|LETTERS TO THE EDITOR
|Year : 2018 | Volume
| Issue : 3 | Page : 309-310
Unlikely cancer in young patients: A retrospective hospital-based study
Nizara Baishya1, Manigreeva Krishnatreya2, Amal C Kataki3, Jagannath D Sharma4, Munlima Hazarika5, Bhrigu Mishra1, Tapti Kumari1, Binita Das1
1 Hospital-Based Cancer Registry, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
2 Department of Cancer Epidemiology and Biostatistics, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
3 Department of Gynecologic Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
4 Department of Pathology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
5 Department of Pediatric Medical Oncology, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
|Date of Web Publication||28-Jan-2019|
Dr. Nizara Baishya
Hospital-Based Cancer Registry, Dr. B Borooah Cancer Institute, Guwahati, Assam
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Baishya N, Krishnatreya M, Kataki AC, Sharma JD, Hazarika M, Mishra B, Kumari T, Das B. Unlikely cancer in young patients: A retrospective hospital-based study. Indian J Cancer 2018;55:309-10
|How to cite this URL:|
Baishya N, Krishnatreya M, Kataki AC, Sharma JD, Hazarika M, Mishra B, Kumari T, Das B. Unlikely cancer in young patients: A retrospective hospital-based study. Indian J Cancer [serial online] 2018 [cited 2019 Apr 26];55:309-10. Available from: http://www.indianjcancer.com/text.asp?2018/55/3/309/250888
Cancer is more often seen in the elderly population. But in recent years, some adult cancers are also seen to occur in the younger age group. These are “unlikely cancers” or unlikely to occur in young patients and can be labeled as rare cancers considering their low incidence. The National Cancer Institute has defined “rare cancer” as cases fewer than 15 per 100,000 people per year. More recently, a consortium from the European Union (RARECARE) defined rare cancers as those with fewer than six cases per 100,000 people per year. Etiologically, they are different from that of cancers in the adult as there is least exposure of tobacco and alcohol., Treatment depends upon the site of origin of the cancer. We herein present the clinicopathological features of unlikely cancers in patients less than 20 years of age from real-world evidence data.
The histologically confirmed patients' data from January 2010 to December 2016 that were designated as “unlikely” by the Hospital Based Cancer Registry Data Management (HBCRDM 1.0) software designed and developed by the National Centre for Disease Informatics were reviewed. If the patients' age, primary site, or histology of cancer did not confront to be on the expected line, the patients' data were automatically designated as “unlikely” by the HBCRDM 1.0. There is always possibility of error during the data entry level, so these designated “unlikely cases” were again reviewed in the case files for age and site by the cancer registry staff. Once the re-check confirmed the match of age with the site or histology then these cases were recruited for the present study. Various parameters such as age, gender distribution, clinical features, primary site of cancer, clinical stage, and type of treatment instituted were recorded and analyzed.
A total of 59,191 patients' data were entered during the study period. 46 (0.07%) patients' data were identified as unlikely cases. Age of presentation ranged from 2 years to 19 years (median age = 16.5 years). Males were most commonly affected than females (male: female ratio was 2:1). The median interval between the first appearance of symptoms and patient seeking medical advice was 6 months (range 2–11 months). The most common site involved was colorectal (33 patients, 71.7%) followed by breast (three patients, 6.5%), gall bladder, ovary, and lung (two patients, 4.3%), and esophagus, ampulla of vater, and pancreas (one patient, 2.1%). Adenocarcinoma (78.2%) was the most common histological variant followed by squamous cell carcinoma (SCC) (6.5%). Majority of the patients presented in Stage IV (25 patients, 54%) and followed by Stage III (39.1%). Twenty-five patients (54%) presented with distant metastasis.
Twelve patients (54.5%) received concurrent chemoradiotherapy and four (18.1%) patients underwent surgery followed by chemoradiation. Radiation therapy (RT) alone was the treatment in four (18.1%) patients and two (9%) patients received chemotherapy (CT) alone.
The data of unlikely cancers in the younger population are sparse. In this present study cohort, 0.07% patients' data were identified as unlikely cancers in younger population. Unlikely cancers were two times common in male than female, as seen in our population. Colorectum is the most commonly involved site among all sites. Cancers of the gall bladder, trachea, breast, ovary, pancreas, esophagus, and lung are extremely rare in the younger population. Gall bladder cancer (GBC) is one of the fatal cancers and is common in both men and women of our population. The presence of GBC in young patient population underscores the presence of environmental risk factor(s) in the region. The presence of lung cancers (non-small cell) in children is a worrisome signal and warrants urgent investigation of environmental risk factor(s) like the presence of high level of indoor radon, etc. Cancers in the pediatric age group are usually associated with certain genetic conditions. However, in the recent years there is early exposure to tobacco, smoking, and alcohol among the younger population. Consumption of smokeless tobacco in the form of “Gutkha” is an emerging health threat for the younger generation, putting them at significant risk of developing cancer in their life time.
Ninety-three percent of young cancer patients presented in advanced stages (Stages III and IV). These unlikely cancers in the younger age group have a tendency to present in the advanced stages. This could be attributed to delay in diagnosis due to lack of clinical suspicion and consideration of benign pathologies in the differential diagnosis. In this observational study from real world evidence data, we have provided an overview of the burden of these unlikely cancers in our population. In the recent years, collaborations have been forged to address and overcome some of the challenges associated with these unlikely cancers. Similarly, a nationally representative data of unlikely cancers will help to better understand the burden of unlikely cancers in young age group in the country.
Unlikely cancers are rare entities with distinct challenges, as little is known about this diverse group of cancers. Colorectal cancers were most commonly seen in our subset of younger population, and thus there is the need for identification of molecular biomarkers and prevailing environmental risk factor(s) for understanding the etiopathogenesis of this group of cancers.
The authors thank the National Centre for Disease Informatics and Research under Indian Council of Medical Research for providing the necessary technical support to our hospital cancer registry.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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