This chapter gives a summarized account of each of the centres that have collaborated and contributed information on cancer cases.
In all, 105 centres contributed information on 2,17,174 cases for the two year period 2001-2002 (1,03,081 for 2001 and 1,14,093 cases for 2002). The checks on data, inclusion and exclusion criteria, and the basis for grouping to look at leading sites etc, are all given in Chapter 2 on `Overall Plan and Methods'.
Format of Presentation
Overall, the following order of sequence has been followed in arranging the write-up and tabulations of each centre. Broadly the centres consist of the following:
1. Centres with Hospital Based Cancer Registries (HBCRs) under the National Cancer Registry Programme (NCRP);
2. Centres with functioning HBCRs, other than those in the NCRP network;
3. Population Based Cancer Registries (PBCRs) under the NCRP;
4. Functioning PBCRs other than those in the NCRP network;
5. All other centres - mainly, these consist of Regional Cancer Centres other than those covered in 1 - 4 above, private cancer centres, government and private medical college hospitals, non-teaching government and private hospitals and private pathology laboratories.
Under these five broad groups, the profile and summary tables and figure of each centre is arranged in the descending order of the number of cancers (for the combined years 2001 and 2002) on which information was provided towards the project.
Generally, each centre's description consists of a brief write-up of the centre, two statistical tables and a figure. Table 7._(a) gives the summary of number of cancers on which information was provided according to calendar year and gender. Table 7._(b) gives the district-wise distribution (number and relative proportion) of cancers from that centre. This latter table presents a picture of the distribution of cancers in different geographic areas. It is also an indicator of sources of referral to that particular centre. The figure depicts the bar charts of ten leading sites of cancer (ICD-10) separately, in males and females. Calculation of leading sites is based, on the proportion of that site of cancer relative to the total numbers of all cancer sites in that gender.
Since this chapter deals with the pattern of cancer in individual centres, the bar charts and figure of leading sites of cancer is not depicted for the PBCRs. They are reflected in earlier chapters (3 and 5). Moreover, the contribution of information on cancers by the PBCRs is that of persons other than those residing in the respective PBCR area.
Further, no such charts or district-wise distribution of tables are given for centres where the numbers of cancers are relatively small (by and large less than two hundred cases or where counts for leading sites got into single digits).
Summary of Cancer Patterns
There are several limitations in describing patterns of cancer in individual centres especially in the context of geographical distribution. The leading sites of cancer in a given institution are dependent on a number of factors, such as, the popularity of a particular department and/or treating physician, the availability of a particular diagnostic or treatment facility, the affordability of the patients and so on. In some centres one could be dealing with small numbers of cancers. Thus, either the order of leading sites or fluctuation of the same between the years provides little meaning. Still, the patterns observed in most of the cancer centres that function as referral institutions for care of cancer patients do reflect the predominant cancers in the region. Further they give an indication of the magnitude and burden of cancer in the specific institution.
The foregoing points have to be kept in mind while interpreting the description (given below) of the patterns of cancer based on the leading anatomical sites of cancer, by individual institution.
Leading Sites of Cancer in Males (relative proportion (%) of all cancers given in parentheses)
Among males cancers of sites associated with use of tobacco were the most important. These cancers were generally referred as Tobacco Related Cancers (TRCs). Among the TRCs the prominent ones seen in the collaborating centres are mouth, lung, tongue, oesophagus and hypopharynx. They were seen uniformly in all centres regardless of geographical location and were among the five leading sites of cancer in many of the centres. Cancer of the mouth was the leading site of cancer in several centres and constituted nearly 27% of cancers of all sites at the A.H. Regional Cancer Centre in Cuttack, Orissa State. Cancer of the lung was also the leading site of cancer in many centres and in the two major institutions in Kolkata - Chittaranjan National Cancer Institute and Cancer Centre and Welfare Home it forms 13.8 and 13.6% of cancers respectively. Cancer of the tongue was the leading site of cancer in the two collaborating institutions from Gujarat State (Gujarat Cancer and Research Institute and Pramukhswami Medical College - 11.1 and 19.0% of cancers) and in Kuppuswamy Naidu Memorial Hospital (9.1%) in Coimbatore, Tamil Nadu State. Cancer of the oesophagus was the leading site in the Karnatak Cancer Therapy Institute (15.7%) in Hubli, Bharat Hospital (12.7%), Mysore and in Kidwai Memorial Institute of Oncology (9.7%), Bangalore - all in Karnataka State. It was also the leading site at Government Medical College (11.4%), Patiala, Punjab State. Cancer of the hypopharynx was the leading site of cancer in Dr B.B. Barooah Cancer Institute constituting 18.2% of all cancers. Cancer of the larynx, which is also a TRC site was the leading cancer in several centres. Some of these centres included PGIMR (Histology) (13.7%), Chandigarh, Jawaharlal Nehru Medical College (13.5%), Aligarh, Uttar Pradesh State and Government Medical College (11.0%), Nagpur, Maharashtra State.
