HOSPITAL BASED CANCER REGISTRY REGIONAL CANCER CENTRE, THIRUVANANTHAPURAM ANNUAL REPORT FOR THE YEAR 2011

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2 HOSPITAL BASED CANCER REGISTRY REGIONAL CANCER CENTRE, THIRUVANANTHAPURAM (Partially supported by the National Cancer Registry Programme, Indian Council of Medical Research) ANNUAL REPORT FOR THE YEAR 2011 Published by Regional Cancer Centre Thiruvananthapuram December 2014

3 ACKNOWLEDGEMENTS The Hospital-Based Cancer Registry of Regional Cancer Centre, Thiruvananthapuram expresses its sincere gratitude to the following institutions/ individuals for supporting and promoting the activities of the registry. Indian Council of Medical Research (ICMR), New Delhi National Cancer Registry Programme (NCRP), Bangalore Principal, Medical College, Thiruvananthapuram Medical Superintendent, Medical College, Thiruvananthapuram Medical Superintendent, S.A.T Hospital, Thiruvananthapuram Department of Pathology, Medical College, Thiruvananthapuram Principal, Dental College, Thiruvananthapuram Medical Records Division, Medical College, Thiruvananthapuram Medical Records Division, S.A.T. Hospital, Thiruvananthapuram Divisions of Pathology, Information Systems, Medical Records and all Clinical divisions of RCC, Thiruvananthapuram Regional Cancer Centre, Medical College P.O, Thiruvananthapuram , Kerala, India. Telephone: , Fax:

4 FOREWORD I am pleased to write this foreword for the annual report of the Hospital Based Cancer Registry (HBCR) of Regional Cancer Centre (RCC), Thiruvananthapuram for the year This report provides information on the magnitude and pattern of cancers seen at RCC. Socio-demographic characteristics, diagnostic details, stage at diagnosis and treatment modalities of the patients are presented. The HBCR data contributes greatly to the Thiruvananthapuram and Kollam district Cancer Registries and in the conduct of cancer surveillance studies. The data obtained from the registry has been quite useful for other population based registries in Kerala and Tamil Nadu and planning and evaluating cancer control programmes in the state of Kerala. This report is expected to be of value to academicians, researchers, policy makers and other stake holders. Dr. Paul Sebastian Director Regional Cancer Centre, Thiruvananthapuram

5 CANCER REGISTRY STAFF Dr. Aleyamma Mathew - Additional Professor in Statistics & Epidemiology Mrs. G. Padmakumari Amma - Assistant Professor in Bio-statistics Dr. M.C Kalavathy - Assistant Professor in Epidemiology Dr. Preethi Sara George - Assistant Professor in Bio-statistics Mrs. Anita Nayar - Social Investigator, Sr.Gr Mrs. N. M. Asha - Clerk - Gr I Mr. Jayakumar P - Clerk - Gr I Mr. Prasanthkumar R K - Data Entry Operator Gr I

6 CONTENTS Sl.No. Title Page no Executive Summary Introduction Data abstraction, coding and data entry Data processing and analysis Magnitude of cancers Leading sites of cancer System-wise distribution of cancers Cancer sites by age and sex Tobacco related cancers Distribution of patients by date of diagnosis Cancer sites and method of diagnosis Cancer sites and clinical extent of disease Cancer directed treatment Religion of patients Educational status of patients Marital status of patients Mother tongue of patients Leading cancer sites - detailed information i) Oral cancer

7 19 ii) Pharyngeal cancer iii) Esophageal cancer iv) Stomach cancer v) Rectal cancer vi) Laryngeal cancer vii) Lung cancer viii) Female breast cancer ix) Cervix uteri cancer x) Corpus uteri cancer xi) Ovarian cancer xii) Prostate cancer xiii) Brain and nervous system cancer xiii) Thyroid cancer xiv) Lymphoma xv) Leukemia Cancer sites and morphology Appendix Tables

