneficial especially if we talk when we talk at the age of 40-45 then this is a very good technique in its lower age Memography is not so sensitive but after 40-45 especially its sensitivity and such guidelines tell us that every 2 years if from 60 to 75 every 2 years we should do Memography 50-60 years every year we should do Memography and this is information about normal ladies but some ladies who are at a higher risk who are at a higher risk and for them our recommendation is a little bit more strict you will remember that normally we recommend to start at 45-50 but for high risk we recommend screening from 30-40 and how high risk and why this can be the reason which your doctor can explain to you like a very strong family history it is not that there is no such family history but a very strong family history about which doctor can explain who we are a strong family history so we recommend to start a little bit early i.e. starting from 30-35 as i told you earlier i told you that in the younger age such a good investigation is not accepted in 30-35 so we join MRI together especially in 30-40 years and this was for high risk screening so i talked about breast cancer now i will talk about male and female which are important for example colon cancer for colon which is also called large intestine we have two or three ways of screening one is like you are seeing diagrams on the left side this is our large intestine but in large intestine either we do endoscopy which is called colonoscopy and we can do it with light so we can see if there is any problem another way is we do not do scopy it is a scan and we reconstruct the colon and see if there is any problem and third way is because when we pass all the stool when we touch the colon the stool examination is also a way for screening of cancer now as you are seeing in this slide there is a recommendation that in the age of 50-75 in males and females there should be any test if you are doing colonoscopy then in every 10 years sigmoidoscopy means we have seen so many parts because the chance of getting more painful is only in the lower part so if you test colonoscopy then in every 5 years there is one more special test which is fecal pocalt blood test or fecal immunochemical test we see that there is no blood in the stool and it should be annulled and along with fecal immunochemical tests if we apply DNA test in which we see cells it is called fit DNA test it is recommended in every 3 years so it is not like everyone has to do one of these and with the advice of khaskar doctor you can select and accept it lung cancer now we are seeing khaskar our new generation is coming there was a lot of struggle and the doctor of smoking has told us how much of a loss of smoking and we should hope that our young generation should treat it and stay away from it because there is a lot of loss so for lung cancer screening criteria which are which people should do lung cancer screening there are 77 years of population and not all of them among them who are smoking or they have left for 15 years but there is a smoking history i.e. 2 packs for 15 years 2 packs per day if a cigarette is smoking then its 15 x 2 is equal to 30 packs per day if one pack is smoking for 30 years then it is also 30 x 1 30 packs per day so this 30 pack history plus you are currently smoking or you have left in the last 15 years and your age is 75-70 so you should do lung cancer screening and provided you are fulfilling this criteria what happens in this a low dose CT is taken in which the chest is screened in CT scanner and it is seen that there is some abnormality now I will talk about one more which is a very important issue of cervical cancer screening and about this I request you to listen carefully it is very important that the column on the left side of the age is seen so in less than 21 years screening is not typically recommended but the exception is that if a female is less than 21 years but infected with HIV or immunocompromised 21-29 years in cytology or perhaps mayor alone is good enough every 3 years 30-64 years in this age, cytology and HPV co-testing is preferred perhaps mayor with HPV co-testing every 5 years or in just 3 years and after 65 years you can stop screening if you have negative results like 3 consecutive negative cytology if your tests are normal then after 65 years you can close it and perhaps mayor which you must have heard you are seeing this this is the mouth of the child and in this we put a brush and take a smear and the smear is tested and it is called perhaps mayor this is a snapshot I am showing you a summary snapshot I told you about the rest what are the ways of age and how to repeat in 1-2 years for cervical cancer perhaps mayor and HPV test which is to start at the age of 20 I have told you about the lung for which age group and for which risk factor you have to use and once in a year for colorectal after 50 years for men and women there are many test options which we have to choose with these words thank you very much you took the time to listen about screening now I will repeat from my colleague Dr. Piyush Bhatpay that he came and what can you do about red flag signs about cancer and more important information Dr. Piyush Bhatpay very good afternoon to all good afternoon sir I hope my slides are visible right now yes very much thank you and I am clearly audible as well am I clearly audible as well yes yes so Dr. Vedant had started cancer how to prevent it which is called nipping in the bud that is we don't let the root be born and don't let it come in the body that is primary prevention Dr. Anushil touched on what are the screening methods and screening methods he said mainly there are 5 cancer such as cervical breast pulon lung cancer for which he told us about the screening test so we got so much information that there are some cancers which we can manage with the lifestyle prevention in the cancer screening program like the timetable age groups Dr. Anushil told us if we follow it we produce many cancers which don't produce symptoms before before they become symptomatic before we catch them cancer screening or a second prevention method Dr. Anushil told us I am going to talk about red flag science when I am talking so what this means that red flag science these are the symptoms that many times cancer screening is being done by people or not so if there is any change in the body then how should we be prepared and if we come then what should we think that we can do so I will tell you in the coming slides we are talking about the red flag science and the cancer so just a very basic question what is cancer so these are the