Cancer of the stomach was prominent among the leading sites in the centres at Civil Hospital (29.1%), Aizawl, Mizoram State, Regional Institute of Medical Sciences (15.2%), Imphal, Manipur State. It was also the first or second leading site of cancer in three collaborating institutions (Sudharma Laboratory - 19.7%; Government Medical College - 14.5%; Amala Cancer Hospital and Research Centre - 10.4%) in Thrissur, Kerala State.
Cancer of the penis, was observed as a leading site of cancer at Rangaraya Medical College (second leading site - 11.0% of all cancers), Kakinada, Andhra Pradesh State; JIPMER (fourth leading site - 7.6% of all cancers), Pondicherry and in the Sai Subramaniam Pathology Laboratory (sixth leading site - 5.2% of all cancers) in Coimbatore, Tamil Nadu State.
The anatomical site - termed as 'Other Skin' that excludes melanoma of the skin was seen to be a major site of cancer in some centres. This was not observed in the hospital cancer registries under the NCRP. It was the second
leading site of cancer at S.N. Medical College (7.6%) Jodhpur in Rajasthan State; at Mahatma Gandhi Institute of Medical Sciences (6.2%), Wardha, Maharashtra State, Tirunelveli Medical College (6.1%), Tirunelveli, Tamil Nadu State, and at JIPMER (5.1%), Pondicherry.
The leukaemias and Non-Hodgkin's lymphomas constituted a major leading site of cancer in most centres. Cancer of the prostate was also one of ten leading sites in several centres. Apart from these, other sites that appeared as the first or second leading site of cancer were more likely due to the biases indicated above including the small numbers of cases reported from that institution than due to any reflection of geographic patterns.
Leading Sites of Cancer in Females (relative proportion (%) of all cancers given in parentheses)
Cancer of the cervix was the leading site of cancer in many institutions. The relative proportion was highest (77.6%) at the MNJ Institute of Oncology, Hyderabad, Andhra Pradesh State. The relative proportion was also high at JIPMER (55.1%), Pondicherry and at Karnatak Cancer Therapy Institute (43.2%) in Hubli, Karnataka State.
Cancer of the breast was also the leading site of cancer in various institutions. At Apollo Hospital, Hyderabad, Andhra Pradesh State it formed 36% of all cancers in females. The relative proportion of cancer of the breast was higher than 30% in many centres, notably, Government Medical College (32.7%), Patiala, Punjab State; Bhagwan Mahaveer Cancer and Research Centre (32.2%), Jaipur, Rajasthan State; Goa Medical College (31.9%), Goa State.
Cancer of the ovary was an important site of cancer constituting 9% of cancers in Government Medical College, Thrissur, Kerala State, 7.2% at PGIMER (Cytology), Chandigarh and 6.8% at Government Medical College, Nagpur, Maharashtra State.
Nine percent of cancers in females reported at the Regional Cancer Centre, Thiruvananthapuram, Kerala State, were cancers of the thyroid. The relative proportion of this site of cancer was 5.0% at Kasturba Medical College, Manipal and 4.9% at Kasturba Medical College, Mangalore, both in Karnataka State.
Cancer of the gall bladder accounted for 9.6% of all cancers in females at the Mahaveer Cancer Sansthan in Patna, Bihar State and was the third leading site of cancer. Both the major institutions in Kolkata - Cancer Centre Welfare Home and Chittaranjan National Cancer Institute recorded this site of cancer to be 6.0% and 5.8% of all cancers, being the third and fourth leading sites respectively.
In females also, cancer of the stomach was an important leading site in the institutions in the states of Mizoram and Manipur. In the Civil Hospital in Aizawl, Mizoram State, it formed 14.4% of all cancers and was the second leading site of cancer. Similarly, in the Regional Institute of Medical Sciences, Imphal, Manipur State, stomach cancer constituted 8.6% of all malignancies in females and was the fourth leading site of cancer. Cancer of the stomach was also one of five leading sites in the centres at Thrissur, Kerala State (Sudharma Laboratory - second leading site and 9.9% of all cancers; Government Medical College - fifth leading site and 5.0% of all cancers; Amala Cancer Hospital and Research Centre - fifth leading site and 4.5% of all cancers).
Cancers of the mouth and oesophagus were among the important and leading TRCs in females. Cancer of the mouth was the second leading site at A.H. Regional Cancer Centre (15.5%), Cuttack, Orissa State. In JIPMER (8.1%) and in Dr B.B. Barooah Cancer Institute (8.2%) it was the second and fourth leading site of cancer respectively. In the latter institution, cancer of the oesophagus was the third leading site forming 12.6% of all cancers. Cancer of the oesophagus was also the third leading site in the Karnatak Cancer Therapy Centre (9.7%), in Hubli, Karnataka State, at the Acharya Tulsi Regional Cancer Treatment Centre (7.6%) in Bikaner, and at Santokba Durlabhji Memorial Hospital (7.4%) at Jaipur in Rajasthan State. Two institutions in the North Eastern states - Regional Institute of Medical Sciences (9.9%), Imphal, Manipur State and Civil Hospital (10.3%), Aizawl, Mizoram State had cancer of lung as the third and fourth leading site of cancer respectively.