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  Table of Contents  
ORIGINAL ARTICLE
Year : 2012  |  Volume : 49  |  Issue : 3  |  Page : 298-302
 

Profile of gynecologic malignancies reported at a tertiary care center in India over the past decade: Comparative evaluation with international data


1 Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
2 Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India

Date of Web Publication12-Dec-2012

Correspondence Address:
K P Malhotra
Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.104494

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 » Abstract 

Objective: Comprehensive statistics on gynecologic malignancies reported from India are deficient. This study was performed to ascertain the profile of gynecologic cancers reported at our center regarding incidence, histologic subtypes, frequency of involvement at various sites and stage at presentation. We endeavored to compare our data with gynecologic cancers reported at other national and international centers. Materials and Methods: Retrospective review of records of gynecologic cancers obtained from Departments of Pathology and Gynecology, at a tertiary care center, Delhi from January 2000 to December 2009 was performed. Comparison with international data was performed using Fishcher's exact test and chi square tests. Results: A total of 1315 gynecologic cancers were reported. Cervical malignancies were the commonest at our center as compared to uterine malignancies in data from Surveillance, Epidemiology, and End Results (SEER) Program of United States and European Union. All malignancies except cervical cancers affected a younger age group at our center than in the US population. Cervical cancer presented at a relatively more advanced stage, ovarian cancers at more localized stages, whereas uterine cancers presented at similar stages as compared to Western data. Conclusions: Our registry presents composite data from North India. Higher age and advanced stage at presentation of cervical cancers suggests lacunae in screening programs available. Ovarian malignancies were more localized at presentation than in the Western population for which environmental or genetic factors may be causative.


Keywords: Gynecologic cancer, epidemiology, stage, age specific incidence, India


How to cite this article:
Agarwal S, Malhotra K P, Sinha S, Rajaram S. Profile of gynecologic malignancies reported at a tertiary care center in India over the past decade: Comparative evaluation with international data. Indian J Cancer 2012;49:298-302

How to cite this URL:
Agarwal S, Malhotra K P, Sinha S, Rajaram S. Profile of gynecologic malignancies reported at a tertiary care center in India over the past decade: Comparative evaluation with international data. Indian J Cancer [serial online] 2012 [cited 2019 Aug 24];49:298-302. Available from: http://www.indianjcancer.com/text.asp?2012/49/3/298/104494



 » Introduction Top


Gynecologic cancers form a huge burden of morbidity and mortality around the world. Data available from various centers worldwide are indicative of vast regional variability in incidence, common sites of occurrence, age and stage of presentation. While information on such issues is readily available from the developed world, composite data from the Indian subcontinent is deficient.

We aimed to undertake this study to collect comprehensive information from our center on gynecologic malignancies. Our center is a tertiary care referral center in Delhi. Gynecologic out patient department attendance over the past ten years, averaged 41,606 patients per year. A retrospective analysis of gynecologic malignancies at our center over the past decade was done. An attempt has been made to compare our data with that available from cancer registries in India and across the world. Salient features of gynecologic malignancies in our cohort of patients of Indian origin are discussed.


 » Materials and Methods Top


The records of the Departments of Pathology and Gynecology at our center were retrospectively reviewed to identify all cases of Gynecologic malignancies. All cases reported at our center or referred to it and treated in the Department of Gynecology over the past decade from January 2000 to December 2009 were reviewed. Information on site of affliction, patient age, duration of symptoms, histopathologic subtypes and stage of presentation according to FIGO classification was collected. Case files of patients diagnosed elsewhere and referred to our center were reviewed and only those with review of Pathology reports from the department of Pathology at our center were included for the study. All cases included for the study had a definite histologic diagnosis made either on biopsy or resection specimens. Cancers diagnosed only on aspiration or cervical scrape smears, not followed by histologic confirmation were excluded. Tumors of gestational trophoblastic origin and metastases to genital organs from other primary sites were also excluded from the study. The data was analyzed using Microsoft Excel software and SPSS 16. Comparison between two groups was performed using Fischer's exact test and chi square tests as applicable. Cut off for a significant P value was calculated using Bonferroni correction. For the purpose of comparison of incidence data and stage of presentation, our data was curtailed to the corresponding periods for which international data was available (2003-2007 and 2000-2007 respectively). Stage conversions from FIGO stages to localized, regional and distant were done for comparability with western data available. [1],[2]


 » Results Top


A total of 1315 new cases of gynecologic malignancies were reported and treated at our center between January 2000 and December 2009. The age ranged from 1.5 to 93 years (Median). The sites of involvement included Cervix (927 cases), Ovary (196), Corpus Uteri (129), Vulva (35), Vagina (9) and  Fallopian tube More Details (1). Twelve cases of metastases to genital organs and six borderline tumors were encountered and excluded from the present study.