cells the basic structure of our body the basic structure if our cells change there is a mutation which changes their life cycle their cell cycle and as we know in life cycle there is a production and then maintenance and thereafter each cell dies if this cell does not die and if this cell does not die for some reason as it is said in the computer there is an error in the software so in the same way if there is a mutation in the cells if there is a mutation in the DNA then this cell which is a kind of anarchic and if it starts making many more cells of its kind then this there is a change in the form of a gantt when this gantt is called 10 to the power of 12 if this type of gantt gets so many cells then this gantt becomes like a cricket ball now you can imagine this type of cell division does not take much time 10 to the power of 12 when the cellular mass is equal to a cricket gantt then it puts pressure on the cells around it by putting pressure we call it tumor mass which is a swelling which is putting pressure on the normal cells putting pressure effect the nutrition around it is absorbing this cellular mass we call this cancerous conversion so these are physical attributes of cancer putting pressure on the nearby organs putting pressure the second attribute is the metabolism of the body alter all that metabolism and all the glucose, fat requirements are directed towards cancer cells because of this there is a major symptom of weight loss we keep this in mind that if we get cancer quickly then we can get a good curability element this is very important because of this we discussed screening we discussed reflack science so the reason is if we look at mortality that is deaths because of cancer we are an urbanized population we are facing this challenge but we see this compared to western world why is the mortality of cancer not so much in India or in third world countries the reason is that in India in our country the presentation from the early symptoms to the clinic is taking a long time so in our country stage 3 and 4 cancers about 70 to 80 percent are seen in our country when the doctor is sitting in the clinic in western world in Europe and US because screening strategies are strictly followed like today we are doing this education program education programs are going on so in this way the early stage cancers are 70 to 80 percent and the advanced stage cancers are 20 to 25 percent the problem is the death of the cancer is less compared to India we see this a lot so are there any signs that we should be careful and I will say that these are 9 warning signs for which as soon as we see these signs in our body we immediately talk to our family physician oncologist or any gynecologist we should take medical advice not to neglect it number one sign we should talk about unexplained weight loss when we talk about unexplained weight loss the first thing that comes to mind is that the weight is decreasing we know this in cancer differential diagnosis what does unexplained weight loss mean weight i.e. there is no change in our diet the food we were eating is the same we ate as much as we were eating even now but our weight is decreasing if someone's weight is decreasing and it does not cause any other physical problems i.e. thyroid hyper functioning also increases weight our dietary pattern also increases weight chronic diarrhea also increases weight so if any other disease is coming unexplained weight loss we should definitely talk to our family physician in this way cancers are usually related to GI tract sometimes lung cancer causes weight loss we should be careful how much weight we are told how much weight is a alarming signal so it is said that in the last 6 months if the weight loss of 10 kg has happened we will call it a significant weight loss i.e. this weight loss is a weight loss which we should definitely give medical attention number 2 symptom is pain if we talk about pain then it could be a pain or a symptom usually when the cancers are advancing so it may be an early symptom in certain cancers like bone cancers or it could be a symptom in a very advanced situation like breast cancer breast cancer is usually painless breast lump early stage is painless so breast cancer is 90% of the time it is painless but if it is bone cancer or testicular cancer or if we have a brain or if we have a headache it could be a brain tumor pain what is the type of pain most of the time cancer pain is usually not the type of pain it is usually not the type of pain number 2 cancer pain is often more painful during the night so especially a headache which is more in the night it is so much that a patient or a person has broken his knee due to pain so it should be checked up immediately this type of pain if it is in the stomach then we should immediately do imaging or brain MRI or spine MRI may be needed when there is this type of pain we often get to see advanced cancers change in bowel habits or bladder function Dr. Anushin had told that we should get a colonoscopy every 10 years or do imaging colonoscopy so if we see a person at the age of 50 if the constipation is not there and the constipation starts to happen in the last few weeks the constipated brain or instead of constipation the diarrhea starts to happen or the change in the size of the stool meaning the type of fecal matter that used to happen starts to change in the next few weeks so it may be the change in the colon cancer because of this such a person should go to his family physician or gastroenterologist to tell that this type of pain Dr. Anushin had told in that case the first test should be like this sometimes in the mail if I talk in the patient there should be some change in the age of 50 if the patient's spine is broken or the bone falls or the patient is not able to control if these symptoms are there then they should get a prostate checkup by meeting their family doctor and in this situation prostate specific antigen or digital rectal examination these two hold the prostate cancer they hold source that do not heal meaning any body which is not filling here in the photo you can see there is a plate in the mouth which is a patient from many times now the reason for this can be either to chew the stomach because often the stomach or the stomach people press the gum or the cheek so in that way there are chalets and these chalets are changed in the cancerous source so or tobacco chewer another common non-tobacco chewers or those who use tobacco but if they have sharp tooth the gum or the cheek is cutting the inside of the stomach the chalets are coming and the nose and mouth they should immediately chew if the