OCCUPATIONAL CANCER
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Transcript OCCUPATIONAL CANCER
OCCUPATIONAL
CANCER
Dr. Majid Golabadi
Occupational Medicine Specialist
Isfahan University of Medical Sciences
What Is Cancer?
Cancer is a large group of
diseases (over 200)
characterized by
uncontrolled growth and
spread of abnormal cells.
The majority of cancers in adults:
Genetic factors
Lifestyle
Environmental and occupational exposure
Stress
Sleep disturbances,
Diet: high fat and low in fruits and vegetables
Lack of exercise
Chemicals In Foods
Smoking – 30% of all cancer deaths, 87% of lung cancer deaths
Obesity – 50% higher risk for breast cancer in postmenopausal
women, 40% higher risk in colon cancer for men
Viral Factors
5-10% of all human cancers are thought to be caused by
occupational exposure to carcinogens
Carcinogen: Any chemical , physical or biologic agent present
at the workplace which increases the risk of cancer among
exposed workers
Stages in Tumor Development
1. Initiation
Cancers come from an abnormal cell (mutation in
DNA)
2. Promotion
To a benign or preneoplastic tumor
3. Progression
To a malignant tumor
Carcinogens
Initiator
Promoter
Complete Carcinogens
Medical surveillance :
Occupational cancers are completely preventable
Induction-latency period
3-5 years for radiation or toxin induced leukemias
40 or more years for some cases of asbestos-
induced mesothelioma
For Solid tumors usually 10-25 years
There is controversy about the existence of threshold
doses for carcinogenic agents
OCCUPATIONAL CANCER
Avoid the use of chemical in IARC groups 1 and 2A
Use agent in group 2B only with very tight controls
when there are no viable alternatives
OCCUPATIONAL HUMAN CARCINOGENS
GROUP 1 (IARC) CLASSIFICATION
Arsenic
Lung, Skin, Liver
Asbestos
Benzene
Beryllium
Cadmium
Pleura & peritoneum, Lung, Larynx, GI
Leukemia
Lung
Lung
Chromium
Coal tar
Mustard gas
Lung
Skin, Scrotum, Lung
Lung
Nickel
Solar radiation
Lung, Nasal sinus
Skin
Vinyl chloride
Liver
Selected industrial processes causally
associated with human cancer
Industrial
process
Agent
Cancer site
Aluminum
production
Shoe
manufacture
Iron and steel
founding
PAH
Lung,bladder
Benzene
Leukemia
PAH,Silica
lung
Aromatic amines,
solvents
Bladder, leukemia
Rubber industry
عوامل زیان آور شغلی
LUNG
MESOTHELIOMA
NASAL CAVITY & SINUSES
LARYNX
BLADDER
LIVER
SKIN
HEMATOLOGIC
LUNG CANCER
LUNG CANCER
The currently accounts for almost 30% of all cancer
deaths
The most preventable risk factor: cigarette smoking
In occupations with high prevalence of smoking
There is no one cell type that is pathognomonic of an
occupationally related lung cancer
Asbestos
Radon
Chloromethyl ethers
PAHs
Chromium
Nickel
Arsenic
Mustard
Asbestos
(Asbestos miners, Textile, Insulation ,filter, Shipyard)
Blue asbestos (Crocidolyte)
White asbestos (Chrysotile)
Brown asbestos (Amosite)
Asbestos
The accounting for 20% of all deaths in asbestos-
exposed
7% of all lung cancer is attributable to asbestos
exposure.
