Orginal Research
2024 June
Volume : 12 Issue : 2


A hospital based cancer registry in a tertiary care centre of South India

David PL, Chitra CB

Pdf Page Numbers :- 158-163

Leo David P1 and Beyaril Chitra C1,*

 

1Department of Pathology, Kanyakumari Government Medical College, Asaripallam, Nagercoil-629201, Tamil Nadu, India

 

*Corresponding author: Dr. Beyaril Chitra C, Department of Pathology, Kanyakumari Government Medical College, Nagercoil-629201, Tamil Nadu, Email: beyarilchitra@gmail.com

 

Received 28 December 2023; Revised 1 March 2024; Accepted 8 March 2024; Published 18 March 2024

 

Citation: David PL, Chitra CB. A hospital based cancer registry in a tertiary care centre of South India. J Med Sci Res. 2024; 12(2):158-163. DOI: http://dx.doi.org/10.17727/JMSR.2024/12-30

 

Copyright: © 2024 David PL et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Abstract

Introduction: Hospital based cancer registry maintains data on all newly diagnosed and treated cancer patients in a particular hospital. This helps in the estimate of magnitude of cancer and the pattern of cancer. We did not have cancer registry from Kanyakumari Government Medical College. So, this study was aimed to assess the burden of cancer since the inception of Kanyakumari Government Medical College and to analyse the pattern of the reported malignant cases.

Methodology: This is a retrospective observational study. Institutional research and ethical clearance obtained. Records from the year 2006 to 2022 were retrieved from the pathology department of Kanyakumari Government Medical College. All the malignant cases were entered in access database according to ICD-10 classification and were further categorised based on the patient’s age, sex and site of origin of the tumour. A quantitative analysis was made and exhibited in tables and graphs.

Results: Relative proportion of cancer is more among females (5%) than men (4.3%). The top five leading cancer sites in female in descending order of frequency are breast, female genital tract, stomach, skin, tongue and larynx.

Conclusion: This study shows that the magnitude of cancer cases reported at Kanyakumari Government Medical College over a period of 2006 to 2022 is less compared to the nearby districts. Female breast cancers are at increasing trend. In males it is oral cavity cancer. This data could help to document, analyse and set a base for population based cancer approach in and around Kanyakumari District.

 

Keywords: hospital based cancer registry; Kanyakumari; relative proportion male: female; breast cancer; oral cancer; ICD-10

Full Text

Introduction

Hospital based cancer registry maintains data on all newly diagnosed and treated cancer patients in a particular hospital. This helps in the estimate of magnitude of cancer and the pattern of cancer. Cancer registry programs were started way back from 1980s in India by ICMR. Since then, cancer registry has been maintained all over India. Even though we get to see data from South Tamil Nadu, we did not have cancer registry from Kanyakumari Government medical college. So, this study is aimed to assess the burden of cancer since the inception of Kanyakumari Government Medical College and to analyse the pattern of the reported malignant cases. Thereby we initiate and maintain a track of the reported cancer cases in our facility. This will contribute to active follow-up of cancer patients. Hospital based cancer registry can potentially help, support a better understanding of health care system, process of cancer care, the clinical endpoints and patient outcome of care [1].

 

India has one of the highest cancer incidence and mortality rates in the world. A good surveillance system in the form of cancer registries is important for planning and evaluating cancer-control activities [2]. Cancer registration in India should be complemented with a nationwide effort to foster systematic investigations of cancer patterns and trends by states, regions and sub populations and allow a continuous cycle of measurement, communication and action [2].

 

This study was aimed to assess the burden of cancer from 2006 to 2022 in Kanyakumari Government Medical College and analysed the pattern of the reported malignant cases.

 

Materials and methods

This is a retrospective observational study. Institutional research and ethical clearance obtained. Records from the year 2006 to 2022 were retrieved from the pathology department of Kanyakumari Government Medical College. All the malignant cases reported were included except the blood malignancies. The collected data were entered in access database. The data were organised according to ICD-10 classification and are further categorised based on the gender and site of origin of the tumour.

 

The results were entered in cross tab and quantitative analysis was made to find out the percentage, the mean values and are exhibited in tables and graphs.

 

Results

35022 biopsy specimens were received in the Department of Pathology, Kanyakumari Government Medical College from 2006 to 2022. In this 3266 cases were diagnosed as cancer by light microscopic method, with male and female percentage of 4.3% and 5% respectively (Table 1).