ulcer heals after chewing then this was of a non-nature otherwise the ulcer if the ulcer does not heal for 6 weeks then its biopsy definitely should have a discussion with an ENT surgeon or a general physician this type of chalets are anywhere in the mouth whether in any other body it can be in genitalia so we should also have a discussion with the doctor whether it is a gynecologist or family physician whether it is because of the infection it can be because of the infection it can also be a sign of early cancer unusual bleeding or discharge unusual bleeding where from any part of the body if the bleeding comes like in post-menopausal ladies if we see parveginal bleeding then this is an alarming symptom so it can be because of the infection so it should not be neglected this cancer or endometrial cancer most of the endometrial cancer can be a sign of it so if there is any kind of discharge or bleeding then this should be discussed even in urine it can be bleeding it can be because of the urine tract infection otherwise cancer can also be a possibility similarly if there is any discharge from ripple if there is any bloody discharge then breast cancer can be very strong so if there is any bleeding then we should consult the doctor thickening or lump in the breast or otherwise anywhere any lump so if we talk about breast lump breast lump breast lump all the patients of cancer in the early stage breast lump they tell us that it is a painless lump it does not have much pain in it breast cancer does not have pain in the initial stage but if it involves skin or breast muscles then it becomes painful so any other painless lump especially after the age of 40 years then it should be discussed with the doctor that what is it mammography should be done ultrasound breast should be considered so these all are usually done less than 35 years less than that age usually the breast lumps there are no lumps but still if you see any changes as Dr. Anushil said if there is any changes then it is always necessary to discuss with the gynecologist especially as Dr. Anushil said that there are 5-10 patients in which there is a genetic tendency because of this an early cancer presentation in 5-10 years indigestion and travelling this is a common problem as Dr. Vidaan said that people nowadays often order food with Zomato or Swiggy and they have acidity and the use of Pantop has become the most common over the counter drug people take Pantop and take it for many weeks Pantoprazol is good for short term acidity but if there is any acidity more than 2 weeks the demand for Pantop needs to be taken so once you consult your doctor you can need to check the distance in this type of problem and it becomes important to see esophagus and food pipe any mass in our body any mass that has its own color and variation we should see it once if this type of mass is sometimes sunbathing especially in India sunbathing is not a problem because it is our tropical country so the most sunbathing or if someone else changes their color their size their bleeding it can be a sign of skin cancer it is also called melanoma otherwise skin cancer is also called carcinoma in which in the sun exposed area it is possible it can be a face or neck so you can see the changes and if this type of mass is seen then you should consult your doctor nagging cough or porcelain so nagging cough that means a cough that is going on one or two days cough is common flu we know corona we know these are small time symptoms if cough is going on for a long time or a lung respiratory disease like asthma COPD tuberculosis infection TB is a long cough and third thing especially in a person who is chronic smoking or if he is doing it in such a situation cough can always be a sign of lung cancer in this we should immediately consult the doctor just imaging like Dr. Anushil had told that CT can be needed we should consider this in that situation changing the voice i.e. the voice becomes heavy this is a voice box or laryngeal cancer so this especially if you use smokers and BD smokers this can be found so this our discussion was screening and catching up early signs the important thing is that as much as we talk what is the cure for cancer in today's day in 2021 can we cure some cancers in today's day many cancers can be cured but the important thing is to catch them early or we are a part of a systematic screening program and despite being a part of a systematic screening program if we see any changes in our body we should immediately report it to our doctor if no one is following the screening program then if we get to see this in any patient or in any person then we immediately contact our family physician this is very important not only from a prognostic point of view but we see the health costs as much as we delay in the cancer diagnosis as much as we keep the gap in the past presentation the treatment costs are actually high the reason is that we have to get involved in advanced cancer for example, breast cancer if we catch them early if we take a small body we take some action of it then maybe only surgery maybe only tablets after surgery no need for radiation no need for chemotherapy curability will be good in early stage cancer also the treatment cost would definitely be dua so with this I hand over Dr. Sunny Garku my medical oncologist is coming we will talk about recent advances in cancer care and after that we would be more than happy to take up questions if there would be any questions good afternoon everyone so before me you must have got an idea about all the basic things like what are the risk factors and what are the screening methods and symptoms how to detect cancer what are the symptoms which we can help to diagnose cancer in the earliest possible stage so now there is one thing left what are the basic treatment options like how the treatment has evolved how the treatment of cancer has evolved in the last few years so if you start with a basic so this is something which we call as cell cycle so cell cycle is a phase like is a group of is a sequence of events with which our cell growth is regulated so there are some phases like you can see the circle in which it is written the cell cycle so it is G0 phase G1 phase S phase, G2 phase these are the various classes of chemotherapy drugs which act on cell cycle in particular phases and cancer cells basically they are replicated very fast more than normal cells so these chemotherapy agents effect on cancer cells because they stop the cell replication cancer cells which are replicated fast they have more effect on them and wherever they work you can see there are some classes of drugs