Cancer pattern among newly registered patients in a cancer hospital of South Gujarat

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International Journal of Medical Science and Public Health 748
2018 | Vol 7 | Issue 9
Cancer pattern among newly registered patients in a cancer hospital of
South Gujarat
Ketankumar Patel1, Hiteshree Patel2, Vipul Chaudhari2, Sachin Mehariya3
1Factory Medical Officer, International SOS, Jamnagar, Gujarat, India, 2Department of Community Medicine, Government Medical College,
Surat, Gujarat, India, 3Surveillance Medical Officer, WHO – Bihar, India
Correspondence to: Ketankumar Patel, E-mail: drketanrpatel@gmail.com
Received: February 25, 2018; Accepted: June 07, 2018
INTRODUCTION
In the 21st century, increasing facilities for better lifestyle and
better treatment have improved the health scenario of most
of the countries of world; it also increases the life expectancy
of the population by decreasing deaths due to acute diseases
mainly communicable diseases. However, adaptation of
the 21st centuries’ lifestyle and behavior such as increased
tobacco consumption, high fat and low fiber diets, and
reduced physical activity were commonest factors associated
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DOI: 10.5455/ijmsph.2018.0206207062018
with the increasing burden of cancer.[1] Cancer incidence is
increasing in developing countries (Global Health Council,
2010) and the increase is attributable to changes in risk
factors including lack of physical activity, unhealthy diet,
obesity, contaminants, ultraviolet or ionizing radiation,
occupational or environmental exposure, aging, ethnicity or
race, heredity, and infectious diseases.[2] From the list of the
non-communicable diseases, cancer is more important from
the public point of view. Better diagnostic facility, increasing
public awareness, and early health seeking to hospitals has
been increasing the cancer detection at early stage which
leads to higher survival chances among cancer patients.
The term cancer refers to a group of diseases which share
similar characteristics. It is a general term used to refer to a
condition where the body’s cells begin to grow and reproduce
in an uncontrollable way. These cells then invade and destroy
healthy tissue, including organs. Cancer sometimes begins in
Background: Cancer is a chronic disease, its prevalence is increasing worldwide due to various advances exist for
the diagnosis and treatment. Cancer occurs as a result of unusual growth of cells and invasion of nearby tissue and
organs. At present, cancer is the second leading cause of death. Cancer distribution has a wide variation in different
parts of the world. Objectives: To observe the pattern of different types of Cancer, Age and Gender wise distribution of
common cancer in newly registered cancer patients at Cancer Treating Institute. Materials and Methods: This cross-
sectional study conducted in newly registered cancer patients at D.B. Tejani Cancer Institute, Surat. Total 690 patients
purposively selected from December 2015 to January 2016. Results: The most common sites of cancer in decreasing
order were oral cavity (19%), female genital tract (15.1%), breast cancer (14.5%), gastrointestinal tract (11.3%),
lympho-hematopoietic system (9.9%), respiratory tract (5.6%), and others. In less than 14 years, lymphatic leukemia
was found to be the most common cancer in boys and ovarian cancer (25%) among girls. Conclusion: Tobacco-related
cancer was more common among more than 15-year-old males, while breast cancer was the most common type of
cancer in females.
KEY WORDS: Cancer Pattern; Gender; South Gujarat
ABSTRACT
International Journal of Medical Science and Public Health Online 2018. © 2018 Ketankumar Patel, et al. This is an Open Access article distributed under the terms of the Creative
Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to
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Research Article

Patel et al. Cancer pattern among newly registered patients in a cancer hospital
749 InternationalJournalofMedicalScienceandPublicHealth 2018 | Vol 7 | Issue 9
one part of the body before spreading to other parts. Cancer
can affect all living cells in the body, at all ages and in both
genders. The causation is multifactorial and the disease process
differs at different sites. Tobacco is the single-most important
identified risk factor for cancer. A host of other environmental
exposures, certain infections, as well as genetic predisposition
play an important role in carcinogenesis. Diagnostic workup,
treatment methods, and outcome of treatment are not uniform
for all cancers. Advanced technology is required in many
situations and on-going research initiatives might lead to
better understanding of the disease and its control.
