|Year : 2009 | Volume
| Issue : 4 | Page : 323-330
Distribution of malignant neoplasms reported at different pathology centers and hospitals in Jaipur, Rajasthan
RG Sharma, R Kumar, S Jain, S Jhajhria, N Gupta, SK Gupta, S Rawtani, K Kohli, L Prajapati, R Gupta, N Swamy, D Pathak, H Verma, SS Ratnawat
Department of Surgery, SMS Medical College Hospital & Rajasthan Cancer Society, Jaipur, India
|Date of Web Publication||9-Sep-2009|
R G Sharma
Department of Surgery, SMS Medical College Hospital & Rajasthan Cancer Society, Jaipur
Source of Support: None, Conflict of Interest: None
Background: Cancer data from Rajasthan are limited. Only two studies, one from Western Rajasthan, and the other from Eastern Rajasthan have been published by Sharma et al. in 1992 and 1996. Aims: To put the cancer profile from this region in proper perspective, we conducted the present study on the patterns of various malignancies in Jaipur region, i.e., Eastern Rajasthan. Setting and Design and Material and Methods: The study spans over one and half decade (1990-2004) and is based on a retrospective six-year sample analysis of approximately 200,000 histopathological and cytological reports for the years 1990, 1991, 1996, 1999, 2001 and 2004. Results: A total of 21,868 cancers were recorded in the six sample years. There were 59.11% (12,926) males and 40.89% (8942) females, with the male to female ratio being 1.45:1. Organ wise, lung (8.45%), prostate (7.12%), brain (6.04%), urinary bladder (5.31%), esophagus (4.67%) and tongue (4.60%) are most common sites involved in males with regard to frequency, whereas breast (20.44%), cervix (14.99%), ovary (4.35%), brain (3.80%), esophagus (3.67%), uterus (3.01%) and rectum (2.80%) are common sites for malignancies in females. Conclusions: Significant findings were a higher frequency of cancers of the prostate, urinary bladder, and brain in males along with gall bladder cancers in females. Our figures have been compared with the national data.
Keywords: Cancer profile, frequency, malignancy
|How to cite this article:|
Sharma R G, Kumar R, Jain S, Jhajhria S, Gupta N, Gupta S K, Rawtani S, Kohli K, Prajapati L, Gupta R, Swamy N, Pathak D, Verma H, Ratnawat S S. Distribution of malignant neoplasms reported at different pathology centers and hospitals in Jaipur, Rajasthan. Indian J Cancer 2009;46:323-30
|How to cite this URL:|
Sharma R G, Kumar R, Jain S, Jhajhria S, Gupta N, Gupta S K, Rawtani S, Kohli K, Prajapati L, Gupta R, Swamy N, Pathak D, Verma H, Ratnawat S S. Distribution of malignant neoplasms reported at different pathology centers and hospitals in Jaipur, Rajasthan. Indian J Cancer [serial online] 2009 [cited 2019 Dec 14];46:323-30. Available from: http://www.indianjcancer.com/text.asp?2009/46/4/323/55553
| » Introduction|| |
Variable cancer pattern in different geographical regions may be dependent on genetic, environmental, dietary, social and other factors. It is important to know the differential disease pattern in a population subgroup. Limited data are available on cancer from Rajasthan. Only two studies, one from Western Rajasthan and the other from Eastern Rajasthan have been published by Sharma et al. in 1992 and 1996. , Recently, " Atlas More Details of Cancer" project of the National Cancer Registry Program (ICMR) 2001-2002 published data from Rajasthan.  Hence, to put the cancer profile from this region in a proper perspective we conducted the present study to determine the patterns of various malignancies in Jaipur region, i.e., Eastern Rajasthan.