which act on a particular phase so it has a very scientific basis behind it how to design how to act how to select mechanism according to that so I may not have understood in a lot of detail because it is a very new thing, must be a very new thing but yes this is the basic for this so chemotherapy new chemotherapy drugs are being discovered along with that if you have heard the name of hormonal agents in some cancers hormonal therapy is also very effective like breast cancer is the most common example so in that Temoxifen Leuprolide many types of hormonal therapies which increases the effects of some cancers in the body we can also control it by giving hormonal therapy so this is the advanced stage of treatment or advanced treatment which has evolved over time and the advantage of this is that the side effects are very less compared to conventional chemotherapy but yes this is a useful line for all cancers there are some particular cancers just like our science has advanced now we have come up with targeted therapy also targeted therapy is a cell surface receptor which acts on a particular pathway and it is highly targeted to that particular step in the whole multiplication or cell regulation if it works on a particular step then as an example I can show you that the left column shows the area on which it acts and the drug which acts on that particular receptor and the type of cancer in which we can use it so these are the most advanced treatments which are available the most research basically it is going on a particular topic because its side effects are much lesser compared to conventional chemotherapy which I have discussed with you and the chances of getting a beneficial effect are much more because we are studying the genes or pathway or receptor and acting on it so as the medical science advances with oncology we have a lot of genetic tests available which we can use to detect which human being which genetic mutation is active among them and we can target that genetic mutation and use medicine so this is the most modern and the most latest advancements which are available for cancer treatment similarly there are some cell enzymes which we can block and reduce the replication of cancer cells so next is monoclonal antibodies which I think if I give a brief about the B lymphoma cells and B lymphocytes we can expose them to antigen in medium we prepare some antibodies in the lab and then the hybridoma technology we prepare it and then we call it as a monoclonal antibody and then we introduce those monoclonal antibodies into the human for treatment of cancer these antibodies basically act on the surface of the cancer cells and the antigen they they detect on the cancer surface the cancer antigens express and selectively kill cancer cells so this is also one of the very recent treatments which have come up in a very big way it has revolutionized the treatment of some cancers like lymphomas, breast cancer or other cancers it has been found to be very useful and this one of the most recent treatment is called immunotherapy which you have heard of basically its other name is check point inhibitor so this basically the cell surface increases the immune system increases its work increases its efficacy and helps to kill cancer cells so how it works a little bit based on a diagram I have put a small one but it may be difficult to understand but just in short I would like to say that by increasing the body's immune system with the help of body's immune system this is the technique this is the most recent technique and in many cancers the role of immunotherapy is being detected very fast that immunotherapy is very useful recently the Nobel prize was also awarded for discovering this particular technique for cancer treatment so this has also come up now in a big way so by doing it slowly cancer treatment has evolved very rapidly now we have a lot of options even for metastatic disease and we can reduce side effects so with this I will like to conclude the session and if you have any questions or specific we are ready to answer thank you so much to all the esteemed doctors for enlightening the audience on various lifestyle management sign and symptoms diagnostics self-examination and treatment options of cancer so may I now request Dr. Neha to take over the question answer session Dr. Neha thank you and Dr. Spati is also here thank you very much to all the speakers I shall take the questions there is one participant who wants to know can blood test be used as a diagnostic method to get cancer detected and are there any specific tests that are there for this yes now actually for blood cancers blood tests are the mainstay for diagnosing the if we talk specifically about blood cancers but yes now even for solid tumors nowadays new techniques have come up like circulating tumor cells circulating tumor DNA next generation sequencing so these are basically the genetic tests which detect the circulating tumor DNA and the circulating tumor cells in the human blood and even next generation sequencing and these genetic PCR based tests are available so nowadays like lung cancer, breast cancer nowadays we are and even for genetic testing like BRCA mutation testing which is genetic testing to detect breast and ovarian cancers so we have the armamentarium of the blood test is increasing gradually and nowadays we even have that option when if we can't do a biopsy for some cancers like lung cancer or somewhere blood test also okay thank you these are some questions from the earlier part of the talk one participant wants to know that some people work in night shifts they have they are in a particular job where they have to do night shifts can this be a reason for breast cancer see exactly doing a night shift is not a direct causative effect and I don't know indirectly also how it can be regretted okay is there one participant also wants to know is there anything like females or who are already suffering from CCOD which is already a lifestyle disease higher risk of breast cancer see not exactly best but yes for ovarian we can label it as an indirect cause because it leads to some it is an indication that there is some kind of hormonal imbalance already in the body so yes for some gynecological cancers it can be an indirect indirect respect for some gynecological illnesses okay then there is one participant who says that one of the talks had mentioned that headache may be a sign of a pathological situation so this participant wants to know how is headache related to cancer and how about migraines because migraines are also severe headaches so we have to understand Nihaji that one important