According to GLOBOCAN 2012, an estimated 14.1 million
new cancer cases and 8.2 million cancer-related deaths
occurred in 2012, compared with 12.7 million and 7.6 million,
respectively, in 2008.[3] Worldwide, the most commonly
diagnosed cancers were those of the lung (13.0% of the
total), breast (11.9%), colorectal (9.7%), prostate (7.9%),
and stomach (6.8%); together, cancers of these five sites
constitute half of the overall global cancer burden. Among
men, the five most common sites of cancer diagnosed in
2012 were lung (16.7%), prostate (15%), colorectal (10%),
stomach (8.5%), and liver (7.5%). However, among women,
the five most common sites diagnosed were breast (25.2%),
colorectal (9.2%), lung (8.7%), cervix (7.9%), and stomach
(4.8%).[4] The most common causes of cancer death were
cancers of the lung (1.6 million, 19.4% of the total), liver
(0.8 million, 9.1%), and stomach (0.7 million, 8.8%).[4]
Cancer has arisen as a major public health concern in India.
About 1.25 million new cases are diagnosed every year and
around 2.8 million cases of cancers are prevalent at any given
point of time.[5] It also claims lives of about 6.8 lakh patients
per year. Every day, 2500 persons die due to tobacco-related
diseases. The top five cancers in men and women account for
42.7% of all cancers; these cancers can be prevented, screened
for and/or detected early, and treated at early stages.[6] Even
children and adolescents were not spare from cancer disease.
The most common types of cancer among pediatric patients were
acute lymphocytic leukemia (37%) followed by acute myeloid
leukemia (13%), non-Hodgkin’s lymphoma (8%), Ewing’s
sarcoma (8%), osteosarcoma (7%), Hodgkin’s lymphoma (6%),
and other cancers such as Wilm’s tumor, medulloblastoma,
retinoblastoma, sarcomas, and germ cell tumor (26%). The diet
was non-vegetarian in 93% and 7% vegetarian. At diagnosis,
52% had weight for the age between 3rd and 97th centile, 44%
patients were undernourished, and 4% were obese.[7]
In 1982, the Indian Council of Medical Research has launched
a registry program for cancer in the name of National Cancer
Registration Programme (NCRP) to provide true information
on cancer prevalence and incidence. The coverage of cancer
registration by the NCRP was <10% of Indian populations.
These registries generate annual reports which indicate the
annual incidence of particular cancer in population which
help in planning and evaluation of cancer control. From these
registries, trend is indicating to put more emphasis on cancer
prevention. The operational wing at the NCDIR-NCRP,
headquartered in Bengaluru, collects data from all 29 PBCRs
and 27 HBCR, analyzes the data, and monitors them regularly.
In Gujarat, Population-based study conducted by GCRI
(Gujarat Cancer Research Institute) in urban and rural areas
of Ahmedabad district, Patan district. In Patan district, age-
adjusted incidence rate (AAR) among males was 61.84 and
28.63 in females per 100,000 populations, while the age-
specific incidence rates range between 2.4 (10–14 years’
age group) and 277.1 (70–74 years’ age group) per 100,000
populations among males and 1.56 (0–4 years’ age group)
and 116.08 (55–59 years’ age group) per 100,000 populations
among females. Comparing crude rate (CR), AAR, and
truncated incidence rates per 100,000 in different population-
based cancer registries of Gujarat state.[8]
Surat is a fast developing city with increase in
industrialization, urbanization, migration of population,
overcrowding, and changes in behavioral pattern of people.
Day by day, the population density is increasing in Surat
city due to increasing migration from different parts of the
country. Although Surat city is developing very fast, it lacks
in medical services for early detection and management of
cancer. No studies conducted in Surat city that provide the
details regarding the most common cancer in population
of different age and gender. In South Gujarat, there was no
data available regarding the burden of different types of
cancer, sociodemographic and treatment profile of cancer,
and risk factor responsible for different types of cancer. Shri
Devarajbhai Bavabhai Tejani Cancer Institute (DBTCI),
managed by D. B. Tejani Trust, is located in the campus of
New Civil Hospital, Surat. It is a diagnostic and treatment
center, which provides free-of-cost services to all types of
cancer. Based on the information, a study was plan at DBTCI
to observe the pattern of the cancer among newly registered
patients at the institute.
