|Year : 2014 | Volume
| Issue : 1 | Page : 45-53
Spectrum of malignancies in Jaipur region (2004-2008)
RG Sharma, R Kapoor, BA Bang, K Gurjar
Division of Surgical Oncology, SMS Medical College Hospital, Jaipur and Rajasthan Cancer Society, India
|Date of Web Publication||18-Jun-2014|
R G Sharma
Division of Surgical Oncology, SMS Medical College Hospital, Jaipur and Rajasthan Cancer Society
Source of Support: Rajasthan Cancer Society, Conflict of Interest: None
Context: Cancer data from Rajasthan is limited. Only three studies, one from Western Rajasthan, and the other two from Eastern Rajasthan have been published previously. Aims: To find out the spectrum of malignant neoplasms in Jaipur region by studying the proportion and site wise distribution of malignancy cases reported at five major hospitals and pathology centers in Jaipur region. Settings and Design: A retrospective analysis of histopathology records of 5 years (2004-2008) was done. Approximately 200,000 histopathology and cytology reports were analyzed and 34,486 new cancer cases were identified. Statistical Analysis Used: Percentages and proportions. Results: A total of 34,486 new cases of cancers were recorded in five years. There were 58.58% (20202) males and 41.42% (14284) females, with the male to female ratio being 1.41:1. Organ wise, Lung (13.25%), Larynx (5.35%), Oropharynx (5.09%), Brain (4.84%), Tongue (4.62%) and Prostate (4%) were the most common sites involved in males, whereas Breast (25.6%), Cervix (10.26%), Ovary (5.4%), Brain (3.68%), Esophagus (3.4%), Lung (3.01%) and Gall Bladder (2.35%) were common sites for malignancies in females. Conclusions: Significant findings were, a higher frequency of tobacco related cancers i.e., Lung cancer and Head and neck cancer in males, and screening detectable cancers (Breast and Cervix) in females. A higher frequency of Lung cancer in females was also noted as compared to previous studies. An unusually high frequency of Gall Bladder Cancers especially among the female population in this region is also a cause of concern. Our data was compared with the national data.
Keywords: Cancer profile, frequency, malignancy
|How to cite this article:|
Sharma R G, Kapoor R, Bang B A, Gurjar K. Spectrum of malignancies in Jaipur region (2004-2008). Indian J Cancer 2014;51:45-53
| » Introduction|| |
Cancer spectrum in a region is dependent upon various genetic, environmental, dietary and social factors. Accurate reporting of cancer profile from a region has several limitations especially in a developing country. The problem of proper record keeping represents a major handicap for medical statistics and research in this setting. The problems involved in collecting and analyzing cancer registry data in developing countries have been due to lack of basic health care, lack of stable population, lack of trained personnel, poor follow-up, as well as poor availability of census estimates and data processing facilities. 
In India, with over 1.2 billion population, cancer data comes mainly from 23 population-based cancer registries (PBCR). These registries cover only about 7% of the population (20% Urban and 1% Rural).  An attempt was also made by the Atlas of Cancer in India to define the cancer spectrum in the country. 
Jaipur District is located in the Eastern part of Rajasthan and has a population of 5, 252, 388, with a population density of 471 persons per km. Males constitute 53% of the population and females 47%. Fifteen percent of the population is under 6 years of age. The overall literacy rate is 60.41%, with male literacy rate being 75.70% and female, 43.85%. The city has been ranked 31 among the 50 Emerging Global Outsourcing cities. 
Jaipur region gets patients from eastern Rajasthan and neighbouring regions like Haryana, UP, MP and other neighbouring states, as it is a tertiary referral centre with various super specialty services. Hence, the data obtained here are expected to be fairly representative of the overall incidence and pattern in this region. In Rajasthan, the major centres catering to the health needs of the people include seven medical colleges and various semi government and private hospitals.