 

Table 1: Number (n) and relative proportion (%) of cancer cases reported in the Department of Pathology, Kanyakumari Govt. Medical College from 2006 to 2022.  

Period 2006 -2022

Male

 

No. of cancer (n)

1515

 

% of cancer among total biopsies

4.3

Female

 

No. of cancer (n)

1751

 

% of cancer among total biopsies

5.0

Total

 

Total No. of cancer (n)

3266

 

No. of all Biopsy specimens (n)

35022

 

% of cancer among total biopsies

9.3

 

Table 2 shows that head and neck cancers are the frequently reported cancers and the least presented cancers are carcinoma of adrenal gland and carcinoma of eye. Breast cancers predominates to female patients.

 

Table 2: Number (n) and relative proportion (%) of cancers on various sites reported from 2006 to 2022.  

Site

ICD-10

Male

Female

Total

 

n

% (all sites)

n

% (all sites)

n

% (all sites)

Head & neck

C00 – C06, C09 –

C14, C32

688

45.4

239

13.7

927

28.4

Gastro intestinal tract

C15 – C25

361

23.8

165

9.4

526

16.1

Breast

C50

18

1.2

596

34

614

18.8

Gynaecological cancers

C51 – C58

0

0

429

24.5

429

13.1

Skin

C43 – C44

131

8.6

80

4.6

211

6.5

Thyroid

C73

21

1.4

104

5.9

125

3.8

Male genetal tract

C60 – C63

80

5.3

0

0

80

2.5

Kidney & urinary bladder

C64 – C67

38

2.5

23

1.3

61

1.9

Lungs

C33 – C34

29

1.9

8

0.5

37

1.1

Retroperitoneum &

soft tissue

C48 – C49

23

1.5

16

0.9

39

1.2

Lymphoid tissue

C81 – C90

21

1.4

13

0.7

34

1

Secondary neoplasm of

lymph node

C77

57

3.8

36

2.1

93

2.9

Brain, meninges & cranial

nerves

C70 – C72

14

0.9

13

0.7

27

0.8

 

Table 3 is based on the ICD-10 classification, C02, C06 categories in oral cavity are the most common site for cancer. This area points to the gingival-buccal mucosa of the oral cavity. Breast and thyroid malignancies are female predominant whereas all other malignancies are more prevalent among the male population. Colorectal cancers and oral cavity malignancies are near equal in both sexes although it is little more among the men.

 

Table 3: Number (n) and relative proportion (%) of cancers on various sites based on ICD 10 classification, reported from 2006 to 2022.  