8 HBCR, Thiruvananthapuram, EXECUTIVE SUMMARY During the year 2011, a total of 14,051 new patients (6872 males and 7179 females) were registered at RCC. Among these, 88.9% (n=12,498; 6255 males and 6243 females) of cases were invasive, 0.35% (n=49) were in-situ and 1.5% (n=207) were boarderline malignancies. Among the cancer cases reported for the year 2011, date of diagnosis was 2011 itself for n=10,961(87.8%) cases and the remaining cases had their date of diagnosis was in the previous years. Average age at diagnosis of cancer cases was 54.2 years (SD: 17.4 years) in males and 50.0 years (SD: 16.7 years) in females. Among males, lung cancer (14.3%) was the leading site followed by cancer of the oral cavity (14.1%). Among females, cancer of the breast (28.4%) was the leading site followed by cancer of the thyroid (13.0%). Cervix uteri cancer is only the third leading female cancer site (8.0%). Children (0-14 years) constituted 4.2% of all cancers. In children, leukemia (46.4% in males & 44.8% in females) was the predominant cancer in both genders. 10.0% of all cancers were in the age group years. In this age group, the leading cancers were leukemia in males (26.4%) and thyroid cancer in females (37.7%). 61.7% of all cancers were in the age group years. In this age group, the leading cancer sites were oral cavity in males (16.1%) and breast in females (35.0%). 24.1% of all cancers were in the age group 65+ years. In this age group, the leading cancer sites were lung in males (17.8%) and breast in females (19.4%). The proportion of tobacco related cancers (oral cavity, pharynx, oesophagus, larynx, lung and urinary bladder) relative to all cancers was 43.17% in males and 12.16% in females. 1

9 HBCR, Thiruvananthapuram, 2011 Among the cancer cases (n=12,498), diagnosis by microscopic verification was available in 94.84% of males and 93.69% of females. Among the microscopically diagnosed cancer cases (n=11,853), histology from primary site was available for 70.6% in males and 84.9% in females. Among the total cancer cases (n=12,498), 68.85% cases reported at RCC for the first time without any cancer directed treatment and the remaining cases (n=3940) had undergone partial treatment elsewhere before registration at RCC. Among the previously untreated cases (n=8605), 72.58% of males and 69.19% of females had disease extending or spreading beyond the primary site of cancer. Among the previously untreated patients (n=8605), intention to treat was radical for 65.75% of patients. Among the previously untreated patients (n=8605), 76.43% received complete cancer directed treatment and among the patients who received first treatment elsewhere (n=3893), 56.38% received rest of the cancer directed treatment at RCC. Chemotherapy alone or combination with other modalities was 50.8% and it was the predominant form of treatment among the previously untreated patients (n=8605), as well as among the patients who received first treatment elsewhere (32.38%). Radiotherapy alone or in combination with the other form of treatment was 38.1% among the previously untreated patients (n=8605) and 31.1% among the patients who received first treatment elsewhere (n=3894). 2

10 HBCR, Thiruvananthapuram, INTRODUCTION The Hospital Based Cancer Registry (HBCR) of the Regional Cancer Centre (RCC), Thiruvananthapuram started in 1982 under the network of Indian Council of Medical Research (ICMR). The RCC is an exclusive cancer specialty hospital established in 1981 and today caters to more than 12,000 new patients in Kerala, which is one third of the new cancer patient load in one calendar year in the State of Kerala (population in Kerala: approximately 31 million as on 2001 census of India). The RCC also caters to patients from the neighbouring state of Tamilnadu and the neighbouring countries such as the Maldives (approximately 1,500 new cancer patients). Initially the HBCR of RCC collected information on cancer patients attending RCC and Medical College Hospitals. All the above hospitals are located in the same campus. Since 1997, the registry is restricted to patients from RCC only. A total of 14,051 new patients (males: 6872; females: 7179) were registered in RCC in the year Among these 12,498 (6255 males and 6243 females) (88.9% of the total) were malignant tumours (Table 1). Since its inception in 1982 (n=3696), the RCC has been recording increasing number of patients and in 2011 there were 14,051 patients which is 280% more than in 1982 (Figures 1 & 2). Table 1: New patient registration, Regional Cancer Centre, Thiruvananthapuram, 2011 Type Male Female Total Malignant Tumours ,498 In-situ Borderline Malignancy Benign Tumours Non-Neoplastic * Diagnosis not confirmed Total ,051 *include pre-malignant conditions and others This statistical report consists of two parts- the first includes detailed information on malignant tumours (n= 12,498) and the second part includes the pattern of other tumours. 3