Cancer data from Rajasthan are limited. Three studies, one from Western Rajasthan and the other two from Eastern Rajasthan have been published previously in 1992,  1994  and 2009. 
| » Subjects and Methods|| |
The study spans over five years (2004 2008) and is based on retrospective analysis of approximately 200,000 histopathology and cytological reports. Data were collected from five major pathology departments in Jaipur region. Only cases which had microscopic verification of diagnosis, either by Cytology (n = 6778 cases) or Histopathology (n = 27708 cases), were included. Overall site, frequency, year, age and sex pattern were recorded. Classification of various malignant tumors was done according to the International Classification of Disease coding system derived by WHO (9 th revision) using code number 140-208. A total of 34,486 cancers were recorded in the five years (2004-2008). Data was collected and classified in Visual Fox Pro (X Base, Version 6).
| » Results|| |
Out of a total 34,486 new cancer cases recorded, 20202 were males (58.58%) and 14284 were females (41.42%), giving a male- female ratio of 1.41: 1 [Table 1]. Frequency of cancers was found to increase exponentially with age. This increase was first seen in 4 th decade followed by a continuous spurt up to 7 th decade. In 4 th decade, prevalence of malignancies was higher in females than in males. Maximum number of cancer cases was seen in 6 th decade in males and 5 th decade in females [Figure 1].
|Table 1: Site wise distribution of malignant neoplasms in males and females (2004‑2008)|
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Site wise distribution
Site wise distribution of cancers in the overall study group revealed that Breast constituted the most common site (10.06%) followed by Lung (8.97%), Larynx (6.53%), Brain (4.41%) and Cervix (4.28%). In males Lung cancer was the leading site of cancer (13.25%) followed by Larynx (5.35%), Oropharynx (5.09%) while in females, Breast cancer (25.6%) dominated followed by Cervical cancer (10.26%) and Ovarian cancer (5.4%).
System wise distribution
System wise distribution of cases revealed that head and neck cancers were most common (17.96%), followed by genitourinary tract cancers (14.55%). and gastrointestinal tract cancers as the 3 rd most common group (11.67%). Other commonly involved organ systems were Breast cancers (10.81%), lower respiratory tract cancers (8.88%), lymphoid malignancies (7.09%), Brain malignancies (6.38%), secondaries (5.39%), cancer of bone and connective tissue (5.03%), skin (2.05%) and endocrine malignancies (1.39%). Secondaries include those to Lymph node, respiratory and digestive system and other sites. Data for males and females revealed differing pattern with Head and Neck cancers (24.93%), Lung cancers (13.25%), Gastrointestinal cancers (12.01%), Lymphoid malignancies (10.6%) and genitourinary tract cancers (10.5%) being common in males. In females, system wise distribution of cases revealed that Breast cancer was most common at 25.6% followed by genitourinary tract cancers (20.27%), gastrointestinal cancers (11.2%) and head and neck cancers (8.11%).
Head and neck cancers
Head and neck cancers formed the single largest group in our study (17.96% of all cancers) with majority (81%) of these cancers found in male patients and M: F ratio of 4.26:1. Age distribution of these cancers revealed that maximum numbers of cases were seen between 51 to 60 years of age in males (27.2%) and 41 to 50 years of age in females (26.8%).
In the Head and neck region, larynx (3.57%) was the most common tumour site closely followed by tongue (3.48%) and oropharynx (3.43%). Among head and neck cancers in male patients, laryngeal cancers were most common (5.3%) followed by oropharynx (5.08%) and tongue (4.6%). In female patients, tongue (1.8%) was the most common site involved. When head and neck cancer cases are grouped together, Oral Cavity was leading (44%) followed by Pharynx (30%), Larynx (20%), Nasal Cavity (3%) and Salivary Gland (3%).
Squamous cell carcinoma was the most common (89.86%) histopathology.
Genitourinary tract malignancies
Genitourinary system formed the second most common system involved after head and neck cancers with a total of 14.55% cases. In males, genitourinary tract malignancies formed 10.5% of all cancers while in females, they formed 20.27% of all cancers.
Urinary tract cancers
In the urinary tract malignancies, renal carcinoma formed 1.07% of all cases. In males it formed 1.3% of all cancer cases while in females it formed 0.67% of all cases. Most of these cases were reported in 51 to 60 years of age group. Histopathological analysis revealed that 69% of the tumors were renal cell carcinoma while 9.78% of these tumors were Wilm's tumor.