ICD 10 Code

ICD 10 Name

Number

%

F

M

Total

F

M

Total

C00

Lip

24

40

64

1.37

2.64

1.96

C01

Base of Tongue

12

35

47

0.69

2.31

1.44

C02

Other areas Tongue

29

115

144

1.66

7.59

4.41

C03

Gum

19

44

63

1.09

2.9

1.93

C04

Floor of Mouth

16

42

58

0.91

2.77

1.78

C05

Palate

2

23

25

0.11

1.52

0.77

C06

Other & unspecified parts of mouth

118

227

345

6.74

14.98

10.56

C09

Tonsil

1

18

19

0.06

1.19

0.58

C10

Other Oropharynx

1

31

32

0.06

2.05

0.98

C11

Nasopharynx

4

8

12

0.23

0.53

0.37

C12

Pyriform sinus

2

12

14

0.11

0.79

0.43

C13

Hypopharynx

3

15

18

0.17

0.99

0.55

C14

Pharynx unspecified

2

15

17

0.11

0.99

0.52

C32

Larynx

6

63

69

0.34

4.16

2.11

C07

Parotid

2

9

11

0.11

0.59

0.34

C08

Other salivary glands

6

4

10

0.34

0.26

0.31

C15

Oesophagus

16

69

85

0.91

4.55

2.6

C16

Stomach

42

137

179

2.4

9.04

5.48

C17

Small Intestine

6

11

17

0.34

0.73

0.52

C18

Colon

35

42

77

2

2.77

2.36

C19

Recto sigmoid

1

2

3

0.06

0.13

0.09

C20

Rectum

40

45

85

2.28

2.97

2.6

C21

Anus & anal canal

7

14

21

0.4

0.92

0.64

C22

Liver

3

17

20

0.17

1.12

0.61

C23

Gallbladder

3

9

12

0.17

0.59

0.37

C24

Other biliarytract

0

0

0

0

0

0

C25

Pancreas

12

15

27

0.69

0.99

0.83

C30

Nasal cavity & middle ear

7

10

17

0.4

0.66

0.52

C31

Accessory sinuses

6

3

9

0.34

0.2

0.28

C33

Trachea

0

0

0

0

0

0

C34

Bronchus & lung

8

29

37

0.46

1.91

1.13

C40

Bone of limbs

2

3

5

0.11

0.2

0.15

C41

Bone of other areas

0

1

1

0

0.07

0.03

C43

Melanoma of skin

6

9

15

0.34

0.59

0.46

C44

Other skin

74

122

196

4.23

8.05

6

C45

Mesothelioma

0

0

0

0

0

0

C46

Kaposi Sarcoma

0

0

0

0

0

0

C47

Peripheral nerves

0

2

2

0

0.13

0.06

C48

Retroperitoneum

6

4

10

0.34

0.26

0.31

C49

Soft tissues

10

19

29

0.57

1.25

0.89

C50

Breast

596

18

614

34.04

1.19

18.8

C51

Vulva

5

0

5

0.29

0

0.15

C52

Vagina

4

0

4

0.23

0

0.12

C53

Cervix uteri

287

0

287

16.39

0

8.79

C54

Corpus uteri

51

0

51

2.91

0

1.56

C55

Uterus unspecified

0

0

0

0

0

0

C56

Ovary etc

82

0

82

4.68

0

2.51

C57

Other female genital

0

0

0

0

0

0

C58

Placenta

0

0

0

0

0

0

C60

Penis

0

64

64

0

4.22

1.96

C61

Prostate

0

14

14

0

0.92

0.43

C62

Testis

0

2

2

0

0.13

0.06

C63

Other male genital

0

0

0

0

0

0

C64

Kidney etc

6

12

18

0.34

0.79

0.55

C65

Renal pelvis

0

0

0

0

0

0

C66

Ureter

0

0

0

0

0

0

C67

Urinary bladder

17

26

43

0.97

1.72

1.32

C68

Unspecified urinary organs

0

0

0

0

0

0

C69

Eye

1

1

2

0.06

0.07

0.06

C70

Meninges

9

6

15

0.51

0.4

0.46

C71

Brain

4

8

12

0.23

0.53

0.37

C72

Spinal cord, cranial nerves

0

0

0

0

0

0

C73

Thyroid

104

21

125

5.94

1.39

3.83

C74

Adrenal gland

5

1

6

0.29

0.07

0.18

C75

Other endocrine glands

0

0

0

0

0

0

C77

Secondary neoplasm of lymphnode

36

57

93

2.06

3.76

2.85

C81

Hodgkins disease

2

2

4

0.11

0.13

0.12

C82

Follicular lymphoma

0

1

1

0

0.07

0.03

C83

Non-follicular lymphoma

11

18

29

0.63

1.19

0.89

C84

Mature T/NK – cell lymphoma

0

0

0

0

0

0

C85

Other lymphomas

0

0

0

0

0

0

C88

MaligImn. prol D

0

0

0

0

0

0

C90

Multiple myeloma

0

0

0

0

0

0

C91

Lymphoid leukemia

0

0

0

0

0

0

Total

 

1751

1515

3266

100

100

100

 

Table 4 shows that among the head and neck cancers, prevalence of carcinoma of mouth is more followed by tongue, oropharynx, larynx, lip, hypopharynx and nasopharynx. Figure 1 shows that all the head and neck cancers are male preponderant.

 

Table 4: Number (n) and relative proportion (%) of each site of cancers of head and neck relative to all sites of cancer reported at the Department of Pathology, Kanyakumari Govt. Medical College, from 2006 to 2022.  

Sites of cancer

(ICD – 10 code)

Males

Females

Total

n

n

n

%

(all sites)

Lip (C00)

40

24

64

2

Tongue (CO2)

115

29

144

4.4

Mouth (CO3, CO4, CO6)

313

153

466

14.3

 

Gum (CO3)

44

19

63

1.9

 

Floor of mouth (CO4)

42

16

58

1.8

 

Other and unspecified par of
 mouth (CO6)

227

118

345

10.6

Oropharynx (C01, C05, C09, C10, C14)

122

18

140

4.3

 

Base of tongue (C01)

35

12

47

1.4

 

Palate (C05)

23

2

25

0.8

 

