HOSPITAL BASED CANCER Chandigarh, Dibrugarh and Trivandrum for Hospital based Cancer Registries (HBCR)

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  • Individual Registry Data: 1984-1993 Chandigarh

    203D:\Ncrp\Chandigarh.p65

    Non-communicable disease, particularly cancer and cardiovascular disease, are emerging publichealth problems in developing countries. The magnitude of the problem of cancer, in terms of its largenumbers, warrants attention of the policymakers and planners to evolve a national programme of action todevelop, implement and coordinate and also to evaluate the cancer control activities in the country. It wasfelt by the Government that there is not definite information and data available for cancer incidence in thecountry which can implement and recommend for augmentation of the existing facilities. The professionalswho are closely involved in diagnosis and treatment of cancer do not have statistics of the prevalence ofcancer as well as the facilities available.

    In order to obtain data and information the National Cancer Control Programme, drafted in 1984,recommended to set up three population based and three hospital based Cancer Registries in the country.The Indian Council of Medical Research, New Delhi, was the nodal agency for controlling and monitoringthe Cancer Registry programme. Bangalore, Bombay and Madras were identified for population basedand Chandigarh, Dibrugarh and Trivandrum for Hospital based Cancer Registries (HBCR). In Chandigarh,the Department of Radiotherapy and Oncology of the Postgraduate Institute of Medical Education &Research, under the supervision of Prof. B.D.Gupta was designated as the resource centre for Hospitalbased Cancer Registry covering this region. The Registry started functioning from April 1984.

    The Hospital based Cancer Registry aims to provide mainly the number of cancer cases attendingthe host institute in various disciplines and the exact type of cases diagnosed and classified according toInternational Classification of Diseases (ICD). In addition, great details of the patient such as age, sex,address, living conditions and environment, particular lifestyles of the community in which he/she lives,socio-economic strata, personal habits, past history, family history, marital status, number of children etc.were recorded by trained social workers and a Medical Research Officer. It also aimed to get the exactdetails of histopathology and to record other sources of diagnosis. Attempts were also made to givediagnosis of the cases by histopathology and cytopathology so that in a large number of patients correctand speedy diagnosis is made. The patients were further investigated by Radiology and Laboratoryexaminations in the form of Biochemistry, Nuclear Medicine and related areas to know the actual staging ofthe disease in terms of clinical status. Attempts were also made to classify according to TNM (TumourNode Metastases) Classification. The HBCR also included the treatment and follow up to measure thesurvival rate as well.

    The Hospital-based Cancer Registry at Chandigarh completed ten years of its existence and functionsand achieved a great success in the collection of data and information. There are some observationswhich are the highlight of the HBCR at Chandigarh.

    1. There is almost 100 per cent confirmation by histopathology or cytopathology of the patients attendingthe hospital duly registered in the programme.

    2. The treatment modalities which included surgery, radiotherapy and chemotherapy and in a few casesof hormone or other modalities, were also classified.

    HOSPITAL BASED CANCER REGISTRY

    Prof. B.D. Gupta, MD, FRCR(London)Former Professor & Head Dept.of Radiotherapy & Oncology and

    Principal Investigator

    Post Graduate Institute of Medical Education & Research, Chandigarh

    Individual Registry Data: 1984-1993 Chandigarh

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  • Individual Registry Data: 1984-1993 Chandigarh

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    3. Radiotherapy was the treatment of choice for more than 50 per cent of the cases and this was in theform of curative and palliative therapy.

    4. Carcinoma cervix in females and carcinoma bronchus in males was the leading site of cancer. Morethan 50 per cent of the cases (exactly 62 per cent) of carcinoma cervix presented in stage - 3 diseases.In cancer bronchus there was no case reported in early stage where surgery was the choice oftreatment. Carcinoma Gall Bladder reported higher incidence, which is more than that observed inother hospital based cancer registries in the country. On further enquiry and investigation, it wasfound that these patients belonged to higher socio-economic strata and had more nutritional value intheir diet.

    5. Oral cancer was the lowest in the HBCR at Chandigarh ( 5 per cent) and most of the cases camefrom western UP and part of Haryana. There was not a single case of buccal mucousa reported inSikh population, male or female.

    6. Cancer breast in females and cancer prostate in males were reported high in the population ofChandigarh city. This unlike the other population of the region attending the hospital.

    7. Brain tumour - There was high incidence of brain tumour as revealed from the Registry. This may beattributed to the fact that there is well-developed facility for neuro-surgery in the entire region; hencethe large number of cases reported.

    The Hospital-based Cancer Registry has great potential to define and to evaluate the cancer treatmentprogramme in a particular region or a hospital. This supports the curative treatment leading to disease-freesurvival for five years or longer of a particular modality and finally to recommend greater emphasis oncancer control programme. This can also correct the lacuna in the treatment programme in the countryand the region.