thing is if there is a new change in the body it was not a headache but a new change and I had told you all the pains of cancer are often in the night and in the night it can be so severe that the person's sleep breaks this is the pain migraine is often the time of day the time of the day when the body passes through stress so it happens and the part of migraine which happens is often a very old history it is coming together it is hemicemporal it is in the middle of the brain but other migraine is also developing of course to diagnose the migraine and the imaging is important in the brain so for MRI migraine it is very important for MRI cancer but if I know that I have migraine and I have this headache in the middle of the brain whenever I take stress then we have to understand whether it is a new type of headache whether it is the character of the headache is changing we will need awareness so this is what is the basic difference but whenever the other migraine changes its character then we definitely need imaging, re-imaging MRI brain yes sir, ok sir, thank you there is one participant who wants to know can your emotional state also cause cancer sorry can I get the question again can emotional state also lead to cancer? it is a very important question so emotional state actually changes a lot of our lifestyle and I said cancer is a major 90% of the cancers are lifestyle disease patterns so emotional state if one is an introvert if one is a depressed person because of whatever reasons then the chances that he will present with the red flag signs which I mentioned will be those would be delayed let's say not only that he or she could be probably getting into negative addictions so Dr. Vellanta as you mentioned that eating the processed foods going for tobacco consumption going for alcohol consumption all these are interlinked basically so it could be not the sleep pattern which might not be a healthy one so all is interlinked it could actually lead to cumulation of all the oxidants and because of that phenomena we can get the conversion of the normal cells one participant wishes to know having a mark on the breast which was not by birth but developed later would it be a red flag having a mark which was not there at the time of birth but developed later so yes any change definitely if it's a mark a mark is different than a mole so there could be stretch marks there could be marks post lactation so that would be a different thing my my emphasis for a red flag sign was a mole or a nivas massageist but it could a mark could be a stretch sign or a post lactation so that has to be again examined if there is any doubt please do not hesitate to go to your doctor okay sir there are some studies which say there is increased breast cancer among women who work predominantly at night okay I think this is kind of related to yes I think we addressed this earlier one participant wishes to know I am a non-vegetarian I want to know how much frequency of eating non-vegetarian food may be a can give chances can increase the key word for everything the previous question what you asked is happiness the key word for and passion so if you are passionate about doing anything and you are happy with what you are doing so there would be people who work at night and are very happy about it they are contented in life they are doing and they are very happy with what they are doing so they are actually having the positive inputs in their body they are not generating a negative response inside their body people who are actually cursing themselves why are they are in a position right now why should they be waking up when the word is sleeping they are again the whole cycle coming to the question of non-vegetarian again the key word is again moderation it is not like that you are being exposed to the basic Indian diet is actually predominantly vegetarian it is a very small portion of it that in certain states that they take the non-vegetarian so predominantly it is a wheat rice based diet at what we take and it is a very high rich fiber very high rich fiber diet what is now happening or what we are seeing and what Dr. Vidhan was telling that there is now a change an adoption of the western world diet processed food fast foods that is what is basically the thing of course important is moderation you need to balance out things you cannot at times escape of ordering a pizza but of course if in case you happen to order it almost a fortnight every day then there comes the problem the point is that once the occasional eating a pizza would be would you get your cells into becoming cancerous? No it is not like that important is moderation and of course do not get elected to such sort of conflicts okay sir one participant wants to know how WBC count and ESR can be can have some relation to cancer WBC count WBC is the white blood cell count or the policing cells of our body and ESR is nothing but a marker of inflammation in our body so coming to WBC count when I say policing cells as in the cells which are responsible for throwing out infections bacteria, viruses from the body likewise once they find what I told that cancer starts behaving as a foreign body in terms it is actually not a foreign body it is a part of our body but then it behaves in a manner that the nearby organs start getting you know compressed or it starts invading then the body strikes a resistance and then it wants to ward it off throw it back and therefore what you find is in a proportion to what the invasiveness of the cancer is there is a rising white blood cell count also so WBC count is somewhere trying to you know ward off or push back the cancer invasion likewise ESR is a marker of inflammation therefore it is wherever the white blood cells count increase in number sometimes the ESR the inflammation the marker of inflammation would also go up so they are indirectly related if the question is related to WBC count increase only and does not relate to the tumor in the body if it's just an isolated WBC count increase if the the audience is trying to ask whether it is related to some sort of blood cancer then yes it could also be related to some sort of blood cancer but then most common of the times most of the times it is the infection which is responsible for increase in WBC count but of course one of the differential diagnosis is blood cancer okay sir thank you one participant wants to know would having a power station close to place of work be a risk for cancer so I would take it on two points one is a power station and one is the the mobile phone antennas so the power station there were theories earlier that those who are living