In Rajasthan, the onus of diagnosis and treatment of cancer falls mainly on the six Medical College hospitals. The total population of the state as per 1991 census is 44,005,990. The population density of Rajasthan is 129/km 2 as compared to 274/km 2 in India. The per capita income is Rs. 2923.00. The female population is 48% as compared to 52% of males. The population growth rate is +28.44%. The overall literacy rate is 38.55%, with male literacy rate being 54.99% and female, 20.44%. The staple diet is bajra, jowar, maize and wheat. About 60.23% of the population resides in rural areas and agriculture is the mainstay of their livelihood. Sandstone, soapstone, silica sand, iron ore, china clay and limestone are the important minerals found here. The main industries are skin hide, blacksmithing, oil crushing, limestone, structural stone goods, textile printing, dyeing and finishing. The main addictions are tobacco in various forms, betel and nut, pan masala, alcohol, opium and bhang.
Jaipur is the capital of Rajasthan and is situated in Northwest India. It has a high-density population (336/km 2 ). Jaipur drains practically the whole of Eastern Rajasthan and neighboring states, as it is a tertiary referral center with all super specialties and very economical health care facilities, which cater to a population of approximately 13,451,881. Hence, the data obtained here are expected to be fairly representative of the overall incidence and pattern in this region.
| » Material and Methods|| |
The study spans over one and a half decade (1990-2004) and is based on retrospective six-year sample analysis of approximately 200,000 histopathology and cytological reports for years 1990, 1991, 1996, 1999, 2001 and 2004. Data were collected from various pathology centers in Jaipur region, Department of Pathology Medical College and private hospitals in Jaipur. To maintain the authenticity and reliability of data obtained, only those cases were recorded, which had microscopic verification of diagnosis. Overall site frequency and sex pattern were recorded. Classification of various malignant tumors was done according to the International Classification of Disease coding system by WHO (9th revision) using code number 140-208. A total of 21,868 cancers were recorded in the six sample years (1990, 1991, 1996, 1999, 2001 and 2004).
| » Results|| |
Out of approximately 200,000 histopathology and cytology records, which were studied during the selected six years from 1990 to 2004, a total of 21,868 new cancers were recorded [Table 1]. There were 59.11% (12926) males and 40.89% (8942) females, male to female ratio being 1.45:1.
Organ wise (in the order of frequency), lung (8.45%), prostate (7.12%), brain (6.04%), urinary bladder (5.31%), esophagus (4.67%) and tongue (4.60%) are the most common sites for malignancies in males, whereas breast (20.44%), cervix (14.99), ovary (4.35%), brain (3.80%), esophagus (3.67%), uterus (3.01%) and lymph nodes (2.81%) are the common sites for malignancies in females [Table 2].
The frequency of various systems involved was genitourinary system (20.79%), gastrointestinal tract (14.46%), head and neck (13.05%), respiratory tract (9.16%), breast (8.47%), hematological (7.35%), bones and connective tissues (4.21%), metastatic (2.29%) and others (20.22%).
The most noteworthy feature of the present study is that cancers of genitourinary system (20.79% of all malignancies) are the most common single group of cancers in both sexes. In males, genitourinary system formed 17.48% of all malignancies. Predominantly, prostate (7.12%) and urinary bladder (5.31%) were involved. When considered individually, prostate cancer formed 40.71% of all genitourinary cancers in males and urinary bladder formed 30.40%.
In females, genitourinary cancers formed 25.56% of all cancers. Cervix uteri (14.99%) and ovary (4.35%) were the major sites involved.
Urinary cancers formed 4.89%of all cancers (6.96% of all males and 1.89% of all females). Cancer of urinary bladder formed 5.31% of all cancers in males and 0.95% in females, whereas kidney cancers formed 1.65% in males and 0.94% in females.
Digestive tract (15.85%) is the second most common system involved. In males, it forms 16.29% and in females 15.21%. Esophagus (4.26%) formed the most common site among all gastrointestinal malignancies. It constituted 26% of all GI cancers (28.64% in males and 24.12% in females). Rectum was the second most common site of cancer in both sexes (20.05% in males and 18.38% in females). Stomach was third most common site of cancer in males (14.89%), but in females, gall bladder cancer was the third most common cancer (14.49%) followed by stomach cancer (9.93%). Esophagus, rectum, stomach, and colon formed about 77% of all gastrointestinal malignancies. Remaining sites together formed only about 23%.