A latency period: 20 years
Synergic effect with Smoking
Cigarette smoke: initiator
Asbestos: promoter
Adenocarcinoma
Radon
(Uranium mining , Domestic exposure)
Excessive lung cancer in uranium miners is
independent of cigarette smoking, although
exposure to both is synergistic
Polycyclic Aromatic Hydrocarbons (PAHs)
From the incomplete combustion of coal tar, pitch, oil
and coke
The scrotal cancer in chimney sweeps
(Dermal exposure to soot)
Coke oven workers, Roofers, Printers, Truckers, Rubber
plant workers, Asphalt workers
Chloromethyl Ethers
Chloromethylmethyl ether (CMME)
Bischloromethyl ether (BCME)
Bactericides, Pesticides, Dispersing agents, Water
repellents, Flame-proofing agents
Small cell lung cancer
Arsenic (Organic Arsenic)
Lead, Copper and Zinc smelting
Pesticides
Chromium
Chromate production
Nickel
Soluble forms
Probably Carcinogenic for lung cancer
Acrilonitryl
Beryllium
Cadmium
Vinyl chloride
Formaldehyde
Acid Sulfuric
Medical monitoring in the workplace
(Screening )
Periodic examination:
History , Physical exam, smoke, training
Symptoms: persistent cough, blood-streaked
sputum, chest pain, Voice change
Environmental monitoring
Serial Chest Radiography and Sputum cytology
(OSHA,NIOSH)
CT Scan (spiral,…..), HRCT
Prevention
Primary prevention:
The most effective methods
Complete avoidance of exposure to the carcinogen
Identification of etiologic agents in the workplace
Worker education
Asbestos
Asbestos miners
Textile manufacturing
Insulation and filter production
Construction workers
Welders, Plumbers, electricians
Roofers
Shipyard workers
MESOTHELIOMA
The latency period:
30 years or more
Cigarette smoking dose not
increase the risk of MM
Symptoms: Persistent gnawing chest pain, dyspnea, dry
cough, weight loss
Pleural effusion, pleural thickening or nodularity, interstitial
pulmonary fibrosis, pleural plaques, pleural calcification
CXRay: Unilateral pleural effusion
CT_Scan: Most sensitive test for pleural surface
Sputum cytology
Thoracentesis
Thorachotomy and thoracoscopy
MESOTHELIOMA
Treatment:
Surgical
Radiotherapy
Chemotherapy
Prognosis:
75% of patients die within 1 year after diagnosis
Pleura, peritoneal
More frequent in men than women (2:1)
Usually squamous cell histology (50%),
The disease is very uncommon in workers under 50
years of age, and rates increase with age
Wood and other dusts
(Furniture, Textile, boot and shoe manufacturing, bakes )
Chromium (Nasal septum ulcer and perforation)
(Chromate pigment production , metal plating )
Nickel
(Nickel refinery workers)
Isopropyl alcohol, Formaldehyde
(laboratory workers , other industries )
•Owen workers, foundry workers, Radium, Radon, mustard
Symptoms:
Unilateral nasal obstruction
Non-healing ulcer
Occasional bleeding
A low-grade chronic infection, associated with discharge,
obstruction ,and minor intermittent bleeding
Chronic hypertrophic rhinitis
Dry atrophic nasal mucosa
Nasal polyps
Almost Adenocarcinomas
Prevention
Primary prevention:
Complete avoidance of exposure to the carcinogen is the
ultimate goal, but this is not always possible
Identification of etiologic agents in the workplace
Worker education
Laryngeal cancer is primarily a disease of older workers.
Cancer of the larynx is much more common than sinonasal
cancer
Cigarette smoking and alcohol abuse are the primary
etiologic factors
Much more frequent in men than women (4.5:1) ,usually
middle aged or older
Asbestos
Asbestos miners
Textile manufacturing
Insulation and filter production
Shipyard workers
Hoarseness is an early presenting symptom
Usually squamous cell histology
At the time of diagnosis:
60% localized
30% regional spread
10% distance metastases
40% supra-glottic, 59% glottic, 1% sub-glottic
Prevention
Primary prevention:
Complete avoidance of exposure to the carcinogen is the
ultimate goal, but this is not always possible
Identification of etiologic agents in the workplace
Worker education
Periodic examination:
History , Physical exam, smoke, training
Environmental monitoring (limits)
BLADDER CANCER
5% of all malignant tumors
M/F = 2/1
Cigarette smoking is the most important etiologic factor (60%)
Water infected to pesticides and other chemicals
The latency period: mean of 20 years
Presenting complaints of hematuria and vesical irritability