Shri Devarajbhai Bavabhai Tejani Cancer Institute (DBTCI),
managed by D. B. Tejani Trust, is located in the campus of
New Civil Hospital, Surat. It is a diagnostic and treatment
center, which provides free-of-cost services to all types of
cancer. In South Gujarat, there is no particular cancer registry,
which provides details regarding the burden of different types
of cancer, sociodemographic and treatment profile of cancer,
and risk factors responsible for different types of cancer.
Based on the information, a study was planned at DBTCI
to observe the pattern of the cancer among newly registered
patients at the institute.
Objectives
1. To observe the pattern of different cancers in newly
registered patients at a cancer-treating institute.
2. To observe the age- and gender-wise common cancers.

Patel et al. Cancer pattern among newly registered patients in a cancer hospital
International Journal of Medical Science and Public Health 750
2018 | Vol 7 | Issue 9
MATERIALS AND METHODS
It was a cross-sectional study conducted at Shri DBTCI,
New Civil Hospital, Surat. It delivers diagnostic and
treatment facility free of cost for almost all types of cancers.
Around 15–20 new cancer patients are registered daily at
the DBTCI for undergoing treatment for different types of
cancer.
A purposive selection of a total of 690 cancer patients
newly registered at the outpatient department of Shri
DBTCI, Surat, from December 2015 to May 2016 except
critically ill patients and who were not giving consent was
made for enrolling patients into the study. A pre-designed
semi-structured questionnaire was used for data collection.
After completing data collection, data were entered into
MS Excel data file. Data analysis was done using software
IBM SPSS Statistics version 20 [(Statistical Package for the
Social Sciences) IBM company, Armonk city, New York
State, United States of America].
RESULTS
In the present study, 690 patients were included, of which
50.6% patients were females and 49.4% patients were
males, with a male-to-female ratio of 0.98:1 showing female
predominance. The most common cancer was oral cavity
cancer (19%). In the oral cavity, tongue (9%) and floor of
mouth (6.1%) were the most commonly affected sites. Oral
cavity cancer followed by Female genital tract (15.1%)
[8.3% uterine cervix and 4.8% ovary], Breast (14.5%),
Gastrointestinal tract (11.3%) [5.5% colon-rectum and 2.8%
stomach], Lympho-hematopoietic system (9.9%) [4.2%
leukemia, 3.4% lymphoma, 1.2% multiple myeloma, and
1% others], Respiratory tract (5.6%), Bones and articular
cartilage (3.5%), Abdominal organs (3.6%), Mediastinum
(0.7%), Male genital tract (2.9%) [1.3% prostate, 0.9% penis,
0.7% testis], Urinary tract (1.1%), and other remaining cancer
types [Table 1].
The present study had found that children and adolescents
were also not spare from the cancer. Lymphatic leukemia was
the most common cancer among <15-year-old boys (38.5%),
whereas ovarian cancer (25%) was the most common among
girls. Tobacco-related cancer such as tongue cancer and floor
of the mouth cancer were the most common cancer types
among 15–34-year-old and 35–64-year-old male patients,
while lung cancer was the most common in individuals aged
more than 65 years. Among female patients, breast cancer
was most common in all age groups except <15-year-old girls
[Table 2].
DISCUSSION
In the present study, a total of 690 patients who were newly
registered to an institute were included. The most common
cancer sites in decreasing order were oral cavity (19%), female
genital tract (15.1%), breast cancer (14.5%), GIT (11.3%),
lympho-hematopoietic system (9.9%), respiratory tract
(5.6%), and others. In less than 14 years, lymphatic leukemia
was most common in boys and ovarian cancer (25%) was
most common among girls. Tobacco-related cancer was more
common among more than 15-year-old males while breast
cancer was the most common cancer in females.