System-wise analysis shows the gastrointestinal tract as second most common site following closely genitourinary tract, which is the most commonly involved organ system of body in this region. In other parts of the country, the gastrointestinal tract was the leading site of cancers.
Head and Neck Cancers
Head and neck cancers also ranked second being equal to digestive tract cancers. They formed 15.85% of all cancers. The malignancies of the oral cavity as a group were most common in head and neck cancers; they formed 7.06% of all cancers (8.84% in males and 4.48% in females). Tongue as an individual site (3.53% overall) was most common in head and neck group. In males, it formed 4.6% and in females 2.0%. Oropharynx (3.02%) was the next area to be involved (males 4.22% and females 1.29%) followed by Larynx 2.24% (males 3.24% and females 0.79%).
In the head and neck group, overall tongue formed 22.3% of all head and neck cancers (22.26% in males and 22.43% in females). Oropharynx formed 19.07% overall (males 22.46% and 14.41% in females) followed by Larynx, which formed 14.13% of all head and neck cancers (males 15.7% and females 8.9%). Hypopharynx formed the fourth most common site 11.77% overall but it formed the third most common site in females (10.65%), whereas in males, the third most common site was the larynx followed by hypopharynx.
Respiratory Tract Malignancies
Carcinoma lung is the most common site (8.45% in males, 1.64% in females), with a large male to female ratio. If nasal cavity, nasopharynx and larynx (carcinoma larynx males 3.24%, females 0.79%) are included, then respiratory tract cancers form 9.16% of all cancers (13.09% in males and 3.48%in females). This makes it the fourth most common system involved.
As a group, hematological malignancies formed the fifth most common site involved, i.e., 8.84% of all malignancies in both sexes (in males 10.45% and in females 6.52%).
In this group, myeloid leukemia was the most common type. It formed 23.53% in both sexes combined (in males 22.80% and in females 25.21%). It is followed by non-Hodgkin's lymphoma. This formed 19.70% of hematological malignancies in males and females combined together (in males 20.58% and in females 17.67%). In females, it is the third most common type, whereas in males it is the second most common. The third most common type is lymphoid leukemia in both sexes combined 19.03% (in males 18.58% and in females 20.07%).
Malignancies of the breast form the sixth most common site of carcinoma in both sexes combined (i.e., 8.47% of all malignancies). In females, it is the most common site of malignancy (20.44%), whereas in males it constitutes only 0.19%.
Malignancies of the brain form the seventh most common site having a frequency of 5.13% in both sexes combined (in males 6.04% and females 3.80%). In males, malignancies of brain as an individual site form the third most common site involved in the body, whereas in females it is the fourth most common site in the whole body.
Bone and Connective Tissues
This is the eighth most common system involved in both sexes combined. It forms 4.21% of all malignancies (4.54% in males and 3.74% in females).
| » Discussion|| |
There are several limitations in describing patterns of cancers in individual centers, especially in the context of geographical distribution. The leading sites of cancers in a given place are dependent on a number of factors. The popularity of a particular department or treating physician, the accessibility of a particular diagnostic or treatment facility, affordability of patients and so on. In some centers, one could be dealing with small number of cancers. Thus, either the order of leading sites or fluctuation of the same between the years provides little meaning. Still, the patterns observed in most cancer centers that function as referral institutions for care of cancer patients do reflect the predominant cancers in the region. Further, they give an indication of the magnitude and burden of cancer in specific institution or region.
Our study spans over almost one and a half decade including sample analysis of approximately 200,000 histopathologies, although we have taken data-based cytological reports for the years 1990, 1991, 1996, 1999, 2001 and 2004.
Ten leading cancer sites in both sexes are compared with the incidence of cancer from population-based studies conducted in different parts of the country [Table 3],[Table 4].
Cancer in Males
Cancer of the lung was the leading site of cancer in males in present study (8.45%). It was also the leading site in males in Bikaner (8.63%). Lung cancer as leading site of Cancer in males was also reported from Karunagoppally (18.0 %), Bhopal (12.0%), Delhi (9.9%) and Mumbai (9.2%). The highest incidence of cancer lung was reported from Karunagoppally (18.0%) in India, and the lowest from Bangalore (7.3%) and Tata Memorial Hospital (TMH) (7.1%).