Tonsil (C09)

18

1

19

0.6

 

Oropharynx (C10)

31

1

32

1

 

pharynx (C14)

15

2

17

0.5

Nasopharynx (C11)

8

4

12

0.4

Hypopharynx (C12-C13)

27

5

32

1

 

Pyriform sinus (C12)

12

2

14

0.4

 

Hypopharynx (C13)

15

3

18

0.6

Larynx (C32)

63

6

69

2.1

Cancers of head and neck

688

239

927

28.4

 

 

Figure 1: Relative proportion (%) of each site of cancers of head and neck relative to all sites of cancer reported at the Department of Pathology, Kanyakumari Govt. Medical College, from 2006 to 2022.

 

Discussion

The relative proportion of the reported cancer cases were 9.3%. This is slightly less compared to the prevalence in our neighbouring district Tirunelveli as stated in a study by Usha and Suresh Durai [3]. We found that the female cancers were more compared to the male cancers over the period of 2006 to 2022. In a research article by Hridhaya et al also shows more cancer prevalence among the female population [4]. This is owed to the major contribution from the breast cancer. Breast cancer represents 1 in 4 cancers diagnosed among women globally [5].

 

As compared to the GLOBOCON data, thyroid carcinomas were high among females. Colorectal carcinomas though little less compared to the male population, it is almost reaching to the sum which is also coinciding with the findings of GLOBOCON [6].

 

The top five leading cancers sites in female in descending order of frequency are Breast, uterine cervix, mouth, thyroid and ovary. Whilst in the surrounding districts are as follows: Tirunelveli: female breast followed by cervix, head and neck, GIT and thyroid in descending order. Thiruvanathapuram: Female cancers- breast >thyroid >ovary>uterine cervix>uterine corpus [7]. The most important finding is that breast carcinoma is at its peak among the female population,

 

The top five leading cancer sites in male in descending order of frequency are mouth, stomach, skin, tongue and larynx. Tirunelveli: head and neck followed by GIT, male genital tract, lymph node and urinary tract malignancies in descending order of frequency. Thiruvanathapuram: Lung>prostate> mouth>tongue>liver [7]. The findings are almost comparable to Tirunelveli district [7].

 

According to other studies like Mallath et al [4] Colorectal, lung, cervical, and thyroid cancers are also common among women. Lung cancer and prostate cancer are more among the men. A study by Binu et al says among males, 33.1% of all cancers were in the respiratory system followed by digestive organ cancers (23.2%). Among females, 28.4% cancers were related to the reproductive system, 22.8% to the respiratory system and 14.1% to digestive organs [8].

 

While going through the head and neck cancers particularly oral cancers involving the unspecified parts of mouth, floor of mouth and gums were at its lead when categorised according to various site and is more among the males.

 

Mouth cancers are more among the male population which is attributed to practices like betel nut, tobacco chewing, cigarette smoking and poor oral hygiene. This statement is upheld in a study by Mallath et al and it is also reported in the small taluks of Kanyakumari district since early 20th century as documented by the medical missionaries of Neyyoor Cancer Hospital [9]. It is more commonly seen among the lower socioeconomic group who were less informed about healthy practices and are the group of people who have to toil from dawn to dusk as labourer. This statement is supported by Behera and Patro in their research article. It states that the people can die due to cancer without access to health care in rural parts of the country due to lack of awareness about the cancers remains the key. Distance from appropriate health services and lower socioeconomic classes add more to it [9, 10].

 

Few studies by Hussain et al and Qazil et al also points that, among men, hypopharyngeal cancer, esophageal cancer, lung cancer, stomach cancer, and oral cancer were the major cancer types prevalent and, among females, cervical cancer, mouth cancer, breast cancer, ovary cancer, and thyroid cancer were the common cancer types [11, 12]. Significant prevalence of pharyngeal and laryngeal carcinoma is also noticed, whereas all other cancers were more among the male population.

 

Limitations: The present study was based on a limited number of cases and provides only a single centre report. A multicentre approach will provide a conclusive data.

 

Conclusion

This study shows that the magnitude of cancer cases reported at Kanyakumari Government Medical College in the period between 2006 to 2022 is less compared to the nearby districts. Female breast cancers are at increasing trend. In male patients, oral cavity cancer predominates. This data could help to document, analyse and set a base for population-based cancer approach in and around Kanyakumari district.

 

Conflicts of interest

Authors declare no conflicts of interest.

 

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