near power station they could have solid tumors as in the brain tumors or some sort of lymphomas this theory there have been various contradictions to them but then these are difficult to prove or disprove as simple as that but for that matter it has been seen that nobody would want to live near such a situation and it is also very true that the mobile antennas there have been hypothesis but then for for the matter of fact to prove it is a very difficult situation because nobody would be a control you know you have a trial group in the trial group experiment group and then you have a control group so nobody would be there in the experimental arm who would be willing to stay near the power station only one can do is have a retrospective analysis and in a retrospective analysis in the study which is usually retrospective there are many variables which actually play which actually spoils the nature of the study or probably are the deficits of the loop books so that is what it is it is better that we can avoid then the good it is so does again increase immunity I am sorry so does healthy food like probiotics, antioxidants increase our skill to fight with cancer and related disease also does increase immunity come in picture after COVID so the question what comes in front of me in the textbook is does again increase immunity come in picture so does healthy food so of course as I said that the work of immune system in the body is to ward off cancer WBCs are a part of immune system so is antibodies so all they all actually fight against cancer now the thing is that cancer is a part of the self the immune system is trained to differentiate between self and non-self it is easier for the immune system to identify the non-self that is the bacteria the virus cancer is self until unless cancer becomes too advanced then only the immune system slightly rises but then that is too late there are now drugs which can actually shake up the immune system and what is commonly known and classified as immunotherapy these days so these drugs basically shake up the immune system and then the immune system rises against cancer so yes by all means immunity is important we have seen in certain patients and these are only case reports that somebody who had some major infection might have a decrease in cancer size but these are just high total reports nothing more than that can be computed from that so I don't think so we have much of scientific evidence for that matter on this part but yes there is no doubt on that that immunotherapy can be harnessed for the for defeating cancer we are looking forward for cancer vaccines as well in coming decade we already have a cancer preventive vaccine for cervical cancer there is a lot of work going on the work would be accelerated it is my feeling after the covid vaccine research because a lot of data and a lot of work is being generated on those platforms only which are going to actually be beneficial for making a cancer vaccine so those platforms are being used I think so in coming times in the coming decade we would have something for cancer vaccine another question from the Q&A chat box in some cases MRI detection also fails to detect whether it is a breast cancer or not then in those cases what are the other methods and there is another question can we use PET scan for screening there is no role of PET scan for screening for now CT scan role of CT scan as Dr. Mouishi mentioned in Garcinoma lung and the subgroup is very specified it is heavy smokers 30 pack years and those who have an age group between 55 to 70 years and of course a life expectancy for 10 years the thumb rule is that anybody who takes a screening should have at least a life expectancy of 10 years that is important the organ results should be important as regarding the MRI what did you mention I can not follow that in some cases MRI detection also fails MRI detection also fails to detect whether there is a breast cancer or not then what are the other methods that can be used no problem no problem Neha ma'am Daman ma'am also wants to ask in continuity of this only I wanted something else to ask him let him come back to that are you there I think he was coughing because he was constantly reading the feedbacks also that there are people who wants to know about the diagnosis the the ambient air being dry yeah can I add like you know in continuity many people are very scared of getting MRI and PET scan they feel that you know this may because are injected in PET scan we are injecting radioisotope it may cause more radiation and more problem in the body because sometimes PET scan is given once and then after one year in some of the cancers I know it was recommended again once or one year to follow up especially when the metastasis has kicked in ma'am I leave with you that is a very genuine concern but the problem is that we need to weigh the benefits in which the PET CT should be indicated so of course we need to weigh out that would it catch cancer earlier or am I expecting a result of radiation after 15-20 years what am I looking at so I think so with somebody who is having active cancer PET CT has turned out to be a good modality to follow up certain certain things there is always a chance or minuscule chance though but it is a chance and a true chance that after several years down the line radiation induced cancer could be a possibility I am not denying that PET CT is not a tool for screening at all same should be true even for radiotherapy ma'am that with radiotherapy yes there is always a chance of a secondary cancer but again the benefits of radiotherapy requires it is much more than for you know in saving an immediate life for the next 10 years because radiotherapy induced cancers they have been found to occur mostly 20 years down the line so somebody who has been a survivor for 20 years more important point is that now with the techniques being used it is specifically the tumor cell the tumor the site which is being radiated so earlier there were concerns that the normal tissue also gets affected where now the technology is able to zero down with the help of imaging image guided radiotherapy to that particular specific point and therefore we can actually bring down that particular drastically thank you there was a question on MRI I could not answer that I could not comprehend the the question was that if MRI is not able to detect the breast carcinoma then what are the other methods of detecting breast cancer which is MRI is usually not the method for screening of breast cancer however MRI is a very useful tool which is there for screening an individual who has a strong hereditary