Carcinoma Urinary Bladder accounted for 2.07% of total cancer cases. In males, bladder cancer formed 3.06% of all cancer cases while in females it formed 0.65% of all cancers. Most of the cases of bladder cancer in either sex were seen in the age group of 61 to 70 years. Histopathology revealed that 90% of these tumors were transitional cell carcinoma.
In males, prostate cancer was the most common urinary tract cancer forming 4% of all the cancers followed by testicular cancer in 1.1% and penile cancer in 1% male cases.
Age distribution of male urinary tract cancer revealed that the most common age group was between 61 to 70 years for prostate cancer, 21 to 30 years for testicular cancer and 51 to 60 years for penile cancer.
Histopathological analysis revealed that adenocarcinoma was most common type in prostate (96%), while in testis Non-Seminoma (39.1%) followed by seminomas (35%) were most common. Germ cell tumor and lymphoma made 6.2% each of the testicular cancers. For penile cancer, Squamous cell histology was most common (88%).
Cervical cancer was the most common cancer of female genital tract forming 10.25% of all cancers in females followed by ovarian cancer in 5.3%. Uterine cancer was 3 rd , forming 2.1% of all cases.
Age distribution of genitourinary tract cancers in females revealed a peak between 41 to 60 years of age group. The majority of cases of carcinoma cervix and ovary fell into 41 to 50 years of age group. The commonest age group for uterine cancer was 51 to 60 year.
The most common histopathology for cervical cancer was squamous cell cancer in 89.3% cases followed by adenocarcinoma in 5% cases. As for the histopathology of ovarian cancers, adenocarcinoma was present in 63% cases followed by poorly differentiated cancer in 9.26% cases and malignant epithelial neoplasm in 6% cases. Histopathological analysis of uterine cancer revealed adenocarcinoma in 64.4% cases and squamous cell cancer in 18.6% cases.
Gastrointestinal tract cancers
Gastrointestinal (GI) tract cancers formed the third largest group among all organ systems forming 11.67% of the total cancer patients.
Among the GI tract cancers, Esophagus was the most common site (29.9% of GI cancers and 3.4% of all cancers) followed by rectum (18.26% of GI and 2.1% of all), gall bladder (14.26% of GI and 1.6% of all), stomach (13.19% of GI and 1.5% of all), colon (12.5% of GI and 1.5% of all), liver (6.1% of GI and 71% of all), pancreas (3% of GI and 34% of all) and small intestine (2.9% of GI and 33% of all).
Sex wise distribution data revealed that esophagus (3.5% of all cancers), colon (1.76%) rectum (1.6% of all cancers) and stomach (1.6% of all cancers) were most common sites involved in males. In females, esophagus (3.4%) was the leading site involved followed by gall bladder (2.34%) and Rectum (1.6%). Thus females had greater preponderance of gall bladder cancers than males. Otherwise the M: F ratio for the overall study group was 1.55:1.
Esophagus was the most common site of involvement in both male and female patients. The peak incidence for esophageal cancers in males was in 51 to 60 years age group and in females in 41 to 50 years age group. Predominant histopathology found in esophageal cancers was squamous cell carcinoma (SCC) which was present in 85% cases. Thus SCC is still the predominant tumor found in this region. The incidence of adenocarcinoma was 10.6%.
Stomach cancer formed the 4 th most common GI malignancy (4 th most common group in male as well female patients) forming 13.18% of GI and 1.53% of all malignancies. Most common histopathology was Adenocarcinoma (64.97%) followed by Non Hodgkin Lymphoma (9.22%). Maximum number of cases was seen between 51 to 60 years in males and 41 to 50 years in females.
Cancers of the small intestine were very uncommon forming 2.9% of all GI cancers and 0.3% of all cancers. Adenocarcinoma was most common type in our study (57.39%) followed by Lymphoma (13%) and Gastrointestinal stromal tumors (GIST) in 8.6%.
Colon cancer formed 1.76% of total cancers in males and 1.03% of total cancers in females. Adenocarcinoma was most common histopathological type (86%). Age distribution revealed maximum cases in 41 to 50 years age group in male and 31 to 40 years age group in female.
