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No. Cancer Defence is aimed at students from the 2nd grade of secondary school through the 3rd grade of upper-secondary school. It is important that you give the number of students who will be participating so that we can determine the amount of didactic materials needed to carry out the programme at your school.

A suspicious skin lesion can be noticed by:
- any doctor who, while examining the patient for any reason, inspected also their skin;
- any dermatologist during a routine inspection of the patient’s skin;
- the sick, themselves;
- family and friends of the sick.
Suspicious lesions are skin lesions that meet at least one criterion on the American ABCDE scale, a checklist helpful in detecting early signs of melanoma:
A. (asymmetry) – a melanoma is asymmetrical with respect to any axis, as opposed to benign lesions, which are usually circular or oval; it can also present an irregular shape composed of small elevations above the skin surface;
B. (borders) – irregular or ragged edges;
C. (colour) – variegated – from light brown to black or steely) – with uneven distribution of the pigment and, often, with its punctual deposits (particularly noticeable during dermatoscopy);
D. (diameter) – diameter > 5mm, or (dynamics) – dynamics of morphological changes in the tumour;
E. (evolution) – that is, acquisition of new characteristics in an already existing lesion: itching, bleeding, ulceration, quick growth; alternatively, another criterion, less often used nowadays: (elevation) – the mole or mark is raised above the level of the epidermis surrounding it (it concerns mainly advanced melanomas, melanomas in the early stages don’t form a palpable bulge),

or the British Glasgow scale, helpful in detecting locally advanced melanomas:
1. growth
2. change in shape
3. change in colour
4. inflammation
5. oozing or bleeding from the lesion or a visible crust
6. sensory disturbances (e.g., itch or hyperesthesia)
7. diameter > 7mm

The most common sites for melanomas are the lower leg (in women) and torso (in men). However, the location of the lesions, apart from limbs and torso, may be also face, neck and every other body part (scalp, feet, interdigital spaces, the areas around the genitals and the anus, etc.). A distinct form of this disease is e.g., subungual (nail bed) melanoma.

If a suspicious lesion is found, the next step is a visit to a dermatologist’s office equipped with a dermatoscope. An appointment with a dermatologist does not require a referral.
Dermatoscopy – the examination of skin lesions with a magnifier, a non-invasive, painless exam that lasts only a few minutes – enables doctors to identify additional features of the lesion, which allows them to determine with high probability whether the mark is just a benign lesion or a melanoma.

- if somewhere on your body a new mark appeared that is different in colour than your skin (all shades of brown, black, steely, or red), has a worrisome shape, grows quickly, or has already reached a diameter of 6mm;
- if any of the already existing marks on your body started “behaving” differently, that is: itching, bleeding, growing, changing colour or shape, or if a crust appeared on it
immediately visit a dermatologist to undergo dermatoscopy.

The symptoms of lung cancer depend on the location and size of the primary tumour, and the location of possible metastases. The most common symptoms include:
- persistent, therapy-resistant cough,
- weight loss,
- coughing up blood,
- chest pain,
- shortness of breath,
- neurological symptoms related to brain metastases (epilepsy, morning headaches, visual and speech disturbances, balance problems),
- symptoms related to bone metastases (acute and persistent bone pain),
- other symptoms related to metastases to other organs.

Cervical cancer is one of the malignant cancers which in the early stages are completely asymptomatic or whose early symptoms are minor and non-specific. Therefore, women who suffer from more distinctive symptoms are usually diagnosed with advanced cervical cancer.

Most often, those symptoms include one or more of the following:
- contact bleeding (bleeding during sexual intercourse or a pelvic exam),
- bleeding between regular menstrual periods,
- menstrual periods longer and heavier than usual,
- abnormal (heavy) vaginal discharge,
- pain during intercourse,
- abdominal pain.

If cervical cancer infiltrates the closest organs or metastasizes to remote organs, following symptoms might occur:
- pelvic pain
- urinary incontinence (loss of bladder control),
- urinary retention, hydronephrosis,
- flatulence, alternating diarrhoea and constipation,
- severe pain in the pelvic bone and/or other bones (e.g. the thigh bone)
- persistent, therapy-resistant cough,
- neurological symptoms,
- other.

The final diagnosis of cervical cancer is usually made by an experienced gynaecologist or a gynaecologic oncologist after administering necessary tests, such as:
1. pelvic examination;
2. the Papanicolaou test (known commonly as Pap test or Pap smear);
3. colposcopic examination (colposcopy), during which biopsies might be taken for further histophtological examination;
4. histopathology of the biopsy material, with full report from the pathomorphologist.
(See: What Tests Will the Doctor Order?)