you know chance of getting breast cancer MRI is very useful in young ladies who are less than 35 40 years because hereditary cancers we expect during this particular age group and therefore MRI could be an important screening tool now MRI definitely has a much better resolution than other imaging would be having but MRI fades to detect is always and should always be read in conjunction with the mammogram so mammogram is x-ray technique MRI is based on resonance technique mammogram can actually detect calcification what we call as micro calcification in the breast which is also a sign of cancer so MRI can miss that otherwise most of the times MRI would not miss anything in the breast for that except for calcification so there are two questions regarding what is the best age for getting a vaccine for cervical cancer the best age for getting the recommendations are usually between 12 to 26 years however in various countries the recommendations vary some countries have recommendations right from 9 years so it's basically when the Minar K is defined in that particular epidemiological population so that is there in certain countries like Australia they have extended up to 35 years also so the later age group is extended up to 35 years so this is what it is but the best time since you mentioned I'm sorry the best time is definitely between the age group of 10 years to 15 years that is the best time even now studies are going on to see whether we can do with lesser doses of cervical cancer vaccine because community develops very robustly during that particular age group and if cervical cancer then how can Yoshi prevent the second chance of cancer and I think this is about the last so again if somebody had cancer and since it's been emphasized again and again it's a lifestyle disease a lifestyle modification would always go a very long way so definitely somebody has been a smoker should absolutely quit smoking and of course he requires support it is not just cancer treatment that as a part medical fatality should be looking into but of course supporting the gentleman or lady to quit those habits which have actually lead so this is important of course the positive side of the life that is exercise yoga or healthy food healthy diet should of course be adopted so these are certain measures and of course when the final discharge or the final treatment plan takes place there are apart from medicines follow up protocol given that how do you need to follow up with respect to the various organ sites so you need to do certain set of imaging depending on the sort of cancer that was treated apart from ulcers that are due to tobacco are there any other kinds of ulcers that can lead to cancer so apart from tobacco basically HP was mentioned by Dr. Kavra human papilloma viruses can cause genital cancer and they can cause also oropharyngeal cancers so yes HPV related oral cancers or pharyngeal cancers are also known to happen so apart from tobacco as I said the ulcers because of a sharpened tooth which keeps on chronically irritating also important there are also chances that people have GERD or reflux disease what is called especially in obesity so this acid this water brush sort of thing this keeps on coming in the night especially in obese people and they can develop chronic ulcers in the month so that chronic patient can also need to cancer especially people who actually have a binge of alcohol they have a lot of acid reflux in the night and continuously keep on having those sort of reflux get a laryngeal cancer poisonous of voice okay sir one of the participants is saying if there is a lump in the breast and which is painful is it a sign of breast cancer are teenagers at risk for breast cancer so lump in the breast is 70 to 80 percent as I said that early breast cancer early lump immediate finding that you just one just finds a lump in the breast then most of the times it is if it's actually breast cancer then it will be painless if it's caught early and if it's a new finding and if it's really breast cancer it usually would not present with pain the usual age is also important so a lady who is walking in my clinic and if she is 40 plus I would suspect a painless lump in the breast I would suspect my threshold would be lowered I would lower my threshold I would consider all sort of imaging and would also probably consider a biopsy but however let's say a 25 year old lady who walks in my clinic and she has a lump in the breast and there is no family history as I mentioned at less than 40 years if there is no family history the chances of breast cancer are quite negligible if there is no family history in this 25 year old I would not have my you know I would consider breast cancer as a last differential diagnosis probably a very unfortunate sort of thing that could happen that would be the thing so a lump in the breast and if pain starts happening then is usually a sign of advanced breast cancer because then the lump would start infiltrating the skin or the chest process so a lump in the breast is usually a painless lump in the breast is usually not a cancer but however this is not a blanket statement you need to just do it okay sir one participant who wishes to know about prostate cancer in males if regular ejaculation helps in preventing this type of cancer so could you come again with the question so prostate cancer in case of prostate cancer is regular ejaculation a preventive measure for this for prostate cancer this is in the Q&A box this is the second question basically there is no scientific theory to mention that that the prostate cancer would be prevented with that but again there would be you know various hypothesis which would have been generated there is no scientific study or backing to say that and probably very difficult to do such a look into such a habit or studies we have bound up with most of the questions and there is one question which I myself am having a little difficulty understanding indigestion especially after covid last one month off and indigestion and constipation this is in the question box yes it is in the question answer box I think indigestion especially after covid last one month off and on indigestion plus constipation only it takes dry food so I think so we need to try and understand covid has been a teacher to all of us so we are still learning as medical professionals we do not know we are just at the tip of the tip of iceberg we are knowing new mutations now we are knowing that this vaccine might work might not work we are not knowing itself on a daily basis but one thing we know that if it's been covid and indigestion was there during covid