Rectal cancer formed the second most common group of GI malignancies in male patients (1.6% of all cancers) and 3 rd most common group in female patients (1.6% of all cancers). Overall rectal cancer ranked 10 th most common cancer forming 2.15% of all cancers. Maximum cases of carcinoma rectum in male occurred in the 5 th decade of life with most of the female patients presenting in the 6 th decade. Most common histopathology of carcinoma rectum was Adenocarcinoma (85.78%).
Anal canal cancers were uncommon in our study population forming 0.45% of all cancers (Males - 0.48%, Females - 0.42%). Maximum cases in males occurred in the 5 th decade of life with most of the female patients presenting in the 6 th decade. Most common histopathology of carcinoma anal canal was Adenocarcinoma (41.8%) with Squamous cell carcinoma being the 2 nd most common (27.8%).
Biliary tract cancers included cancers of the gall bladder, bile ducts (cholangiocarcinoma) and periampullary cancer. Cancers of the gall bladder formed the 3 rd most common site involved in GI tract. In females, they formed the 2 nd most common GI tract malignancy (21.47%) and the 7 th most common malignancy overall (2.35%). In males they formed the 5 th most common GI tract malignancy (9.84%). Thus the gall bladder cancers were more common in the female with M: F ratio of 1:1.46. Gall Bladder Cancer in male was most common in 61 to 70 years and in female in the 51 to 60 years age group.
Liver cancer included the hepatocellular carcinoma, intrahepatic cholangiocarcinoma and liver secondaries. It formed 0.71% of total cases recorded (0.86% in male and 0.49% in female of all cancers). Liver cancer was the 6 th most common site in GI tract (6.1%).
Hepatocellular Carcinoma was most common histopathological type (35.51%) followed by Adenocarcinoma (Metastatic) in 19.1% cases.
It formed 0.34% of total cases and 3% of total GI tract cancers in our study.
There was a bimodal distribution with peaks in 5 th and 7 th decades of life.
Breast cancer constituted the most important group of malignant neoplasm in females with about a quarter (25.6%) of cancer cases in females being diagnosed with breast cancer. It was also the most common (10.06%) group of malignancies in the overall group when cancers at individual sites were reported and the 4 th most common site in system wise reporting. Most of the cases were seen in the age group of 41 to 50 years (31.34%). Infiltrating duct carcinoma was the most common histopathological type with 89.3% cases while lobular carcinoma was seen in 1.3% cases only.
Of all the cases of breast cancer, 2% were diagnosed in males. Male Breast cancers formed only 0.37% of overall cancer cases in males. Infiltrating duct cancer was present in 86.66% cases with maximum number of cases (36%) seen in age group 51 to 60 years.
Lungs were the 2 nd most common organ affected by malignancies in the overall group with 8.97% of all cancers. In males it was very common cancer forming the most common site with cancer involvement (13.25%) and the 2 nd most common system involved with cancers after head and neck cancers. In females, cancer lung was the 6 th most common site involved with 2.72% cases. Maximum number of cases was seen between 51 to 60 years. Non Small Cell Carcinoma formed 69% of total cancer cases with Small cell carcinoma being 2 nd most common (10%). In the Non small cell lung cancer, squamous cell lung carcinoma accounted for 23.12% of all cases and Adenocarcinoma accounted for 9.6% of all cases
Hematological malignancies as a group were the 6 th most common with 8.77% patients. In males, these malignancies comprised 4 th most common group forming 10.6% of all patients while in females, it was the 7 th most common system involved with 6.2% cases.
Age distribution of these cancers revealed a striking difference between the male and female populations. While in male patients, maximum number of cases was found in the childhood and adolescence, in female the most common age group was 41 to 50 years. As for the Lymphoid malignancies (Hodgkin's and Non Hodgkin's Lymphoma) a bimodal age distribution was observed with peaks in the 3 rd and 5 th decades of life. As for the Histopathological distribution, myeloid leukemia was the most common type (26%) closely followed by lymphoid leukemia (24.28%). Non Hodgkin's lymphoma (18.6%) was the 3 rd most common hematological malignancy while leukemia unspecified (14.4%) was the 4 th most common hematological malignancy. Hodgkin's lymphoma formed 8.8% of all cases at 5 th place.
