Training of Trainers on Cancer Prevention & Screening

  RECPHEC   30 March, 2017

Non-communicable disease (NCDs) refer to diseases or conditions that occur in, or are known to affect individuals over an extended period of time and for which there are no known causative agents that are transmitted from one affected individual to another. The risk factors for many of the NCDs are associated with lifestyle related choices, environmental and genetic factors. Tobacco use, harmful use of alcohol, unhealthy diets (high in salt, sugar and fat and low in fruits and vegetables) and physical inactivity are some of the established behavioral risk factors of NCDs. South Asia is one of the populous as well as the poorest regions of the world where NCDs account for nearly 50 percent of disease burden among adult population.
In Nepal exact data on NCD is not recorded, however, recent studies have shown that there is growing trend of NCDs among Nepalese in recent years. According to WHO and WB estimates, NCDs account for 39 percent of the total disease burden and half of deaths occurred due to NCDs. Out of all deaths, 22 percent were attributed to CVDs, 7 percent to cancers, 5 percent to respiratory disease and 1.7 percent to diabetes. At present, Nepal is experiencing significant lifestyle changes that are due to social changes. People are changing eating habits in the form of junk foods as well as increasing consumption of alcohol and tobacco products. While NCDs have been referred to as the diseases of the rich, but additionally it has challenged the health of people from lower social positions too. It has been reported that NCDs and poverty create a vicious cycle where poverty exposes people to various behavior risk factors. Treatment for CVDs, diabetes, chronic respiratory diseases and cancer is expensive.
Seven percent of all deaths in the country were attributed to cancers. By 2030 cancer deaths are projected to increase to 12 percent. Cancers of mouth and lungs were dominant in males, whereas cancers of breast and cervix uteri (highest incidence in the region) were the leading cancers in females. In Nepal, cancer cases are treated in the tertiary hospitals like central level hospital, specialized hospitals and medical colleges. District and regional hospitals have no facilities for cancer diagnosis and treatment.
Considering the growing cases of cancer in Nepal, RECPHEC feels the urge in raising awareness on prevention measures against cancer disease. RECPHEC has been actively advocating on health rights of people in different districts of Nepal. Since many years the organization has been involved in addressing various pertinent issues related to public health. Thus, RECPHEC focuses to organize Training on Trainers on Cancer Prevention & Screening to district representatives on cancer prevention and screening on 23rd & 24th March 2017 in Kathmandu.
The main objective of TOT is to give new trainers the background knowledge, skills and practical experience on cancer prevention and screening to provide communities that care training and technical assistance to communities. After completing TOT, trained candidates will be able to: Explain the prevention methods and put them into practice;Use effective instructional methods & Fulfill the responsibilities of a certified trainer
RECPHEC organized Training on Trainers on Cancer Prevention & Screening to district representatives on cancer prevention and screening with collaboration with BPK Memorial Cancer Hospital, Bharatpur on 23rd & 24th March 2017 in Kathmandu. District coordinators, school teachers, female network volunteers from 13-Health Rights & Tobacco Control District Networks participated in this program. They will be significant in delivering the message on cancer prevention & screening to communities at their respective districts from now on.
Role of district coordinator: District coordinators are responsible for organizing district level meeting to bring up the issue of cancer and its effect on one’s health. They will collaborate with other organizations in the district to pressurize the government in addressing the issue widely.
School teacher: School teachers will be responsible in encouraging students to take up healthier life styles such as avoiding junk food, alcohol and tobacco consumption. They will take initiative in introducing chapters on NCD especially focusing on prevention measures.
Female volunteer: Female volunteers will work closely with health posts, FCHVs as well as community people to raise awareness on cancer. They will disseminate information on preventive measures and inform people on services such as screening, treatment facilities in hospitals.
All the participants committed to take up the issue at district level and raise awareness on cancer, motivate people to take up preventive measures to minimize the risks. Schools will put extra class to educate children on cancer.
Welcome Address
Mr. Shanta Lall Mulmi said Non-communicable diseases (NCDs) are the leading cause of mortality in the world, representing over 60% of all deaths. In Nepal the disease pattern has changed. Non-communicable disease has become a major public health problem. This is killing more people than the communicable diseases. Rapid urbanization, change in dietary patterns, behavioral factors and major improvements in the prevention of maternal and child health helping to raise life expectancy are all contributing factors to shift the disease pattern in Nepal. Nepal is now passing through an epidemiological transition with non-communicable diseases accounting for more than 44% of deaths. Tobacco use, physical inactivity, unhealthy diet and harmful use of alcohol increase the risk of most NCDs. He added that district coordinators, school teachers, female network volunteers from 13-Health Rights & Tobacco Control District Networks will be significant in delivering the message on cancer prevention & screening to communities at their respective districts from now on.
After the welcome address a 20-minutes pretest was done to see the understanding of the 39-participants. The pre test questions were focused on cancer, its signs and symptoms, risk factors and other information.
Paper : Situation of Cancer in Nepal
Presenter: Mr. Kishore Kumar Pradhananga, Chief, Cancer Prevention & Control
Research Center, BPK Memorial Cancer Hospital, Bharatpur, Chitwan