If you notice any lasting symptoms in relation to your reproductive organs, you should see your gynaecologist.

Melanoma is a type of skin cancer that forms from melanocytes, which exist in the basal layer of the epidermis. Melanocytes produce melanin – the pigment that causes the skin to tan after exposure to UV radiation (the sun, solarium).

Due to external factors (e.g., solar ultraviolet radiation) or genetic predisposition (e.g., mutations of certain genes), melanocytes acquire new traits: they don’t die at the right time, they multiply uncontrollably, and, eventually, they form a tumour. This tumour grows rapidly, infiltrating and damaging the surrounding healthy tissue, and gains the ability to produce metastases – melanoma cells “break off” from the primary tumour and travel through blood and lymphatic vessels to remote areas, “settling” there and forming new tumours. This way a cancer originating in the skin begins to damage, for instance, lung, liver, or bone tissue, which causes the body to malfunction. With time, the condition of the sick person worsens, which ultimately leads to death.

Melanoma is one of the most aggressive malignant cancers. The course of the disease can be unpredictable – in contrast to many other types of cancer, even a very small primary tumour can be a source of metastases, and the stage in which the cancer spreads can be very short.
What is more, melanoma can recur even than ten years or more after the surgical treatment.
However, another characteristics of melanoma is that, because of the place in which it originates (the skin), it is possible to diagnose and treat it quickly – early diagnosis and proper removal of the lesion can successfully save the patient before the melanoma becomes life-threatening. Receiving the right treatment in the early stages of melanoma can considerably increase life expectancy and even give a chance of full recovery to 60-90% of patients.
About 20% of people with melanoma are diagnosed in the later stages, either when the cancer is locally advanced (it has affected the neighbouring lymph nodes) or when it has already spread throughout the body (it has metastasized). The chances for even 5-year survival are in such situations considerably diminished – only 5-10% of the patients with a metastasized melanoma live that long.
In Poland melanoma still is relatively rare (2400 new cases per year); however, it is a type of malignant cancer with dynamically increasing incidence rate: in Poland, it doubles every 10 years. The average age at the time of diagnosis is 50, but melanoma affects also much younger people, even as young as 20-30 year old.

It has been proven that the following factors increase the risk of melanoma:
• intensive exposure to natural (sunrays) or artificial (solaria) UV radiation;
• constant mechanical or chemical irritation of an existing lesion (e.g., repeated and long-lasting “rubbing” of the lesion with a belt buckle or a part of a bra, or using caustic substances as skin ointments – e.g., creams, salves, and other substances without the proper certificates);
• low level of skin pigmentation (people with fair complexion, particularly those with red hair and/or those with low tolerance for sunbathing);
• genetic predisposition (e.g., FAMS, the familial atypical mole syndrome);
• history of melanoma, either personal or in the family.

The main cause of lung cancer is smoking. It has been proven that smoking 20 cigarettes per day increases the risk of developing lung cancer between 20 and 25 times. Passive smoking, e.g., living with a smoker, causes approximately a third of all lung cancer cases. Overall, carcinogenic substances in tobacco smoke are responsible for 90% of total lung cancer cases.

Other known risk factors include exposure to asbestos, uranium, and other environmental carcinogens, as well as family history of lung cancer.

Cervical cancer is a malignant cancer that originates in the female reproductive organs, more specifically, in the conical part of the uterus (cervix) that connects the upper part of the uterus (corpus uteri) with the vagina.

The main, confirmed cause of cervical cancer is human papillomavirus (HPV) infection, which infiltrates epithelial cells of the cervix, and then damages and “reprograms” them – they start to divide uncontrollably and, as a result, form a tumour. The tumour can infiltrate and damage neighbouring tissue as well as metastasize – cancer cells “break away” from the primary tumour and, through blood or lymph vessels, travel to remote sites, “settling” there and forming new tumours. This way, a cancer originating in the epithelium of the cervix can damage, e.g., lung, liver, or bone tissue, which can cause the body to malfunction and ultimately lead to death of the patient.
Cervical cancer is the third most common cancer in women and the third most common cause of death from cancer among them.

The estimated number of women with cervical cancer worldwide is 1.4 million. Every year there are approx. 500 000 new cases, and approx. 300 000 women die of cervical cancer.
In Poland, there are over 3000 new cases per year, and over 1700 women die of this type of cancer annually. It is one of the highest mortality rates in Europe.

