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Indian Journal of Community Medicine Vol. 30, No. 4, October-December, 2005

Epidemiology of Cancer in Rural Maharastra

G. Mishra Introduction Cancer is commonly recognized as a group of disease affecting many organs of the body. More than hundred different types of cancers are listed. In 1989, malignant disease accounted for nearly a quarter of deaths in UK, being second only to cardiovascular disease (45.9%) of all deaths in the league of individual causes of death (OPCS monitor 1991)1. The necessity of carrying out this study was felt to see if a secondary care level hospital could function effectively as small units of cancer thus decreasing the patient load of a nodal hospital. This hospital is located in Ratnagiri district. This district consists of villages scattered in between hills and valleys and are difficult to approach. Konkan is situated about 300kms from Tata Memorial Hospital (TMH), a nodal cancer hospital located at Mumbai. About 40% of the patients attending TMH each year excluding Mumbai are from Konkan2. The idea is to provide optimum patient care closer to the patients home. This also provides psychological and emotional benefit to the patient which may be lacking in major institutions due to time constraints. The study was conducted with the objectives : 1) to ascertain the pattern, pathology, distribution & determinants of cancer in rural Konkan 2) to determine the clinical & pathological features and treatment profile of cancer patient. Methodology In this study all the cancer patients attending the hospital over a period of last four years (i.e. the time when the hospital started) are included. This comes to a sample size of 212 patients over a period of last four years. The data of these patients regarding their age, gender, diagnosis, histopathological grading, clinical staging, mangement, followup, out-come, recurrence and referrals any, if required is noted and computerised. The data is later analysed and presented in the form of graphs and tables. Results and Discussion Out of total 212 patients 107 (50.47%) males and 105 (49.53%) are females. This shows that gender distribution in nearly equal. 54.5% of cancer patients fall in between 41 to 60 years of age. Therefore all the screening efforts need to be projected between 31 to 40 years of age group. Cancers of the Gastrointestinal tract constitute the highest number of malignancies in males and cancers of the reproductive system contributes to the majority or malignancies in females. According to Guillou, lung cancer contributes the greatest overall number of cancer deaths, although among women carcinoma of the breast is more common. Cancer arising in the gastrointestinal tract
Tata memorial Hospital, Parel, Mumbai-400012, Maharastra
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constitutes 26.5% of all cancer deaths1. Out of 8 paediatric cancer cases 5 were males and 3 were females. 5 patients had ALL, 2 patients had NHL and 1 patient had CLL. 13 out of 212 patients were elderly patients. Amongst them 11 patients were males and 2 patients were females. Leading sites of cancer among elderly are oral cavity, rectum, oesophagus and lung. According to histopathological grading4,5 37 (21.64%) patients had well-differentiated cancer, 77 (45.03%) patients had moderately differentiated cells and rest of the 57 (33.33%) patients had poorly differentiated cells. In rest of the 41 patients grading was not possible. Staging is applied only for those cancers which could be staged according to the presently available classification. Most of the patients have presented in advanced stages III (88), stage IV (38) of the disease. 30.73% of patients were treated by surgery, 21.79% of patients were treated with chemotherapy and 8.94% with radiotherapy. Combined modality of treatment was used in 27.37% of patients. 11.17% of patients could only be provided supportive care, as they presented in highly advanced stages of the disease. Majority of the patients (138) had good follow-up. This may be due to the treatment being made available closer to the patients home as compared to the need of visiting hospitals in the far off cities for follow-up. Outcome was good in 103 patients, Recurrence in 15 patients. 39 patients expired in four years. Rest of the 55 patient were either referred or lost to follow-up and hence their outcome is not known. Comments on recurrence of cancer can be passed only about the 138 patients who regularly followed up. 15 patients among them showed recurrence after treatment. Eleven (5.19%) patients had to be referred directly for treatment to higher centres either because of high risk of anaesthesia, technically demanding surgery or special investigations. Twenty two (10.38%) patients were directly referred after diagnosis for radiotherapy to a nearly centre without any further treatment. Ten (4.71%) patients were treated by surgery and / or Chemotherapy and then referred for Radiotherapy. Eighty percent patients could be totally managed at the hospital and did not need any further referral.
Table-I : Five Leading Sites of Cancer Males (No. of cases) Oral Cavity (17) Lung (10) Colon (9) Stomach (6) Oesophagus (5) Females (No. of cases) Breast (21) Oral Cavity(16) Cervix (13) Ovary (9) Stomach (5) Total (No. of cases) Oral Cavity (33) Breast (22) Lung (14) Cervix (13) Colon (12)

Indian Journal of Community Medicine Vol. 30, No. 4, October-December, 2005

Conclusions Leading sites of cancer in females are breast, cervix and oral cavity. Paediatric cancers constitute mainly medical mailgnancies like leukaemias and lymphomas. Cancer of oral cavity, rectum and oesophagus are common in elderly patients. According to histopathology, 21.64% of patients had well differentiated cells, 45.03% of patients had moderately differentiated cells and 33.33% of patients had poorly differentiated cells. 67.38% of patients present in Stage III & IV. Surgery, Chemotherapy, Radiotherapy, Combined therapy and Supportive treatment are the various modalities of management used. Out of these 30.73% patients were managed by surgery and 21.79% were managed be chemotherpy. 65.09% of cases have followed regularly to the hospital. Outcome was good in 48.59% of cases and 7.08% of cases showed recurrence after initial treatment. 80% of

the patients could be treated here. They did not require any referrals and could be managed totally at the hospital.
References

1. 2. 3. 4. 5.

Guillou P J. Principles of surgery for malignant disease. Clinical Surgery in General : RCS Course Manual, Second Edition, Churchill Livingstone 227. Dinshaw K A., Rao D N. Cancer patients from various regions of Maharashtra, Hospital Cancer Registry. Tata Memorial Hospital, Annual Report 1996; 12. Clinical Staging of Cancer. International Union Against Cancer 1980. Ackerman, Rosai J. : Surgical Pathology Vol 1 & 2 1997, 8th edition. Enzinger F.M., Weiss S.W. : Soft Tissue Tumours 1995, 3rd Editon.

Announcement
Proceedings of 31st Annual National Conference of Indian Association of Preventive and Social Medicine, organised at PGIMER Chandigarh, from 27th to 29th February 2004 are now available on CDs, at following rates: Audio - Visuals/Slides and Text Each Talk in one CD All Text and Slides in one CD = = = Rs. 5000/Rs. 300/Rs. 150/-

To look at List of Speakers and Titles Please visit website www.iapsm.org To order send demand draft in favour of 'IAPSM' payable at Chandigarh. For free download of text and presentations, visit http//indmed.nic.in, search for Indian Journal of Community Medicine, and look in Vol. 29, No. 5, 2005.

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