affection and we know that covid affects the GI tract that is for sure that is scientifically proven so indigestion probably after one month one should not just hop to the diagnosis of malignancy so just wait for some time I think so the residual effects of covid would go after three months probably if it persists then of course we can you can consider going to the medical specialist after three months before you get yourself scoped scoping could be an important part thank you very much I now request Shiranima to please take it from here thank you so much sir for all your answers one just last question has come up from my colleague she wants to ask apart from humans which other animal group suffer from cancer are there any species without cancer in them can you please answer this yes so this is what is topic of research again there are certain species for example it is said that the cancer would happen if in case the telomerase enzyme which is actually a enzyme which cleaves the end of DNA the end of the DNA is called the telomere and if it keeps on cleaving the telomerase enzyme then actually the chances that you know the longer the telomere the longer the age would be so it is said that elephants basically have longer telomere and it is thought that and it is seen also rather because it is basically from the the doctors, basic researchers the data come from that the cancers in such animals who have longer telomere would be lesser likewise there are marine animals where they have found that because of certain antioxidants especially whales or the bigger fishes they have lesser chances of cancer but however most of the mammals are prone to cancerous cells they have this cancer conversion for whatever reason they are exposed to so many viruses in the environment so there could always be a cancer conversion but of course if you look at the lifestyle and what I was talking of course those aspects are not there but of course the infectious aspects are always there which affect them a lot of infections are found in these animals so viruses are very common so you have all sort of viruses in monkeys apes which can cause cancer Thank you Dr. Piyush for answering all the queries for us so now may I request Dr. Swati Gupta to offer the formal vote of thanks please Thank you so much ma'am Honourable speakers Dr. Vigdand Kabla Dr. Anushil Munshi Dr. Piyush Bajpay and Dr. Sanigar Respected Professor Daman Salooja Director Dr. B. R. Ambedkar Center for Biomedical Research Respected Dr. Geeta Mongia Convener Women Development Cell Bhaskaracharya College of Applied Sciences Respected Dr. Shivani Vermani Teacher in Charge Department of Biomedical Sciences Bhaskaracharya College of Applied Sciences our most valued guest and my fellow members of organizing committee a very warm good morning to all the wonderful people present here first of all I would like to request all the participants to fill the feedback form its link is provided in the chat box certificate shall be provided only to those participants who submit the duly filled feedback form it's my privilege to have been asked to propose a vote of thanks on this occasion I Dr. Swati Gupta on behalf of Women Development Cell BCS Department of Biomedical Sciences BCS and Dr. B. R. Ambedkar Center for Biomedical Research extend a hearty thanks to all the speakers for enlightening us with their knowledge I must mention a deep sense of appreciation for Dr. Vidant Kabra for sharing the simple changes that we can make in our lifestyle that can help us to prevent cancer as we all know it's better to prevent and prepare rather than repent and repair I must mention a deep sense of appreciation for Dr. Anushil Monshi for telling us various ways for screening of different cancers which can really help us in early detection of cancer further we are deeply grateful to Dr. Piyush Bajpay for giving an excellent coverage of all the nine red flag warning signals of cancer further we are grateful to Dr. Sunny Garg for explaining the basics as well as recent advances in the cancer treatment I also wish to express our gratitude to Professor Balaram Pani Principal Bhaskaracharya College of Applied Sciences and Dean of Colleges Delhi University and Professor Daman Salooja Director Dr. B. R. Ambedkar Center for Biomedical Research for all the motivation and tremendous support for organizing this event further I may like to express our sincere thanks to Dr. Geeta Mongia and Dr. Shivani Vermani for their immense support and guidance for organizing this event I must not forget to thank my fellow members of organizing team for all the hard work to make this event successful last but not the least I would like to thank each and every participant who attended the seminar and appreciated the knowledge shared by our imminent speakers thank you thank you so much all the speakers for enlightening us thank you so much now thank you so much Fathi and I want to thank Dr. Sakshi who has been coordinating with us all the time so she has really worked hard to make this event a great success and thank you to Mr. Rajbir also who has been helping us with IT thank you so much thank you Daman Nam you have been here for very long now and thanks to all the audience it was really very very good I really enjoyed all the four talks and lot of new things to learn to all of us because we work more in the molecular basis of cancer so many of the hard, real hard facts and it was really very interesting and the best part was that you could speak so well in Hindi and you know I think each masses this way the way he was speaking because lot of non-teaching staff could appreciate this because of it was in Hindi and this is for general public it is more like public awareness program before we close may I request our panelist to have a group photograph image other colleagues had to leave for some clinical work Daman I have been taking the photographs okay good enough so we can just call upon Dr. Saakshi as well nice to see her because we have been communicating but I have never met her hello everybody thank you for joining in and thank you Shivani for conducting such an amazing program where we could reach more and more people and share the knowledge it was not at all possible without your support ma'am and your doctors can really reach masses I think we should do these kind of programs very often absolutely definitely that should be our plan from now onwards and we will be happy to be a part of every program that we plan thank you so much thank you so much thank you ma'am thank you Gita ma'am thank you thank you everybody thank you Daman ma'am most welcome thank you so much everybody