11 HBCR, Thiruvananthapuram, 2011 Figure 1: Annual number of patient attendance, Regional Cancer Centre, Thiruvananthapuram ( ) Figure 2: Annual number of cancer patients, Hospital-Based Cancer Registry, Thiruvananthapuram ( ) 4

12 HBCR, Thiruvananthapuram, DATA ABSTRACTION, CODING AND DATA ENTRY The data abstraction and entry for malignant tumours are done using an in-house developed web based software rccintranet.org. The demographic details are collected and entered into the computer at the time of new patient registration at RCC and transferred to the core-proforma of the National Cancer Registry Programme (NCRP) of ICMR. The data transfer avoids manual documentation of the first part (demographic details) of the ICMR core-proforma. The second part (diagnostic, treatment and follow-up details) is entered using the above software after retrieving case-sheets from the RCC medical records. All variables in the core-proforma except age and various dates are directly selected from a selection box in the hyper text mark up language (HTML) form. The selection box contains all the codes along with their descriptions for each variable. This helps to avoid mistakes beyond the range of values for each variable. The selection box corresponding to the variables topography and morphology contains the third edition of international classification of diseases for oncology (ICD-O-3) and the international classification of diseases (ICD-10). 4. DATA PROCESSING AND ANALYSIS The database was subjected to a series of consistency checks (comparing the values of certain variables against others) to ensure that valid codes were entered using in-house software. The data were edited based on the error list of cases obtained using the above check program. After editing, the data was sent to the coordinating unit of the National Cancer Registry Programme of Indian Council of Medical Research, Bangalore in an electronic format and subjected again to various range, consistency, unlikely combinations, and duplicate checks. Necessary corrections were done based on the error list of cases sent by the coordinating unit & report was generated. 5. MAGNITUDE OF CANCERS During the year under report, the number of cancer patients recorded in the HBCR was 12,498 (male: 6255; female: 6243). Since its inception in 1982, the registry has been recording increasing number of cancer cases and in 2011, this is 280% more than in 1982 (Figure 2). The male to female ratio was 1:1. 5

13 HBCR, Thiruvananthapuram, LEADING SITES OF CANCER The ten leading cancer sites altogether contributed to 69.1% of all cancers among males and 80.2% of all cancers among females. Lung cancer (14.3%) was the leading site among males followed by cancer of the oral cavity (14.1%). Among females, cancer of the breast (28.4%) was the leading site followed by cancer of the thyroid (13.0%). The third and fourth common cancers were leukemia (8.3%) and lymphoma (7.0%) in males and cervix uteri (8.0%) and oral cancer (6.8%) in females (Tables 2a & 2b & Figures 3a & 3b). Male to female ratios of leading cancer sites are given in Table 3. Table 2a: Number (#) and relative proportion (%) of ten leading sites of cancer (Male) ICD-10 Site # % Rank C33-34 Lung C00-06 Oral Cavity (lip, tongue, mouth) C91-95 Leukaemia C81-85,C96 Lymphoma (HD & NHL) C16 Stomach C09-10,12-14 Pharynx (nasopharynx excluded) C32 Larynx C19-20 Rectum C15 Oesophagus C73 Thyroid C00-C96 All Sites % Table 2b: Number (#) and proportion (%) of ten leading sites of cancer (Female) ICD-10 Site # % Rank C50 Breast C73 Thyroid C53 Cervix Uteri C00-06 Oral Cavity (lip, tongue, mouth) C56 Ovary C91-95 Leukaemia C81-85,C96 Lymphoma (HD & NHL) C54 Corpus Uteri C19-20 Rectum C33-34 Lung C00-C96 All Sites % 6

14 HBCR, Thiruvananthapuram, 2011 Figure 3a. Number and relative proportion (%) of ten leading sites of cancer - Male Figure 3b. Number and relative proportion (%) of ten leading sites of cancer - Female 7