Cancer of prostate was the second most common site in males (7.12%), which is significantly higher than that found in population-based studies. It was lower than that reported from Jodhpur (8.11%), Delhi (5.4 %) and Mumbai (5.4%), and the lowest was reported from Karunagoppally (2.3%) and TMH (1.7%).
Brain cancer was the third leading site of malignancies in males, forming 6.04% of all cancers. This is higher compared to other reports. It was reported to be 4.6% in Delhi. Lowest incidence was reported from Karunagappally (2.3%) and a study from TMH reported 1.5% incidence.
The fourth most common site among male cancer was urinary bladder (5.31%). This is higher than that reported by different studies. In Jodhpur, it formed 5.95% of male cancers. It was reported to be 4.2% from Delhi. Ajmer (3.93%), Kolkata (3.7%) and Bhopal (3.6) had similar incidences. In Bikaner, it formed 2.89% of male cancers.
Cancer of esophagus was the fifth leading site in males (4.67%). A similar incidence was reported from Delhi (4.6%). This incidence is lower than most other studies. Highest frequency reported was from Nagpur (8.7%), where it was the leading site of male cancers. In Bikaner, it formed 8.24% of male cancers. Others were Pune (7.2%, second most common site), Bangalore (7.7%), TMH (7.0%) and Ajmer (5.46%).
This was the sixth leading site of malignancies in males (4.60%). A similar incidence was reported from Delhi (4.6%) and Mumbai (4.8%). Highest reported was from Ahmedabad (8.9%, second leading site in the body), followed by TMH (8.2%). In Bikaner, it formed 7.6% of male cancers. Lowest incidence reported was from Thiruvananthapuram (3.5%). From Ajmer, the incidence reported was 10.53%.
Malignancies of lymph nodes formed 4.32% of all. Although it was the seventh most common site in males, it was not included in 10 most common sites because of unspecified sites of primaries.
Mouth was the seventh leading site of male cancers (4.25%). This is similar to that reported from Delhi (3.6%) and Chennai (4.9%).
Highest incidence reported was from Thiruvananthapuram (10.5%). Bhopal (8.9%) and Pune had higher incidence. In Bikaner, it formed 5.93% of male cancers; Ajmer, 5.84% and Jodhpur, 5.95%.
Eighth most common site was oropharynx (4.22%). Jodhpur reported 4.05% incidence and Ajmer, 5.84%. TMH reported 3.4% incidence, which is lower than that observed in the present study.
Rectum was the ninth common site of malignancies in males (4.22%), A higher incidence was reported from Barshi (6.0%), Bangalore (3.4%) and Chennai (3.1%). TMH (3.1%) reported a low incidence.
It was the 10th most common site of malignancy in males (3.24%). Highest was reported from Delhi (6.5%), THM (5.9%) and Mumbai (5.6%). In Bikaner, it formed 5.29% of male cancers and in Ajmer, 7.36%.
| » Cancer in Females|| |
Breast was the leading site of cancer in females (20.44%). This is lower than the incidence reported from Mumbai (25.4%, highest reported incidence), Delhi (23.9%), Bhopal (23.8%) and TMH (24.6%). In Bikaner, it formed 22.89% of female cancers; Ajmer, 20.41%; and Jodhpur, 16.6%. Lowest incidence was reported from Barshi (13.3%), where it was the second leading site after carcinoma cervix.
Cervix uteri was the second most common site of cancer in females (14.99%). Similar incidence was reported from Delhi (16.3%). Highest incidence was reported from Barshi (42.7%) and Chennai (24.4%) where it was the leading site of cancers in female. TMH reported 24.4%. In Bikaner, it formed 25.2% of female cancers. Lowest incidence was reported from Thiruvananthapuram (13.1%), which is only slightly lower than that observed in the present study. Jodhpur reported 39.27% and Ajmer, 24.97%.