    HBCR support the programme for down sizing the staging of the disease and recommend measuresfor early detection programme for a particular type of the disease, which is preventable and curable, ifpatients present in early stages. In the present HBCR at Chandigarh, carcinoma cervix and carcinomabreast in females and carcinoma bronchus and cancers of the pharynx and larynx were the leading sites.There are a large number of patients attending in stage III and IV disease and this can be taken up onpriority for cancer prevention, detection and downsizing of the disease.

    There is an urgent need to develop a standard protocol of treatment of common cancers in India.This should be undertaken by a coordinated study to be entrusted to a few (at least 3-4) centres in thecountry. This can certainly provide the baseline data for improvement in the treatment modalities and torecommend measures for better control of the treatable and curable cancers.

    In fact, Hospital-based Registries can be reliable source of information on survival rate. The ChandigarhRegistry has shown a good follow up system where almost 85 per cent of the patients were followed up.This is a unique feature of the Chandigarh Registry in respect of follow up of cancer patients who haveimproved following establishment of Cancer Registries. The programme has certainly offered functions fordocumentations and hospital cancer registry management as well as support of patient care. The registryhas actively kept the tract of patient history in detailed by this way has become a central information sourceand resource for connected hospital and specialisation in the institute.

    The data in the Registry Programme also supported information on the etiological factors in theincidence of a particular cancer, the analysis of which can provide guidelines for further research andstudy for the National Cancer Control Programme. A large amount of data emerged in Carcinoma of cervixwhich proved that the disease can be prevented and effectively treated for cure even in advanced stagesi.e. stage III to the tune of almost 45-50 per cent. Stage I and IIA are curable disease by radical Radiotherapy,which has proved the primary line of treatment in carcinoma cervix.

    Individual Registry Data: 1984-1993 Chandigarh

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  • Individual Registry Data: 1984-1993 Chandigarh

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    Table CHG - 1(a): Number of Cancers by Site (ICD-9) and 5 Year Age Group:

    1984 - 89 - Males

    ANS=Age Not Specified ; %= Relative Proportion of Cancers of All Sites.

    Chandigarh

    ICD-9 Site 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ ANS Total %

    140 Lip 0 0 0 0 0 0 0 0 1 1 2 3 1 0 1 1 0 10 0.14

    141 Tongue 0 0 0 0 1 10 12 22 38 62 69 63 50 30 30 14 0 401 5.80

    142 Salivary Glands 0 2 0 0 2 7 1 1 5 3 12 8 11 7 4 0 0 63 0.91

    143 Gum 0 0 0 0 1 2 3 1 4 8 9 6 5 3 2 3 0 47 0.68

    144 Floor Of Mouth 1 0 0 0 0 0 0 2 2 2 4 5 3 3 0 0 0 22 0.32

    145 Other Mouth 0 0 0 0 2 4 8 9 8 22 20 22 11 13 12 7 0 138 2.00

    146 Oropharynx 0 0 0 0 2 1 7 16 27 36 25 36 26 16 9 6 0 207 3.00

    147 Nasopharynx 1 0 1 5 2 3 3 5 8 7 9 11 6 2 1 4 0 68 0.98

    148 Hypopharynx 0 0 0 2 6 17 12 20 25 24 42 54 48 31 14 11 0 306 4.43

    149 Pharynx Etc. 0 0 0 2 1 1 0 2 4 2 7 3 7 3 2 4 0 38 0.55

    150 Oesophagus 0 0 0 5 2 6 23 22 33 51 77 54 74 41 42 33 0 463 6.70

    151 Stomach 0 0 0 0 2 3 11 18 24 27 28 35 21 25 12 11 0 217 3.14

    152 Small Intes. 0 0 0 0 0 2 3 2 0 3 0 0 1 1 1 1 0 14 0.20

    153 Colon 0 1 0 0 4 6 7 6 15 18 13 13 11 9 5 3 0 111 1.61

    154 Rectum 0 0 1 5 7 12 16 12 19 21 26 27 43 18 22 12 0 241 3.49

    155 Liver 5 0 0 0 4 2 2 3 6 6 8 9 13 9 1 1 0 69 1.00

    156 Gall Bladder 0 0 0 0 0 2 3 7 8 8 12 7 12 6 7 2 0 74 1.07

    157 Pancreas 0 0 0 0 1 1 6 3 8 8 6 8 10 6 3 1 0 61 0.88

    158 Retroperit. 1 2 1 2 1 2 1 0 4 4 1 2 1 0 1 0 0 23 0.33

    159 Other Dig. Sys. 0 0 0 0 0 0 0 0 0 0 1 0 1 2 1 0 0 5 0.07

    160 Nasal Cavity 3 1 1 4 4 8 7 6 13 10 7 20 15 11 8 2 0 120 1.74

    161 Larynx 0 0 0 0 2 2 7 8 36 54 80 76 68 43 37 16 0 429 6.21

    162 Lung 0 0 0 0 3 7 11 33 58 88 144 136 124 82 48 28