Age- and gender-wise common cancer types in the current
study were compared with that of 2012–2014 Hospital-Based
Cancer Registry (HBCR)[9] of Mumbai, Bengaluru, Chennai,
Dibrugarh, New Delhi, and Chandigarh. In the present study,
among 0–14 years’ age groups, lymphatic leukemia in boys
and ovarian cancer in girls were the most common, while in
all other HBCR data, leukemia was most common in both
boys and girls [Table 3].[9] In the present study, tongue cancer
in males and breast cancer in females were most common
in 15–34 years’ age group; however, breast cancer was
most common among females in all other HBCRs except
Bengaluru where cervical cancer was most common, while
among males, different HBCRs had different common
cancers [Table 3].[9] In the present study, among 35–64-year-
old patients, mouth cancer was common in male patients and
breast cancer in female patients. However, except Bengaluru
HBCR, breast cancer was also most common in females in
other studies, while in male patients, mouth, esophageal,
and lung cancers were common [Table 3].[9] Among patients
those aged 65 and above, the most common cancer was
lung cancer in male and breast cancer in female patients of
this study; though in other studies, lung and hypo-pharynx
ICD 10 Code Site n (%) System
C00 Lip 6 (0.9) Oral cavity cancer (19%)
C01-C02 Tongue 62 (9.0)
C03 Gum 9 (1.3)
C04 Floor of mouth 42 (6.1)
C05 Palate 7 (1.0)
C06 Other and unspecified parts of mouth 5 (0.7)
C07 Parotid gland 5 (0.7) Salivary gland (1.4%)
C08 Other and unspecified major salivary glands 5 (0.7)
Table 1: ICD 10-wise classification of cancer patients in the present study
(Contd...)

Patel et al. Cancer pattern among newly registered patients in a cancer hospital
751 InternationalJournalofMedicalScienceandPublicHealth 2018 | Vol 7 | Issue 9
ICD 10 Code Site n (%) System
C09 Tonsil 14 (2.0) Pharynx (2%)
C10 Oropharynx 2 (0.3)
C11 and C13 Nasopharynx + hypopharynx 9 (1.3)
C15 Esophagus 15 (2.2) Gastrointestinal tract (11.5%)
C16 Stomach 19 (2.8)
C17 Small intestine 5 (0.7)
C18 Colon 18 (2.6)
C19/C20 Rectum 20 (2.9)
C21 Anus and anal canal 2 (0.3)
C22 Liver and intrahepatic bile duct 8 (1.2) Abdominal organs (3.6%)
C23/C24 Gallbladder and biliary track 10 (1.4)
C25 Pancreas 7 (1.0)
C30 Nasal cavity and middle ear 2 (0.3) Respiratory tract (5.6%)
C32 Larynx 14 (2.0)
C34 Bronchus and lung 23 (3.3)
C38 Heart, mediastinum and pleura 5 (0.7)
C40-C41 Bone and articular cartilage 24 (3.5)
C43 Skin 1 (0.1)
C45-C49 Malignant neoplasms of mesothelial and soft tissue (mesothelioma, Kaposi
sarcoma, peripheral nerves, retro-peritoneum and peritoneum, connective and
soft tissue)
10 (1.4)
C50 Breast 100 (14.5)
C51 Vulva 1 (0.1) Female genital tract (15.1%)
C52 Vagina 2 (0.3)
C53 Cervix uteri 57 (8.3)
C54 Corpus uteri 11 (1.6)
C56 Ovary 33 (4.8)
C60 Penis 6 (0.9) Male genital tract (2.9%)
C61 Prostate 9 (1.3)
C62 Testis 5 (0.7)
C64-C65 Kidney 3 (0.4) Urinary tract (1.1%)
C66 Ureter 1 (0.1)
C67 Bladder 4 (0.6)
C69 Eye and adnexa 3 (0.4)
C70-C72 CNS: Meninges, brain, spinal cord, cranial nerve and other 5 (0.7)
C73 Thyroid gland 7 (1.0)
C76-C80 Malignant neoplasms of ill-defined, secondary and unspecified sites (ill-
defined, LN, respiratory and digestive, other sites)
26 (3.8)
C81 Hodgkin’s lymphoma 12 (1.7) Lympho-hematopoietic system
(9.9%)
C85 Other and unspecified types of non-Hodgkin’s lymphoma 12 (1.7)
C88 Malignant immune-proliferative diseases 2 (0.3)
C90 Multiple myeloma and malignant plasma cell neoplasms 8 (1.2)
C91 Lymphoid leukemia 12 (1.7)
C92 Myeloid leukemia 15 (2.2)
C93-C95 Monocyte and other leukemia 2 (0.3)
C96 Other and unspecied malignant neoplasms of lymphoid, hematopoietic, and
related tissues
5 (0.7)
Table 1: (Continued)

Patel et al. Cancer pattern among newly registered patients in a cancer hospital
International Journal of Medical Science and Public Health 752
2018 | Vol 7 | Issue 9
cancers were the most common in males and breast, cervical,
and esophageal cancers in female patients [Table 3].[9]
A hospital-based study was conducted in Jabalpur regarding
cancer morbidity and mortality profile. The study results
showed that the most common cancer in males was oral cavity
cancer in all age groups except less than 30 years old where
cancer of reticulo-endothelial system was more common.