Of the remaining 1297 cases, cervix was the commonest site affected accounting for 71.47% of cases. The mean age of patients with cervical cancer was 50.1 ± 12.9 years (median = 50 years; range = 14 to 90 years). Patients between 45 and 49 years of age constituted the commonest age group affected. Twenty one cervical cancers were detected in patients younger than thirty years of age. Only 34 percent patients presented while they were still operable. The surgical procedures included conization with sentinel lymph node dissection in eleven patients, simple hysterectomy in twenty patients and radical hysterectomy with node dissection in 281 patients. Primary chemoradiation was given to 615 patients.

Ovarian malignancies constituted 15.11% of all gynecologic malignancies reported, with a median age of 45 years (range 4 to 93 years). A significant percentage of ovarian tumors (57.14%) presented in stage I. Epithelial ovarian cancers presented most commonly in stage 3. Non-epithelial neoplasms presented most commonly in stage 1. The histologic subtypes encountered in various stages of presentation are shown in [Table 1]. Uterus was the primary site of involvement in 9.95% of cases which ranged from 14 to 82 years in age (mean 50.43; median 52 years). 35 cases of vulval carcinomas were identified. Nine malignancies of vaginal origin and a single case of fallopian tube adenocarcinoma in a seventy year old female were reported. The stage of presentation of malignancies at various sites is illustrated in [Table 1].
Table 1: Stage at presentation and histologic subtypes of gynaecologic malignancies. Stage according to FIGO classification

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 » Discussion Top


Cervix was the commonest site of affliction among gynecologic malignancies in our cohort of patients. It is also the leading site reported from other registries in India and South Asia. [3],[4] In hospital based registries in India, including a consolidated report from the National Cancer Registry Program (NCRP) as well as rural institutes, cervical cancer remains the commonest gynecologic cancer and among the two most common cancers overall in females, rivaled only by breast cancer. [5],[6] [Figure 1] compares data from our center with that available from other centers of the NCRP. Data for corpus uteri, vulva and fallopian tube were available only from our center and the NCRP Delhi composite registry.
Figure 1: Comparative evaluation of sites of involvement at various national centers

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Ovary was the second leading site among gynecologic malignancies at our center. It is also the leading site reported from Tehran. [7] Data from Globocan 2002 also shows a relatively higher incidence of ovarian malignancies in the West as compared to data from our registry, the NCRP and other cancer registries in India. [5],[6],[8]

Uterine malignancies were the commonest ones reported from the Surveillance, Epidemiology, and End Results (SEER) Program (of the United States) and European Union and significantly higher in proportion as compared to those reported at our center. [9],[10]

The median age of occurrence of cervical cancer in our series and SEER data was similar. However, all other gynecologic malignancies occurred at a significantly younger age in our patients than in the US population. [9] A comparative analysis of proportional site involvement and median age of affliction is presented in [Table 2]. [7],[8],[9],[10],[11]
Table 2: Sites of involvement and median age of affliction: Comparison with international data[7-11]

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The percentage incidence of gynecologic malignancies reported at our center according to site and age groups affected is presented and compared with international data. [Table 3] A comparative evaluation of our data with that from SEER Program revealed significantly lesser percentage of cervical malignancies in our cohort of patients in 20-34 yrs; whereas a higher percentage was noted in 45-64 year age group. This may be a manifestation of better screening programs in the US where cervical malignancy is detected in younger patients at a localized stage.
Table 3: Age distribution, percentage of incidence cases by site: Comparison with SEER data (2003-2007)[9]*

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Among uterine malignancies also, significantly higher incidence was noted in 45-54 years of age. A similar trend has been reported from Asian registries where uterine cancer occurs a decade earlier than in the West. [4] On the contrary higher percentage of ovarian malignancies in children and young adults (birth to 44 years) was noted. Above 75 years of age cervical, uterine and ovarian malignancies were significantly lesser in our cohort of patients presumably due to a lower life expectancy in our country. No appreciable differences were seen in the distribution of vaginal and vulval cancers.

Extent of spread of primary malignancies in our cohort of patients was compared with data available from the SEER registry. [9] Significantly higher percentage of cervical cancers presented with regional spread at our center (67.85%), whereas with localized disease in SEER registry cases (35.2%). This suggests disparity in the effectiveness of screening programs. The distribution of uterine cancers in both cohorts was similar.