Thyroid cancer (97%) formed the most important part of endocrine malignancies with a frequency in the overall study group of 1.34% (2.17% in females and 0.76% in males) with M: F ratio of 1: 2. Most common histopathological type was Papillary Carcinoma (61%), followed by follicular neoplasm (22%) and medullary carcinoma (5%).
Malignancies of the brain in our study formed the 4 th most common site of cancer in both sexes and the 4 th most common overall tumor site. It formed 4.41% of all malignancies, 4.84% in males and 3.68% in females with M:F ratio of 1.86:1.
Age distribution of these cancers revealed that most of these tumors were diagnosed in the 31 to 40 years age group. Histopathological analysis revealed that Astrocytoma (Grade I - III) was most common type (45%) followed by Glioblastoma Multiforme (18%) (Grade IV astrocytoma) and Oligodendroglioma (7%).
Bone and soft tissue cancer
Neoplasm of bone and soft tissues ranked tenth in the overall group forming 5.03% of all the cancers. It was 9 th most common system involved in males (5.45%) and 8 th most common in females (4.44%). Frequency of these neoplasms was more in male patients with M: F ratio being 1.7: 1. The proportion of bone and soft tissue tumors was almost equal with former group comprising of 54% and latter comprising of 46% cases. Commonest age group involved was 11 to 20 years with decreasing frequency in higher age groups. Giant cell tumor was the most common histological type of cancer (28%) followed by Osteogenic sarcoma (21%).
Skin cancers were not very common in our study population forming 2.05% of all cases and ranked eleventh in our study group. Most common histology in skin cancers was Squamous cell carcinoma (53%). Basal cell carcinoma was second (28%) followed by Malignant melanoma (10%).
Secondaries or metastatic tumors at various sites comprised 5.39% of all cancers. It was observed that lymph node was the commonest site for metastasis (3.65% of total cases) followed by lung and GI tract (1.65%).
This category included tumors of retroperitoneum, Ill-defined GI cancers, pleura, thymus, ocular tumors and various other unspecified tumors. These tumors comprised 7.09% of all cancers and were ranked 7 th in the overall study group.
| » Discussion|| |
Most of the data on cancer profile in India is derived from various population based cancer registries. As cancer is not as yet a reportable disease in India, methodology of data collection by the PBCRs is active, in that, registry staff makes visits to various sources of registration to collect information on cancers recorded in the respective institutions.  But in a vast country like India, due to lack of complete registration of newly diagnosed cases with these cancer registries, the exact tumor burden and profile is often underestimated. Hospital-based prevalence data therefore also forms an important part of estimating the cancer burden. This data is essential for assessing geographical differences in cancer profile and ascertaining the required healthcare infrastructure in the management of these cancers. Our study spans over a duration of five years (2004-2008) and includes analysis of approximately 200,000 histopathological reports to find out various malignant neoplasms prevalent in the Jaipur region. Ten leading cancer sites in both sexes [Table 2] and [Table 3] are compared with the incidence of cancer from population and hospital based cancer registry data from various parts of the country. ,,
Cancer in males
Lung cancer was most common site (13.25%) of cancer in males in our study. It was also the leading site of cancer in males reported in previous study from Jaipur region in 2009  (8.45%). Lung as leading site of cancer in males was also reported from Chennai (10.84%), Delhi (10.11%), Mumbai (8.24%), Kolkata (16.21%), Imphal (20.8%) and Thiruvananthpuram (14.2). ,,
It was second most common site in males (5.35%) whereas Laryngeal cancer was the tenth most common site of malignancy in males (3.24%) reported in the previous study from Jaipur.  Higher incidence was reported from Kolkata (7.50%), Delhi (6.60%), Barshi (6.20%) and Mumbai (5.34%). ,,