Whereas in female patients, cervical cancer was more
common in all age groups except those less than 16 years old
in whom cancer of the eye was commonest.[10]
Limitation
The study limitations were a small number of patients
were interviewed due to time limit and since this study was
conducted as a part of the post-graduation thesis where
limited time persist for data collection.
Recommendation
In South Gujarat, a proper cancer registry is required that
collects the data and observes the pattern and magnitude
of cancer. A population-based study is needed for finding
further pattern of cancer in rural and urban areas.
CONCLUSION
Tobacco-related cancer was more common among more than
15-year-old male patients, while among female patients, breast
cancer was the most common cancer in all age groups except
those under 15 years in whom ovarian cancer was more common.
ACKNOWLEDGMENT
I acknowledge support from Dr. Sanjay Nandeshwar
(Medical Director), Dr. Roshni Jariwala (Assistant Medical
Table 2: Age- and gender-wise distribution of common cancer in the present study
Age group Gender 1st most
common
(%)
2nd most
common
(%)
3rd most
common
(%)
0–14 years Boys
(n=13)
LL (38.5) HL (15.4) NHL (15.4)
Girls
(n=8)
Ovary (25) LL (12.5) Kidney (12.5)
15–34 years Male
(n=45)
Tongue (20) Floor of
mouth (17.8)
HL (11.1)
Female
(n=35)
Breast (23) Ovary (8.6) Corpus uterus
(8.6)
35–64 years Male
(n=230)
Floor of
mouth (20.4)
Tongue (17) Colon-rectum
(7.8)
Female
(n=248)
Breast (32.7) Cervix (18.5) Ovary (9.7)
65+ years Male
(n=53)
Lung (17) Prostate (9.4) Tonsil (9.4)
Female
(n=58)
Breast (19) Cervix (15.5) Ovary (8.6)
LL: Lymphoid leukemia, HL: Hodgkin’s lymphoma, NHL: Non-Hodgkin’s lymphoma
Table 3: Age- and gender-wise comparison of most common cancer with other studies[9]
Age
group
(years)
Gender Present
study 2016
Mumbai
2012–2014
Bengaluru
2012–2014
Chennai
2012–2014
Dibrugarh
2012–2014
New Delhi
2012–2014
Chandigarh
2012–2014
0–14 Boys LL Leukemia Leukemia Leukemia Leukemia Leukemia Leukemia
Girls Ovary Leukemia Leukemia Leukemia Leukemia Leukemia Leukemia
15–34 Male Tongue ML Brain ML Testis Bone Brain
Female Breast Breast Cervix Breast Breast Breast Breast
35–64 Male Mouth Mouth Esophagus Mouth Esophagus Mouth Lung
Female Breast Breast Cervix Breast Breast Breast Breast
65+ Male Lung Lung Hypopharynx Lung Hypopharynx Lung Lung
Female Breast Breast Cervix Cervix Esophagus Breast Cervix
LL: Lymphoid leukemia, ML: Myeloid leukemia

Patel et al. Cancer pattern among newly registered patients in a cancer hospital
753 InternationalJournalofMedicalScienceandPublicHealth 2018 | Vol 7 | Issue 9
Director) of DBTCI, Surat, for providing permission for data
collection and the staff of this hospital for co-operations and
providing help at various stages of data collection.
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How to cite this article: Patel K, Patel H, Chaudhari V,
Mehariya S. Cancer pattern among newly registered patients in
a cancer hospital of South Gujarat. Int J Med Sci Public Health
2018;7(9):748-753.
Source of Support: Nil,Conflict of Interest: None declared.