Significant difference was observed in ovarian malignancies which were frequently localized at disease detection at our center (54.2%) but presented with distant metastases in SEER countries. There is paucity of data on the stage of presentation and histologic subtypes of ovarian malignancies reported from the Indian subcontinent. The few reports available suggest a similar distribution of ovarian malignancies as at our center. A series by Yeole et al. report 30% localized, 10.3% with regional and 46% ovarian malignancies with distant spread. [12] Whether this implies environmental or genetic differences in tumor profile remains to be ascertained.


 » Conclusion Top


Our registry represents one of the most extensive data on gynecologic malignancies available from India. Comparison with population based international registries like SEER and GLOBOCAN may not be a true comparison. However; due to lack of widespread population based data, hospital based registries form the main source of data for epidemiologic estimates in our country. We present comprehensive data from our institute on gynecologic malignancies which brings to light aspects not adequately reported from the Indian subcontinent including age specific incidence and stage of presentation. Cervical cancer in below 15 years age group has not been reported in other registries. Stage at presentation has also not been quantitatively addressed in most Indian registries. Small number of cases of vulval, vaginal and fallopian tube cancers in our registry due to their rarity were not suitable for making statistical comparisons/estimates however; these are among the only data presently available on these cancers in India.

Comparative analysis with other registries reflects lacunae in the gynecologic cancer detection programs in India. Environmental and genetic causes for differences in stage of presentation cannot also be ruled out. We construe that data from our registry would be helpful in promoting larger studies on gynecologic cancers and help formulate better cancer detection strategies aimed at specific age groups at risk.

 
 » References Top

1.Seer.cancer.gov [homepage on the internet]. Bethesda, Maryland: North American Association of Central Cancer Registries; c2000. SEER Summary Staging Manual-2000. Available from: http://www.seer.cancer.gov/.   Back to cited text no. 1
    
2.Johnson CH, Adamo M, editors. SEER Program Coding and Staging Manual 2007 [monograph on the internet]. Bethesda, Maryland: National Cancer Institute, NIH Publication number 07-5581; 2008. Available from: http://www.seer.cancer.gov/.   Back to cited text no. 2
    
3.Nandakumar A, Ramnath T, Chaturvedi M. The magnitude of cancer cervix in India. Indian J Med Res 2009;130:219-21.  Back to cited text no. 3
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4.Moore MA, Ariyaratne Y, Badar F, Bhurgri Y, Datta K, Mathew A, et al. Cancer Epidemiology in South Asia - Past, Present and future. Asian Pac J Cancer Prev 2010;11:49-66.  Back to cited text no. 4
[PUBMED]    
5.Indian Council of Medical Research [homepage on the internet]. Bangalore: National Cancer Registry Programme-2007. Consolidated Report of Hospital Based Cancer Registries 2001-2003. Available from: www.icmr.nic.in/ncrp/report.  Back to cited text no. 5
    
6.Chhabra S, Sonak M, Prem V, Sharma S. Gynaecological malignancies in a rural institute in India. J Obstet Gynaecol 2002; 22:426-9.  Back to cited text no. 6
[PUBMED]    
7.Momtahen S, Kadivar M, Kazzazi AS, Gholipour F. Assessment of gynaecologic malignancies: A multi-center study in Tehran (1995-2005). Indian J Cancer 2009;46:226-30.  Back to cited text no. 7
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8.Ferlay J, Bray F, Pisani P, Parkin DM, editors. GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide. Lyon, France: IARC Press; 2004.  Back to cited text no. 8
    
9.Seer.cancer.gov [homepage on the internet]. Bethesda, Maryland: North American Association of Central Cancer Registries; c2000. SEER Cancer statistics review 1975-2007. Available from: http://www.seer.cancer.gov/resources.   Back to cited text no. 9
    
10.Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann Oncol 2005;16:481-8.  Back to cited text no. 10
[PUBMED]    
11.Aziz MF. Gynecological cancer in Indonesia. J Gynecol Oncol 2009; 20:8-10.  Back to cited text no. 11
[PUBMED]    
12.Yeole BB, Kumar AV, Kurkure A, Sunny L. Population-based survival from cancers of breast, cervix and ovary in women in Mumbai, India. Asian Pac J Cancer Prev 2004;5:308-15.  Back to cited text no. 12
[PUBMED]    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]

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