Mr. Kishore Kumar Pradhanaga, started with the brief presentation on BPK Memorial Cancer Hospital, Bharatpur, Chitwan. He added that caner is a disease in which abnormal cells divide without control and can invade nearby issues. It can spread to other parts of body through the blood and lymph system. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss and a change in bowel movements. While these symptoms may indicate cancer, they may have other causes. Over 100-types of cancers affect humans from head to toe.
Tobacco use is the cause of about 22% of cancer deaths. Another 10% is due to obesity, poor diet, lack of physical activity and drinking alcohol. Other factors include certain infections, exposure to ionizing radiation and environmental pollutants. In the developing world nearly 20% of cancers are due to infections such as hepatitis B, hepatitis C and human papillomavirus (HPV). Approximately 5–10% of cancers are due to inherited genetic defects from a person’s parents. Cancer can be detected by certain signs and symptoms or screening tests. It is then typically further investigated by medical imaging and confirmed by biopsy.
Many cancers can be prevented by not smoking, maintaining a healthy weight, not drinking too much alcohol, eating plenty of vegetables, fruits and whole grains, vaccination against certain infectious diseases, not eating too much processed and red meat, and avoiding too much sunlight exposure. Early detection through screening is useful for cervical and colorectal cancer. The benefits of screening in breast cancer are controversial. Cancer is often treated with some combination of radiation therapy, surgery, chemotherapy, and targeted therapy. Pain and symptom management are an important part of care. Palliative care is particularly important in people with advanced disease. The chance of survival depends on the type of cancer and extent of disease at the start of treatment. In children under 15 at diagnosis the five-year survival rate in the developed world is on average 80%. For cancer in the United States the average five-year survival rate is 66%.
The most common types of cancer in males are lung cancer, prostate cancer, colorectal cancer and stomach cancer. In females, the most common types are breast cancer, colorectal cancer, lung cancer and cervical cancer. If skin cancer other than melanoma were included in total new cancers each year it would account for around 40% of cases.
Main Points:
 Regions Highest Incidence: Canada: Leukemia, US: Colon Cancer, Brazil: Cervical Cancer, UK: Lung Cancer, China: Liver Cancer, Japan: Stomach Cancer & Australia: Skin Cancer
 Nepal Cancer Registry-Hospital Based Cancer Registry: 7-referal hospitals are T.U. Teaching Hospital, Kanti Childrens hospital, B.P. Koirala Institute of Health Sciences, B.P.K Memorial Cancer Hospital & Manipal Teaching Hospital
 Lung Cancer, Cervical Cancer, Breast Cancer, Stomach Cancer cases are found highest in Nepal
 Contributing factors of cancer: first is Diet than Tobacco, Infection, Sexual behavior, Occupation
 It can diagnose by cytology, histopathology, radiology and clinical examinations.
 It can be cured through Surgery, Chemotherapy, Radiation therapy and Palliative Care
Paper : Introduction to Cancer
Presenter: Dr. R. P. Baral

Paper: Causes, Sign, Symptom & Management of Cancer
Presenter: Mr. Kishor Kumar Pradhananga, Chief, Cancer Prevention & Control
Research Center, BPK Memorial Cancer Hospital, Bharatpur, Chitwan