In the present study, cancer of Oropharynx was third with 5.09% while in previous study from Jaipur,  it was reported as eighth most common (4.22%) in males. Lower incidence was reported from Bangalore (1.26%), Chennai (1.20%) and other registries. ,,
In our study, malignancies of the Brain formed the fourth most common site of cancer in males (4.84%) while in previous study from Jaipur,  Brain malignancies formed the 3 rd leading site of cancers in males (6.04%). The present study shows incidence higher than that reported in other studies in Bangalore (4.61%), Delhi (4.51%), Mumbai (3.77%), Barshi (3.72%), Chennai (3.15%) and Ahmedabad (2.59%). ,,
In the present study, Tongue was fifth leading site of cancer in males (4.62%). It was sixth leading site (4.60%) reported in males in the 2009 study from Jaipur.  A higher incidence was reported from Delhi (5.63%), Chennai (5.38%) and Mumbai (5.21%). Highest reported was from Ahmedabad (10.34%), followed by Bhopal (9.59%) and Thiruvananthpuram (6.9%). Lowest incidence reported was from Mizoram (2.0%). ,,
Prostate cancer formed 4% of all male cancers and sixth most common site in males. It was lower than that reported in the previous study from Jaipur  as the 2 nd most common site in males (7.12%). Second highest incidence was reported from Delhi (6.96%) and 3 rd highest in Mumbai (5.77%). Higher incidence was reported from Bangalore (5.80%), Bhopal (4.24%), Chennai (4.22%), Kolkata (4.20%) and Barshi (4.13%). ,,
Cancer of oesophagus was the seventh most common site of cancer in males in the present study (3.55%). It was 5 th leading site in males (4.67%) in the 2009 study from Jaipur.  It was reported as leading site of cancer in males from Dibrugarh (17.9%) and Mizoram (11.1%). Incidence was also high in Sikkim (9.9%), Chennai (6.91%), Bangalore (6.56%), Imphal (6.5%), Barshi (6.61%) and Thiruvananthpuram (5.1%). ,,
The eighth most common cancer site among males was urinary bladder (3.06%), whereas it was the fourth most common site (5.31%) reported in 2009.  Higher incidence was reported from Delhi (4.77%) and Mumbai (3.65%). Similar incidence was reported from Kolkata (3.03%). ,,
It was ninth most common site of malignancy in males (2.17%) in present study and in 2009 study (4.22%) from Jaipur.  A higher incidence was reported from Chennai (3.47%), Sikkim (3.20%), Bangalore (3.10%), and Mumbai (2.77%). ,,
It was tenth most common site of malignancy in males (2.02%). It was not among the 10 leading cancer sites in the 2009 study from Jaipur.  Highest incidence was reported from Barshi (8.68%) and 2 nd highest in Dibrugarh (12.3%). Higher incidence was also reported from Ahmedabad (7.05%), Mizoram (4.9%), Sikkim (4.7%), and Kolkata (4.57%). Rates similar to our study were reported from Chennai (3.93%), Bangalore (3.88%), Bhopal (3.87%) and Mumbai (3.54%). ,,
Cancer in females
It was leading site of cancer in females (25.6%). It was also leading site according to the National Cancer Atlas Data for 2001,  for Jaipur District (23.96%). Similar findings (20.5%) were reported in the previous study in 2009 study from Jaipur.  Breast as leading cancer site was reported from Mumbai (28.75%), Chennai (28.26%), Thiruvananthpuram (27.1%), Delhi (26.84%), Kolkata (26.76%), Bangalore (26.32%), Bhopal (26.01%) and Ahmedabad (21.72%). In Barshi (15.47%) and Dibrugarh (13.8%), it was 2 nd leading site for cancer in females. ,,
Cervix was the second most common site of cancer in females (10.2%) in the present as well as previous study from Jaipur (14.99%).  In Barshi (36.98%), Imphal (15.9%) and Sikkim (11.1%), it was the leading site of cancers in female. It was 2 nd leading cancer site in female in Ahmedabad (18.56%), Chennai (18.46%), Bhopal (17.87%), Kolkata (15.73%), Bangalore (15.69%), Delhi (14.90%), Mizoram (13.50%), Mumbai (13.20%) and Thiruvananthpuram (11.5%). Lowest incidence was reported from Dibrugarh (6.6%). ,,
Ovary was the third leading site of cancers in females in the present study (5.4%) and in the previous study (4.4%) in 2009 from Jaipur.  A higher incidence was reported from Dibrugarh (8.7%), Ahmedabad (7.71%), Bhopal (7.30%), Delhi (7.05%), Mumbai (6.31%), Kolkata (6.05%) and Barshi (6.04%). Comparative incidence was reported from Imphal (5.9%) and Bangalore (5.26%). Lower incidence, from our study, was reported from Chennai (4.50%), Sikkim (4.4%) and Mizoram (1.7%). ,,