Diagnosis by urine cytologic examination and cystoscopy
Naphtylamine (Textile workers, Dye & pigment manufacture,
Rubber manufacture)
4-Aminobiphenyl (Tire & Rubber manufacture)
Benzidine (Dye & pigment manufacture)
Chlornaphazine (leather worker)
O-toluidine (Painters, Textile workers , Bootblacks)
Phenastin (Petroleum workers, Hairdressers)
High exposed workers
Textile workers,
Dye & pigment manufacture,
Tire & Rubber manufacture
leather worker
Painters,
Bootblacks
Petroleum workers,
Hairdressers
4- Aminobiphenyl
Chlornaphazine
Benzidine
Pathogenesis & Pathology
Body exposure via GI, Dermal or Respiratory
Caused by contact of the bladder epithelium with
carcinogens in the urine
The bladder is exposed to higher concentration of these
materials than other body tissues
Urothelial tumors:
90% transitional cell type
6-8 % squamous cell
2% adenocarcinoma
Clinical findings
The most common:
Hematuria 80%
Painless, gross, and intermittent
20%: the vesical irritability alone, with increased frequency,
dysuria, urgency and nocturia
U/A: RBC, Blood
Anemia, Uremia
Prognosis
Prognosis varies with the stage of the disease
Superficial:
The excellent 5-year survival
Muscle invasion:
40-50% of patients 5-year survival
Local spread of disease in the pelvis:
10-17% of patients survive 5 years
Screening
Urine cytology and U/A:
Screening tool
Sensitivity (75%),specifity (99.9%)
Used to screen only certain at risk occupations
The screening of high-risk patients may result in a
significant reduction of the stage of disease at diagnose,
with improved long-term survival
Vinyl chloride (PVC production)
Arsenic (Pesticide , Copper ,Lead , Zinc smelting , Wine
maker, Fowler)
Thorotrast
Hepatic Angiosarcoma
Angiosarcoma of the liver is a rare tumor
M/F: 4/1
Major exposure to vinyl chloride
Sign & symptoms
RUQ abdominal pain, weight loss
Hepatomegaly on physical examination
Diagonisis by hepatic arterogram and liver biopsy
Clinical Findings
Non-specific:
Fatigue, weakness, and weight loss are seen in 25-50% of
patients
The some patients may be asymptomatic
Abdominal pain is the most common symptom,
usually in the RUQ
Phx:
Hepatomegaly with ascites
Jaundice
Splenomegaly , abdominal mass, tenderness
Laboratory findings
A mild anemia, target cells and schistocytes
Leukocytosis and thrombocytopenia (1/2 patients)
Prolonged PT
Almost all patients: abnormality of liver function
testing
ALT, AST and ALP
Screening tests
Periodic testing:
History and physical examination
CBC, LFT (SGOT, SGPT, ALP)
UV radiation (Outdoor workers, welding arc)
PAHs (coal tar workers , Electrode production , Pigment
Industry , Roofers , Shale oil worker)
Ionizing radiation (Uranium miners, Health care
workers, Military personnel)
Arsenic (Pesticide , Copper ,Lead , Zinc smelting)
Chronic inflamation
UV Radiation
Major risk is ultraviolet radiation
There are 4.8 million outdoor workers in the USA
(agriculture,…)
The estimated 300000 workers are exposed to
industrial radiation sources
(welding arc, germicides and printing processors)
PAHs
Ionizing radiation & skin cancer
High risk: more than 1000 cGy
Early radiation workers with heavy exposure:
Predominantly SCC
The hands and feet and occasionally on the face
More recently, basal cell cancers have been described
following repeated occupational exposures
Arsenic
Punctate keratoses of the palms and soles and
hyperpigmentation are frequently seen
Ionizing radiation (Nuclear power
plant worker, Health care worker, Military
personnel)
Benzene (Petrochemical and refinery
worker , Rubber worker)
Ionizing radiation & aplastic
anemia
Dose dependent
Large dose & long term (small amount)
Risk:
Increased until 3-5 years after exposure
After which there is a marked decline in incidence
Treatment:
Bone marrow transplantation,hematopoietic growth
factors
Benzene & leukemia
Benzene is a cyclic hydrocarbon obtained in distillation
of petroleum and coal tar
It is used widely in chemical synthesis in many
industries
Explosives,soap,perfums, Drugs,dyes,rubber,shoes
Benzene & leukemia
Workers exposed for 5 years or more had a 21-fold increased
risk of death from leukemia
Aplastic or hypoplastic anemia
Acute , chronic (30 years after exposure)
Exposure to 100 ppm cause cytopenia