Mr. Kishor Kumar Pradhanaga presented a paper on causes, sign, symptom and management of cancer. He started with cancer problem in the world. He said cancer is a public health problem around the world. It is a second leading cause of death in the world, accounting for about 13% of all deaths.
WHO estimates over the 40% of all cancers can be prevented; others can be detected early, treated and cured. The three leading cancer killers are different than the three most common forms, with lung cancer responsible for 17.8 per cent of all cancer deaths, stomach 10.4 per cent and liver 8.8 per cent.
First time in Nepal, Cancer Prevalence Survey was carried out (1987-1992 AD.) by BPKMCH in 1994. Hospitals included for survey in Kathmandu Valley: T.U.Teaching Hospital, Kanti Children’s Hospital, Bir Hospital, Military Hospital, Patan Hospital and Maternity Hospital. He added cancer registry program was initiated in January 1994 by BPKMCH Mgmt. Committee first time in Nepal to assess the burden of cancer problem in central hospitals.
In 1997 AD Hospital Based Cancer Registry started in 3-hospitals Bir hospital, TU Teaching Hospital, Kanti children hospital, Kathmandu. 2003 AD HBCR started in 7-hospitals (In kathmandu Bir, TUTH, Kanti, Bhaktapur Cancer hospital, in Dharan BPKIHS, Pokhara Manipal Medical College) supported by WHO-Nepal. 2013 AD HBCR started in 12-hospitals (In kathmandu included Maternity, Civil, Army, Patan hospitals and Kohalpur Medical College, Nepalganj).
The major Cancer Prevention, Control & Treatment centers in Nepal:
In Government sectors: BPKM Cancer Hospital, Bharatpur, Chitwan, Bir Hospital, Kathmandu, TU Teaching Hospital, , Kanti Children Hospital, Maternity Hospital, BPK Institute of Health Science, Patan Academic of Health Science, Civil Hospital and Army Hospital.
In private sectors: Manipal Medical College, Om, Sarvang, Grandy, B&B, Bayodha Hospitals, Kathmandu Medical colleges, Private hospitals, Kathmandu.
NGO: NCRS-Bhaktapur Cancer Hospital, NNCTR, Banepa, Kavre etc.
The study report of 2013 of 12-hospital shows, that female cases are higher than male cancer patients. In male lung cancer and stomach cancer rate is high and in female cervical and breast rate is high.
Paper: Common Cancer in Nepal
Presenter: Ms. Sharmila Neupane, Nurse, BPK Memorial Cancer Hospital, Chitwan

Ms. Sharmila Neupane presented a paper on common cancer in Nepal. She briefly explained about the lung cancer, breast cancer & blood cancer situation in Nepal and its prevention & cure.