15 HBCR, Thiruvananthapuram, 2011 Table 3: Male to Female ratio of leading cancer sites ICD-10 Site Male (#) Female (#) M to F ratio C32 Larynx : 1 C09-10,12-14 Pharynx : 1 C33-34 Lung : 1 C15 Oesophagus : 1 C16 Stomach : 1 C01-02 Tongue : 1 C03-06 Mouth : 1 C81-85, C96 Lymphoma : 1 C71-72 Brain & nervous system : 1 C19-20 Rectum : 1 C91-95 Leukemia : 1 C73 Thyroid : 1 7. SYSTEM-WISE DISTRIBUTION OF CANCERS Among males, oral and pharyngeal cancer together accounted for 20.0% and respiratory system of cancers for 19.5%. Among females, breast cancer accounted for 28.4% and cancers of the reproductive organs together 18.0% (Figure 4). Figure 4. System-wise distribution (%) of patients Male Female (n=6243) (n= 6255) (%) (%) 3.1 Brain & Nervous System Oral Cavity & Pharynx Thyroid Respiratory System Breast Esophagus & Stomach Other Digestive Organs Urinary tract Reproductive System Bone, Conn.tissue & Skin Leukemia & Myeloma Lymphoma All Others 8. CANCER SITES BY AGE AND GENDER 1.7 8

16 HBCR, Thiruvananthapuram, CANCER SITES BY AGE AND SEX a. Age distribution The peak age group at diagnosis was years in males and years females (Table 4). Mean age at diagnosis was 54.2 years (SD: 17.4 years) for men and 49.9 years (SD: 16.7 years) for women. Site-wise break up by five-year age groups and gender are given in Appendix Tables A1 and A2. Table 4. Age distribution of patients Age in Male (N=6255) Female (N=6243) Total (N=12,498) years # % # % # % b. Distribution of sites by broad age groups 58% of males and 65.3% of females are in the age group of years (Table 5). In children (0-14 years), leukemia (46.4% in males & 44.8% in females) was the predominant cancer in both gender. In years, leading cancer sites were leukemia in males (26.4%) and thyroid cancer in females (37.7%). In years, leading cancer sites were oral cavity in males (16.1%) and breast in females (35.0%). In 65+ years, leading cancer site was lung in males (17.8%) and breast in females (19.4%) (Figure 5 & Tables 6 & 7). Table 5. Number (#) and relative proportion (%) of cancers by broad age groups Age (years) Male (n=6255) Female (n=6243) Total (n=12,498) # % # % # %

17 HBCR, Thiruvananthapuram, Table 6. Number (#) and relative proportion (%) of childhood cancers (0-14 years) ICD-10 Site Male (293) Female (232) Total (525) # % # % # % C00 Lip C07 Salivary gland C16 Stomach C22 Liver C38 Heart & mediastinum C40 Bone of limbs C41 Other bone C44 Skin C47 Peripheral nervous system C48 Retroperitoneum C49 Connective tissue C52 Vagina C56 Ovary C62 Testis C64 Kidney C69 Eye C71 Brain C72 Spinal cord C73 Thyroid gland C74 Adrenal gland C75 Other endocrine gland C76 III defined sites C80 Unknown primary C81 Hodgkins disease C83 Diffuse NHL C85 Other NHL C91 Leukemia, lymphoid C92 Leukemia, myeloid C93 Leukemia, monocytic C94 Other specific leukaemia C95 Leukemia, unspecified C96 Other lymphoid neoplasm Total All sites

18 HBCR, Thiruvananthapuram, 2011 Age Table 7: Number (#) and proportion (%) of leading cancer sites by broad age group Male Female Rank Leading sites # % Rank Leading sites # % leukemia Leukemia Brain & other NS Brain & other NS Lymphoma Bone& conn.tissue Bone & conn.tissue Kidney Adrenal Gland Eye Total Total All sites leukemia All sites Thyroid Lymphoma Breast Bone & conn.tissue Leukemia Thyroid Ovary Brain & other NS Lymphoma Total Total All sites All sites oral cavity Breast Lung Thyroid Lymphoma Cervix Uteri Stomach Ovary Pharynx Oral cavity Total Total All sites Lung Oral Cavity Prostate Pharynx Stomach All sites Breast Oral Cavity Cervix Uteri Ovary Thyroid Total Total All sites All sites

19 65+ yrs yrs yrs 0-14 yrs HBCR, Thiruvananthapuram, 2011 Figure 5: Five leading cancer sites (% in each age group) by broad age groups a. Male Age b. Female 12