Cervical cancer is most common in women between 35 and 59. It attacks quietly and slowly. On average, it develops for 14 years. For years, the development of cervical cancer is virtually asymptomatic. The appearance of distinctive symptoms usually means that the cancer is in an advanced stage, therefore difficult or impossible to cure.

HPV infection is usually contracted through sexual intercourse; the infection may be almost completely asymptomatic. Every sexually active woman at least once in her life comes into contact with HPV; however, the infection develops into a disease only in up to 20% of women. Most infections are killed by the immunological system and don’t cause cervical cancer. Some of them, however, develop into a chronic condition lasting years. An important consideration is the type of HPV contracted – types 16 and 18 (called the oncogenic types) are responsible for two thirds of total cervical cancer cases.

Men are usually asymptomatic carriers of the virus and it is they who infect their sexual partners. Larger number of sexual partners increases chances of the infection but cervical cancer is a threat to every sexually active woman – even one who has sexual contact with only one partner.
Even very young women who have just started to be sexually active can be infected. The virus can then insidiously develop for a long time without causing any distressing symptoms, which after several years – usually when the woman is at the age when she is most active in her professional and family life – results in cervical cancer.

Apart from HPV infection, other confirmed factors increasing the risk of cervical cancer include: early sexual initiation, large number of sexual partners, frequent pregnancies and childbearing, and smoking.

You can prevent melanoma by using primary and secondary preventive strategies. The primary strategies involve behaviour preventing even the occurrence of the disease; the secondary involve its early detection.

If you want to reduce the risk of melanoma:
1. don’t sunbathe;
2. avoid direct sunlight between 11 a.m. and 4 p.m.;
3. use creams and lotions with UV filters, cover your head (hats, caps), and wear sunglasses when in direct sunlight;
4. don’t use solariums!
5. once a year visit a dermatologist to have your skin inspected, especially if you:
- have fair complexion,
- get sunburnt easily or have low tolerance for sunbathing,
- have many marks on your skin,
- have family history of melanoma,
- have already had melanoma before.

So far, a uniform and effective secondary preventive strategy has not been implemented anywhere in the world: administering routine chest X-rays turned out to be ineffectual – it does not improve the prognosis for the patients who were asymptomatic at diagnosis.

There are high hopes for administering routine, low-dose CT scans of the chest to those in the high-risk group (particularly to long-time smokers). However, this measure is estimated to lower the lung cancer mortality rate only by 20%; what is more, it is not refunded in Poland.

The basis of effective preventive medicine in lung cancer is primary preventive care, i.e., not smoking, as tobacco smoke is highly carcinogenic.

Cervical cancer is one of the few malignant cancers in which screening tests have been proven to significantly lower incidence and mortality rates.

Currently, Pap test is the standard screening test used in cervical cancer preventive care around the world. The test allows finding precancerous changes (cervical interstitial neoplasia – CIN) and cancer in the early stages (e.g., in the “in situ” stage, when the cancer is not yet invasive). At that stage, surgical treatment normally results in full recovery of the patient, without maiming her; often, it doesn’t even affect her fertility or the ability to gain full satisfaction from sexual intercourse.

In Poland, a routine Pap test is recommended every 3 years for women aged 25 - 59. The exception are women with pre-existing risk factors: those infected with HIV, taking immunosuppressants, or infected with a high-risk type of HPV. Those women should do a Pap test every 12 months. Every gynaecologist who signed an agreement with the NFZ (the National Health Service) will do the test free of charge.

Since 2006, a vaccination against HPV, the virus responsible for cervical cancer, is also available. Currently, the American Advisory Committee on Immunization Practices (ACIP) recommends the vaccination to all females aged 11 – 12 or 13 – 26, if not vaccinated before. In other countries, the recommended age group for HPV vaccination is somewhere between 9 and 18 years old; most often it is 11 – 13 years old, that is, before sexual initiation. HPV vaccines have been proven to be highly effective in preventing diseases related to HPV infections, including the oncogenic types. The efficiency of the vaccine in preventing cervical cancer is rated very high: the risk of squamous cell carcinoma (the most common type of cervical cancer; approx. 85% of total cases) is reduced by 75% and the risk of adenocarcinoma (10% of total cervical cancer cases) – by 96%.
It is estimated that the currently available vaccines prevent 70-80% of cancers caused by HPV.

Cervical cancer can be successfully prevented through:
1. primary preventive care – vaccinations against human papillomavirus (HPV);
2. secondary preventive care – regular Pap tests.


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