Lung Cancer

She said that tobacco consumption both among male and female is very high due to this situation lung cancer patient’s rate is very high in Nepal. She added that the main cause of cancer is tobacco and environmental pollution. Smoking can damage every parts of the body. Cancer: head & neck; lung; leukemia; stomach; kidney; pancreas; colon; bladder; cervix. Chronic Diseases: stroke; blindness; gum infection; aortic rupture; heart disease; pneumonia; hardening of arteries; chronic lung disease & asthma; reduce fertility and hip fracture.
Most lung cancers do not cause any symptoms until they have spread, but some people with early lung cancer do have symptoms. If you go to your doctor when you first notice symptoms, your cancer might be diagnosed at an earlier stage, when treatment is more likely to be effective. The most common symptoms of lung cancer are:
 A cough that does not go away or gets worse
 Coughing up blood or rust-colored sputum (spit or phlegm)
 Chest pain that is often worse with deep breathing, coughing, or laughing
 Hoarseness
 Weight loss and loss of appetite
 Shortness of breath
 Feeling tired or weak
 Infections such as bronchitis and pneumonia that don’t go away or keep coming back
 New onset of wheezing
If lung cancer spreads to distant organs, it may cause:
 Bone pain (like pain in the back or hips)
 Nervous system changes (such as headache, weakness or numbness of an arm or leg, dizziness, balance problems, or seizures), from cancer spread to the brain or spinal cord
 Yellowing of the skin and eyes (jaundice), from cancer spread to the liver
 Lumps near the surface of the body, due to cancer spreading to the skin or to lymph nodes (collections of immune system cells), such as those in the neck or above the collarbone
It can be diagnosed by x ray, bronchoscope, CT scan, cytology & biopsy. It can be cured through surgery, radiotherapy, chemotherapy and palliative care.
 To prevent from lung cancer:
 Passive smoking effects person around you so we should avoid public smoking.
 Prevent yourself from smoke from industries and vehicle pollution.
 Cooking in smoke free stove
 Including green vegetables in your daily meals
Breast Cancer
Breast cancer usually starts off in the inner lining of milk ducts or the lobules that supply them with milk. A malignant tumor can spread to other parts of the body. Breast cancer is the most common invasive cancer in females worldwide. 18.2% of all cancer deaths worldwide, including both males and females, are from breast cancer. Breast cancer rates are much higher in developed nations compared to developing ones. The different lifestyles and eating habits of females in rich and poor countries are also contributory factors, experts believe. The breast, like any other part of the body, consists of billions of microscopic cells which multiply in an orderly fashion and new cells are made. In cancer, the cells multiply uncontrollably, and there are too many cells, progressively more and more than there should be.
 A lump in a breast
 A pain in armpits/breast that does not seem to be related to the woman’s menstrual period
 Pitting or redness of the skin of the breast; like the skin of an orange
 A rash around (or on) one of the nipples
 A swelling (lump) in one of the armpits
 An area of thickened tissue in a breast
 One of the nipples has a discharge; sometimes it may contain blood
 The nipple changes in appearance; it may become sunken or inverted
Risk Factors:
 Drinking alcohol is clearly linked to an increased risk of developing breast cancer.
 Women who have 1-alcoholic drink a day have a very small increase in risk.
 Being overweight or obese after menopause increases breast cancer risk.
 After menopause when the ovaries stop making estrogen.
 After menopause can raise estrogen levels & increase chance of getting breast cancer.
 Women who have no children or who had child after 30 have a slightly higher breast cancer.
 Women using oral contraceptives have a slightly higher risk of breast cancer.
Different tests can be used to diagnose breast cancer such as Mammograms, Breast Ultrasound, Breast MRI Scans and biopsy. For the treatment Local treatments: Some treatments are called local therapies, meaning they treat the tumor without affecting the rest of the body. Types of local therapy used for breast cancer include: Surgery & Radiation therapy; Chemotherapy, Hormone therapy and Targeted therapy
At the end she briefed about the Image Breast Self Exam and Clinical Breast Examination. She stressed the need of CBE at least every 3-years; Women 20-39 should also perform monthly BSE; Women 40 and older should have: CBE (Clinical Breast Exam) every year. High risk woman and/or family history of breast cancer: should have CBE & annual screening mammograms starting between the ages of 30-40; Very high risk woman of breast cancer should consult their physician about beginning annual mammograms as early as age 25.

Blood Cancer
Blood cancer is an umbrella term for cancers that affect the blood, bone marrow and lymphatic system. Unfortunately, blood cancer affects a large number of people. There are three main groups of blood cancer: leukaemia, lymphoma and myeloma. Some types are more common than others:
Leukaemia affects your white blood cells. These are an important, infection-fighting part of the immune system, made in your bone marrow. It produces an abnormal number of immature white blood cells which ‘clog up’ bone marrow and stop it making other blood cells vital for a balanced immune system and healthy blood.
Acute leukaemia comes on suddenly, progresses quickly and needs to be treated urgently. Chronic leukaemia develops more slowly, over months or years. There are 4-main types of leukaemia: Acute myeloid leukaemia (AML), Acute lymphoblastic leukaemia (ALL), Chronic myeloid leukaemia (CML) & Chronic lymphocytic leukaemia (CLL).
Lymphoma is a type of blood cancer that affects lymphatic system, an important part of immune system which helps to protect the body from infection & disease. Lymphoma can develop in many parts of the body, including lymph nodes, bone marrow, blood, spleen & other organs. The two main types of lymphoma are: Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma
Myeloma also called multiple myeloma is a blood cancer of the plasma cells. Plasma cells are found in your bone marrow & produce antibodies which help fight infection. In myeloma, unusually large numbers of abnormal plasma cells gather in your bone marrow and stop it producing an important part of your immune system.
Common symptoms are: Unexplained weight loss: Fatigue, Feeling weak or breathless, Easily bruise or bleed, Enlarged lymph nodes, Swollen stomach or abdominal discomfort, Frequent and repeated infections, Fever/night sweats, Pain in bones/joints, Itchy skin & Bone pain (ribs/back)
Blood cancer can often be diagnosed through a simple blood test. Its treatments are chemotherapy, radiotherapy and, in some cases, a stem cell or bone marrow transplant.