20 HBCR, Thiruvananthapuram, TOBACCO RELATED CANCERS Cancers associated with the use of tobacco [tobacco related cancers (TRC)] comprises oral cavity (lip, tongue, gum, floor of mouth and other mouth), oropharynx, hypopharynx, pharynx unspecified, oesophagus, larynx, lung and urinary bladder) (Table 8). The proportion of TRC relative to all cancers was 43.17% in males and 12.16% in females (Figure 6). The peak age group at diagnosis of TRC was years in both males and females (Table 9 & Figure 7). Figure 6: Relative Proportion (%) of Tobacco Related Cancers (2011) MALE FEMALE Figure 7: Distribution (#) of Tobacco Related Cancers by age group (2011) 13

21 HBCR, Thiruvananthapuram, 2011 Table 8: Number (#) and relative proportion (%) of tobacco related cancers Male (n=2700) Female (n=759) Total (n=3459) ICD-10 Site # % # % # % C00 Lip C01 Base of Tongue C02 Other Tongue C03 Gum C04 Floor of mouth C05 Palate C06 Other mouth C09 Tonsil C10 Oropharynx C12 Pyriform sinus C13 Hypopharynx C14 Pharynx, unspecified C15 Oesophagus C32 Larynx C33-C34 Lung C67 Urinary Bladder Table 9: Number (#) and proportion (%) of tobacco related cancers by age Male (n=2700) Female (n=759) Total (n=3459) Age (years) # % # % # %

22 HBCR, Thiruvananthapuram, DISTRIBUTION OF PATIENTS BY DATE OF DIAGNOSIS Among the 12,498 cancer cases reported to RCC in the year 2011, a total of 10,961 cancer cases (87.7%) date of diagnosis was in the same year itself and 7.9% of cases had their date of diagnosis in the year 2010 (Table 10). Table 10. Number (#) and Relative proportion (%) of patients by date of diagnosis Male (n=6255) Female (n=6243) Total (n=12498) Date of diagnosis # % # % # % Previous years New-new cases: These are cases reported for the first time with or without a confirmed diagnosis of malignancy and not undergone any cancer directed treatment before registration at RCC (n=3591 males and 3810 females) (Table 11). New-old cases: These are cases reporting to HBCR in 2011 for the first time and after partial or complete cancer directed treatment elsewhere before registration at RCC (2674 males and 2433 females) (Table 11). Table 11. Number (#) and Relative proportion (%) of new-new & new-old patients Male (n=6255) Female (n=6243) Total (n=12,498) New/old patients # % # % # % New-New New-Old CANCER SITES AND METHOD OF DIAGNOSIS In a total of 11,853 cases (94.84%), the diagnosis was by microscopic verification (93.7% of males and 96.0% of females) (Appendix Tables B1 & B2). Among these, microscopic diagnosis by histology from primary site was 70.6% in males and 84.9% in females and by cytology was 14.8% in males and 6.5% in females. Cytological diagnosis was primarily for liver and lung (Appendix Tables C1 & C2). 15

23 HBCR, Thiruvananthapuram, 2011 Table 12. Number (#) and relative proportion (%) of all cancers by method of diagnosis Method of diagnosis Male (n=6255) Female (n=6243) Total (n=12,498) # % # % # % Microscopic X-ray and other imaging Others * Clinical * others include endoscopy, explorative surgery, biochemical and/or immunological tests Table 13. Number (#) & proportion (%) of all cancers by method of microscopic diagnosis Method of Male (n=5860) Female (n=5993) Total (n=11,853) microscopic # % # % # % diagnosis Cytology Blood film Bone marrow Primary histology Secondary histology CANCER SITES AND CLINICAL EXTENT OF DISEASE The extent of disease was based on clinical assessment before the first treatment. Among the previously untreated cases, 72.6% of males and 69.2% of females had disease extending or spreading beyond the primary site. Site-wise break up by clinical extent of disease are shown in Appendix Tables D1 & D2. Table 14. Number (#) and relative proportion (%) of cancers by clinical extent of disease (excluding previously treated patients) Clinical extent of Male (n=4665) Female (n=3940) Total (n=8605) disease # % # % # % Localized Regional Lymphnode Distant Metastasis Others* Unknown primary * Others mainly refers to lymphomas and leukaemias which are staged differently 16