Malignancies of the brain formed the fourth leading site of cancers in females (3.68%) in the present study and in the 2009 study (3.8%) from Jaipur.  The present study reported an incidence higher than that reported in other studies: Sikkim (3.0%), Delhi (2.55%), Bhopal (2.53%), Mumbai (2.25%), Bangalore (2.15%), Chennai (1.91%), Ahmedabad (1.75%) and Barshi (1.51%). ,,
The fifth leading site of cancer in females was esophagus in our study (3.4%) and in the 2009 study (3.67%) from Jaipur.  It was leading site in Dibrugarh (13.9%) and 3 rd leading in Barshi (6.79%). Higher incidence was reported from Sikkim (6.6%), Bangalore (4.78%), Chennai (4.01%), Bhopal (3.93%) and Ahmedabad (3.68%). Comparative incidence was reported from Mumbai (3.4%) and Imphal (3.1%). ,,
Lung is the sixth leading site of malignancies in females (2.72%). It was not among the 10 leading cancer sites in females in the 2009 study from Jaipur region.  Mizoram reported highest incidence (15.1%). Others were Imphal (13.6%), Sikkim (8.3%), Kolkata (3.86%) and Barshi (3.77%). Comparative incidence was reported from Delhi (2.75%) and Mumbai (2.71%). Lower incidence was reported from Chennai (2.50%), Bangalore (2.36%), Bhopal (2.06%), and Ahmedabad (1.75%). ,,
Gall bladder is the seventh leading site of malignancies in females (2.35%) in present study. Gall Bladder cancer was not reported among 10 leading cancer sites in females in the 2009 study.  Higher incidence than our study was reported from Imphal (7.9%), Dibrugarh (7.7%), Delhi (6.09%), Sikkim (4.4%), Kolkata (4.26%) and Bhopal (4.21%). ,,
The eighth leading site of cancers in females was thyroid (2.17%). Previous study from Jaipur region  reported thyroid as tenth most common site with 2.3%. Comparable incidence was reported from Bangalore (2.84%), Chennai (2.79%) and Delhi (2.54%). The highest frequency was reported from Imphal (7.1%). ,,
Corpus uteri were the ninth most common site of female cancers (2.1%) in the present study and sixth most common (3.01%) in the 2009 study from Jaipur  Incidence reported at other centers were as follows; Delhi (3.39%), Bangalore (3.25%), Mumbai (2.59%), Bhopal (2.34%) and Kolkata (2.18%). ,,
Rectum was tenth most common site of malignancy in females (2.07%) in our study, whereas it was the seventh most common site (2.80%) reported in 2009 from Jaipur.  Higher incidence was reported in Mizoram (3.0%), Kolkata (2.46%), Imphal (2.3%) and Bangalore (2.27%). Comparative incidence was reported from Ahmedabad (2.10%) and Mumbai (2.0%). ,,
| » Conclusions|| |
The most significant factor highlighted in this study were a high frequency of tobacco related cancers (lung, laryngeal and oropharyngeal cancers) in the male population and that of screening detectable cancers in the female population (breast and cervical cancer). An unusually high frequency of Gall Bladder Cancers especially among the female population in this region is also a cause of concern. Northern India has a belt of high incidence of Gall Bladder Cancer. There might be an etiological factor related to lifestyle, environment or food which needs to be identified quickly.
It was observed that malignant neoplasm of unspecified sites formed 3.49% of total cases recorded in our present study. It shows the lack of systematic data collection and record maintenance. Also, there is a greater need to increase uniformity in reporting of pathology data at various centers so that there is less ambiguity in data collection. Our study 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. There is a greater need to strengthen the preventive oncology services so that steps can be taken for prevention and early diagnosis of cancer cases.
| » Acknowledgments|| |
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 Getwell Diagnostic Center, Jaipur for their valuable contributions.
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[Table 1], [Table 2], [Table 3]