Paper: Importance of Cancer Prevention
Presenter: Mr. Kishor Kumar Pradhanaga, Chief, Cancer Prevention & Control
Research Center, BPK Memorial Cancer Hospital, Bharatpur, Chitwan

Mr. Kishor Kumar Pradhanga presented a paper on the Importance of Cancer Prevention. He briefly explained about the factors that affect cancer. Exogenous (Environmental) Factors 90% and Endogenous 10%. Tobacco, Alcohol, Diet, Viruses, Parasites, Personal Hygiene, Hormonal and Immune Deficiency affects cancer. He further explained on how cancer can be prevented at 3-Level: Primary, Secondary and Tertiary prevention. Primary Prevention: Minimizing or eliminating exposure to carcinogenic agents, and includes reducing individual susceptibility to the effect of such agents.

 Control of tobacco consumption: Tobacco is the single largest preventable cause of cancer in the world today. It causes 80-90% of all lung cancer deaths, and about 30% of all cancer deaths, including oral cavity, larynx, esophagus & stomach cancer.
 Dietary modification is another important approach to cancer control. Overweight & obesity causes many types of cancer such as esophagus, colorectum, breast, endometrium & kidney. Conversely, excess consumption of red & preserved meat is associated with increased risk of colorectal cancer.
 Smoking combined with alcohol increase risk of mouth, throat, larynx, esophagus cancer. High fat diets increases risk of breast, colon and prostate cancer.
 Include vegetables, fruits & whole grains, cut down salt, smoked, colored and nitrated cured foods. Banned and limitation uses of insecticide & chemical fertilizer.
 Personal Hygiene may lead to decline in the cervical cancer, oral cancer, skin and others.

Secondary Prevention is to reduce mortality disease and can be detectable at this point by an appropriate screening method/test applied during pre-clinical phase i.e. at B point in time. Early detection & treatment of precancerous lesion such as cervical tears, warts, chronic gastritis, cervicitis etc. Infectious agents are responsible for almost 22% of cancer deaths in the developing world and 6% in industrialized countries.

 Viral hepatitis B & C cause liver cancer; human papilloma virus infection causes cervical cancer;
 Bacterium Helicobacter pylori increases the risk of stomach cancer.
 Parasitic infection increases risk of bladder cancer & liver fluke increases the risk of of the bile ducts.
 Preventive measures include vaccination & prevention of infection & infestation.
 Exposure to ionizing radiation is also known to cause to blood cancers.
 Excessive solar ultraviolet radiation increases the risk of Skin cancer,
 Avoiding excessive exposure, use sunscreen & protective clothing are effective preventive measures.
 Occupational hazard-Asbestos can cause lung cancer; aniline dyes linked to bladder cancer; and benzene can lead to leukemia.
 The prevention of certain occupational & environmental exposure to these & other chemicals is another important element in preventing cancer.
 Environment pollution
 Health check up
 Avoid multi partner sex habit

Tertiary Prevention is improving prognosis & quality of life. Many treatment methods are used of cancer. Treatment depends on the size and location of the tumor and the stage of the disease. Some methods of treatment for cancer are: Surgery & Radiation. Systemic treatment- destroy or control cancer cells anywhere in the body: Chemotherapy, Hormonal therapy, Palliative care & Hospice.
Paper: Making Cancer Visible
Presenter: Dr. Smriti Mulmi, Radiologist, Kathmandu Medical College Hospital (KMC)
Dr. Smriti Mulmi, Radiologist, KMC Hospital presented a paper on Making Cancer Visible. Cancer, is one of the leading causes of death worldwide. According to the World Health Organisation, the disease accounted for around 13% of all deaths in 2008. Aside from the continuing search for a cure, huge global efforts are being made to improve the prevention, detection, and treatment of cancer, and a very large proportion of this progress is being made in the field of medical imaging.
Radiology’s role is central to cancer management, with a wide choice of tools and techniques available for the detection, staging and treatment of the disease. But what is less well known is the value of medical imaging in recognizing early manifestations of cancer and small clinically undetectable tumors before they become clinically apparent; a capacity that pushes radiology to the fore of oncologic care.
She further added on how it may cause side effects depending on the method used and the area of the body to be examined. The use of contrast agents may cause allergies and may pose risks to patients with renal insufficiency. Techniques such as US and MRI do not entail any radiation exposure and are generally considered to be very safe. In some situations however, Methods like x-ray and CT, on the other hand, expose the patient to ionizing radiation. Radiologists always use the lowest radiation dose possible to get the desired results and modern imaging devices are constantly being improved to generate higher resolution images while significantly decreasing the amount of radiation and exposure time.
 More than 9 in 10 bowel cancer patients will survive the disease for more than 5-years if diagnosed at the earliest stage.
 More than 90% of women diagnosed with the earliest stage ovarian cancer survive their disease for at least 5-years compared to around 5% for women diagnosed with the most advanced stage of disease.
 Around 70% of lung cancer patients will survive for at least a year if diagnosed at the earliest stage compared to around 14% for people diagnosed with the most advanced stage of disease.
 Early diagnosis can increase chances of survival. But improving survival rates is not just down to earlier diagnosis–ensuring patients receive the most effective and appropriate treatment for them is also an important part of the jigsaw.
 Public awareness campaigns play a major role in this dialogue, and the participation of institutional partners is highly desirable.
 Healthcare stakeholders and cancer patient societies should be incorporated into these campaigns.

