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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.  

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.  

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.  

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.  

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.