Ovary was the third leading site of cancers in females (4.35%). A higher incidence was reported from Nagpur (8.9%), Delhi (7.1%) and Mumbai (6.9%). In Bikaner, it formed 5.85% of female cancers; Ajmer reported 4.69% incidence and Jodhpur, 5.26%. A report of lowest incidence came from Karunagoppally (3.5%) and Barshi (3.7%). Incidence similar to that noted in the present study was reported from Ahmedabad (4.4%).
Malignancies of the brain formed the fourth leading site of cancers in females (3.80%). The present study reported an incidence higher than that reported in other studies where all reported incidence <3% (Mumbai (2.7%), Pune (2.5%), Delhi (2.4%) and TMH (0.9%)).
The fifth leading site of cancer in females was esophagus (3.67%). Comparable reports came from Karunagoppally (3.1%) Mumbai (4.3%) Ahmedabad (4.6%) and Nagpur (6.5%). A report of lowest incidence was from Delhi (2.4%). In Bikaner, it formed 7.55% of female cancers; in Ajmer, 4.69%; and in Jodhpur, 1.82%.
Corpus uteri was the sixth most common site of female cancers (3.01%). Incidence reported was higher than that reported in other studies (Thiruvananthapuram (2.7%), Bangalore (2.7%), Delhi (2.3%), Jodhpur (2.02%) and Mumbai (2.3%)).
Although lymph node malignancies formed the seventh most common site in females, these were not included in top 10 sites because of diverse sites of primaries.
Rectum was the seventh most common site of female cancers (2.80%). Incidences in other studies were Chennai (2.0%), Ajmer (2.07%), Barshi (3.1%) and TMH (1.8%).
Mouth is the eighth leading site of malignancies in females (2.48%). A study from Bhopal reported highest incidence (6.1%). Others were Thiruvananthapuram (5.7%), Bangalore (5.3%), and lower incidence was reported from Ahmedabad (3.0%) and Mumbai (3.3%). In Bikaner, it formed 2.36% of female cancers; Jodhpur, 2.23%; and Ajmer, 3.03%.
Skin is the ninth leading site of malignancies in females (2.45%). A study from TMH reported lower incidence (1.0%); from Jodhpur, 3.64%; and Ajmer, 3.72%.
The 10th leading site of cancers in females was thyroid (2.30%). Comparable incidence was reported from Bangalore (2.8%). A study from Barshi reported 1.9% incidence and from TMH, 1.8%. The highest frequency was reported from Karunagappally (7.5%) and Thiruvananthapuram (7.4%).
| » Comments|| |
The most significant observation was the high frequency of gall bladder cancer and CNS/brain malignancies in females and higher frequency of prostate, urinary bladder and CNS/brain cancers in males. Although the database used in this study is lacking completeness in various aspects, it gives an idea of distribution of various cancers reported in this region. Stress needs to be laid on compilation of figures from various parts of the country so that a comprehensive national database could be obtained.
| » Acknowledgement|| |
We are thankful to the Department of Pathology, S.M.S. Medical College & Hospital, Jaipur; Late Dr B.C. Sangal, Department of Pathology S.D.M. Hospital Jaipur; Bhagwan Mahavir Cancer Hospital Jaipur; Dr K C Joshi Diagnostic Lab Jaipur; and Dr M. L. Sharma, MLS Diagnostic Center, Jaipur for their valuable contributions.
| » References|| |
|1.||Sharma RG, Maheshwari MS, Lodha SC. Cancer profile in Western Rajasthan. Indian J Cancer 1992;29:126-32. [PUBMED] |
|2.||Sharma RG, Ajmera R, Saxena O. Cancer profile in Eastern Rajasthan. Indian J Cancer 1994;31:160-73. [PUBMED] |
|3.||Indian Council of Medical Research ICMR. Annual report of population based cancer registries of the National Cancer Registry Program 1993. New Delhi: ICMR Publication; 1996. p. 18. |
|4.||Development of an atlas of cancer in India: First all India report 2001-2002. Mapping pattern of cancer. 2004. p.115-8. |
|5.||Hospital cancer registry: Annual report-2000 Tata Memorial Hospital: 2004. p.119-20. |
[Table 1], [Table 2], [Table 3], [Table 4]
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