Lastly, she stressed on never be proud of not going to the hospital. You really need to visit your doctor before symptoms appear. Early detection of cancer can make you live rest of your life peacefully. You don’t need to undergo all imaging at once. Let the doctor decide which you need 1st. Family h/o & those people with bad addiction needs to do screening as early as possible.

Paper: Cervical Cancer Screening
Presenter: Ms. Sharmila Neupane, Nurse, BPK Memorial Cancer Hospital, Chitwan
Ms. Sharmila Neupane explained about cervical screening and why is it necessary. She said cancer screening is an opportunity to educate and counsel clients/population regarding cancer. It also creates awareness regarding disease and treatment modalities and also helps in cancer prevention. She added treatment (Investigation) of Cancer, esp. in late stage is very costly and have poor results. In Nepal treatment facilities (Centers, labs, equipments being expensive are less in number) are limited.

Trained manpower, specialists are lacking. But for screening paramedics, nurses and General practitioners can be used, so it is practical and possible. PAP costs Rs. 200 and Treatment of CIN cost Rs. 200 but Treatment of Cervical Cancer costs thousands of rupees.

Cervical cancer is a preventable disease. Primary prevention is education to reduce high risk sexual behavior, measures to reduce/avoid exposure to HPV and other STDs & HPV Vaccine. There are different types of cervical screening procedure such as Conventional (pap test), Liquid based test, HPV DNA test, Visual inspection by-with Acetic acid (VIA) and With Lugol’s iodine (VILI).

Pap: A procedure in which cells are scarped from the cervix (the lower, narrow end of uterus) by wooden spatula or cyto brush for examination under a microscope. To detect lesion in precancerous condition to treat cervical conditions before cervical cancer develops; to detect cancer in early stage when it is easier to treat and to make management of cervical lesion cost effective.

All married and sexually active women are recommended for Pap smear. Pap test is best done after 7 days of menstrual period. Vaginal medications should be stopped 3 days prior to Pap test. Coitus should be avoided 3 days prior to Pap test. Pap test is not mandatory after surgical removal of uterus. Unless doctor advises, Pap test may not be required during pregnancy. It is advisable for first Pap smear test about three years after first having sexual relation or at age 21, whichever comes first.

Paper: Breast Cancer Screening
Presenter: Ms. Sharmila Neupane, Nurse, BPK Memorial Cancer Hospital, Chitwan
Ms. Sharmila Neupane explained on how to use finger pads of 3 middle fingers on your left hand to feel for lumps in right breast before going for the breast screening of all the women participants. She further added on how to use overlapping dime-sized circular motions of the finger pads to feel the breast tissue. She added on how to use 3-different levels of pressure (light, medium & firm) to feel all the breast tissue.

Breast Self Exam: Here’s what you should look for: Breasts: size, shape, and color. Breasts: evenly shaped without visible distortion or swelling. If you see any of the following changes, consult your doctor! Dimpling, puckering, or bulging of the skin. A nipple that has changed position or become inverted (pushed inward instead of sticking out). Redness, soreness, rash, or swelling.

Clinical Breast Examination: Is an important part of routine physical checkups performed by health care professionals: Physician, physician assistant, nurse or nurse practitioner which is Valuable in detecting breast cancer earlier. Mammogram is expensive but not available everywhere.

Screening of Cancer
Oral Screening : Mr. Kishor Kumar Pradhanaga, Chief, Cancer Prevention &
Control, Research Center, BPK Memorial Cancer Hospital,
Bharatpur, Chitwan

Breast Screening : Ms. Sharmila Neupane, Nurse, BPK Memorial Cancer Hospital,

Practical Sessions on oral screening and breast screening was done among TOT participants.

Male participants went through oral screening with Mr. Kishor Kumar Pradhanaga. Among… participants 4 of them have lumps. Mr. Kishor has counseled them to visit the BPK Memorial Hospital, Bharatpur, Chitwan for further diagnosis and treatment.

…..Female participants went through breast screening with Ms. Sharmila Neupane, Nurse, BPK Memorial Hospital, Bharatpur, Chitwan. Participants were happy that they got the chance to get scanned from a professional nurse from BPK Memorial Hospital.

Paper: Cancer & Our Lifestyle
Presenter: Dr. Hari Prasad Pokharel

Dr. Hari Prasad Pokharel presented a paper on cancer and our lifestyle. He started with what cancer is and it spreads. He explained about the factors of cancer which is as follows: Age, Smoking, Food, Stress, Alcohol, Smoke, Nature of Work, Hormonal Changes, Radiation, Heredity, Ultra Violet, Bacteria and Virus, Environmental Pollution & Others. He further added it’s important to be aware of any unexplained changes to your body, such as the sudden appearance of a lump, blood in your urine, or a change to your usual bowel habits. These symptoms are often caused by other, non-cancerous illnesses, but it’s important to see your GP so they can investigate. If your GP suspects cancer, they’ll refer you to a specialist – usually within two weeks. The specialist will carry out further tests, such as a biopsy or X-ray, and plan any necessary treatment.
Other potential signs and symptoms of cancer are outlined below:

 Lump in your breast: if you notice a lump in your breast or if you have a lump that’s rapidly increasing in size elsewhere on your body.
 Coughing, chest pain and breathlessness. Symptoms such as shortness of breath or chest pain may be a sign of a severe (acute) condition, such as pneumonia.
 Changes in bowel habits: if you’ve experienced blood in your stools, diarrhea or constipation for no obvious reason, a feeling of not having fully emptied your bowels after going to the toilet, pain in your stomach (abdomen) or back passage (anus) and persistent bloating
 Bleeding: if you have any unexplained bleeding, such as: blood in your urine, bleeding between periods, bleeding from your bottom, blood when you cough, blood in your vomit
 Moles: if you have a mole that has an irregular or asymmetrical shape, has an irregular border with jagged edges, has more than one color – it may be flecked with brown, black, red, pink or white, is bigger than 7mm in diameter
 Skin: If it is itchy, crusting or bleeding, changes means there’s a chance you have malignant melanoma, a form of skin cancer.
 Unexplained weight loss: if you’ve lost a lot of weight over the last couple of months that can’t be explained by changes to your diet, exercise or stress.

He further added that cancer can be diagnosis by: lab test, imaging, tissue biopsy and facial diagnosis. Cancer can be treated through:

 Surgery
 Chemotherapy
 Radiotherapy
 Hormonal therapy
 Immuno therapy
 Oriental health science: yoga, ayurveda and naturopathy

Cancer & Lifestyle

 Making positive decisions
 Eat well and keep to a healthy weight: Eat more vegetables and fruit
 Handle and prepare food safely
 Protect yourself in the sun
 Get physically active
 Look after your bones
 Look after your heart
 Stop smoking
 Stick to sensible drinking
 Getting help and support
Post Test
After the 2-days session on cancer prevention and screening a 20-minutes post-test was done to see the level of knowledge gained of the 39-participants. Participants were asked to evaluate their test by themselves. In the post test, participants shared that they gained better knowledge about cancer and its preventive and treatment aspect.
Concluding Session & Certificate Distribution
Lastly, Mr. Shanta Lall Mulmi thanked all participants from 13-Health Rights & Tobacco Control District Networks for participating in the TOT on Cancer Prevention and Screening. He thanked Mr. Kishor Pradhanaga and Ms. Sharmila Neupane from BKP Memorial Hospital facilitating this TOT program. He said that all the participants should commit to take up the issue at district level and raise awareness on cancer, motivate people to take up preventive measures to minimize the risks. Schools will put extra class to educate children on cancer.
At the end of the program Mr. Shanta Lall Mulmi and Kishor Pradhanaga distributed certificates to all the participants.