24 HBCR, Thiruvananthapuram, CANCER DIRECTED TREATMENT Prior treatment only those who received partial or complete cancer directed treatment (CDT) before registration at RCC and not received any further treatment at the RCC, Thiruvananthapuram (males 10.1%; females 15.3%). Prior treatment & treatment at RCC those who received some CDT prior to registration at RCC and also at the RCC (males 14.6%, females 20.8%). Treatment only at RCC those reporting for the first time at RCC with or without a confirmed diagnosis of malignancy and receiving CDT at the RCC (males 55.8%; females 51.1%). No CDT those who have either not received or accepted any CDT and those who have not completed any form of treatment and when the treatment status is unknown (males 1.6%, females 9.9%). Site-wise break up by treatment group are shown in Appendix Tables E1 & E2. Table 15. Number (#) and relative proportion (%) of cancers by treatment at RCC and / or elsewhere Male Female Total Treatment # % # # % # Prior treatment only Prior treatment & treatment at RCC Treatment only at RCC No cancer directed treatment Unknown Total Intention to treat Among the previously untreated patients (n=8605), intention to treat was radical for 65.8% of patients. Site-wise break according to intent to treat for all cancers are given Appendix Tables F1 & F2. 17

25 HBCR, Thiruvananthapuram, 2011 Treatment Table 16. Relative proportion (%) of all cancers by intent to treat 1 st Treatment at RCC Group (%) 1 st Treatment Elsewhere Group (%) Total (%) Male Female Total Male Female Total Male Female Total Palliative Radical Pain relief Symptomatic No treatment Unknown Total Treatment at RCC Among the previously untreated patients (n=8605), 76.4% received cancer directed treatment at RCC (Table 17). Site-wise break up according to treatment status at RCC are given in Appendix Tables G1 & G2. Treatment Received complete CDT Not received any CDT Not accepted any CDT Incomplete CDT Table 17. Relative proportion (%) of cancers based on treatment at RCC 1 st Treatment at RCC Group (%) 1 st Treatment Elsewhere Group (%) Total (%) Male Female Total Male Female Total Male Femal e Total Total d. Type of treatment at RCC Chemotherapy alone or in combination with other forms of cancer directed treatment was the predominant form of treatment at RCC in (45.06%). Radiotherapy alone or in combination with other forms of cancer directed treatment was 39.6% (Tables 18 & 19). Site-wise break up according to the specific type of treatment received at RCC are given in Appendix Tables H1 & H2. 18

26 HBCR, Thiruvananthapuram, 2011 Table 18. Type of treatment (single/ combination) received at RCC Single/ 1 st Treatment at RCC 1 st Treatment Elsewhere Total combination Group (%) Group (%) (%) of therapy Male Female Total Male Female Total Male Female Total Surgery Radiotherapy Chemotherapy Hormone therapy Total Table 19. Relative proportion of cancers based on type of treatment at RCC Single/ 1 st Treatment at RCC 1 st Treatment Elsewhere Total combination of Group (%) Group (%) (%) treatments Male Female Total Male Female Total Male Female Total Surgery (S) Radiotherapy (R) Chemotherapy (C) S+R S+C R+ C S+ R+ C Hormonetherapy (H) S+H R+H C+H S+R+H S+C+H R+C+H S+R+C+H Others No treatment Total

27 HBCR, Thiruvananthapuram, RELIGION OF PATIENTS (Appendix Tables I1 & I2) Table 20. Number (#) and relative proportion (%) of cancers by Religion Male (n=6255) Female (n=6243) Total (n=12498) Religion # % # % # % Hindu Muslim Christian EDUCATIONAL STATUS OF PATIENTS (Appendix Tables J1 & J2) Table 21. Number (#) and relative proportion (%) of cancers by Education Male (n=6255) Female (n=6243) Total (n=12498) Education # % # % # % < 5 years Illiterate Literate Primary Middle Secondary College & Technical Unknown MARITAL STATUS OF PATIENTS (Appendix Tables K1 & K2) Table 22. Number (#) and relative proportion (%) of cancers by Marital status Male (n=6255) Female (n=6243) Total (n=12498) Marital Status # % # % # % Unmarried Married Widowed Divorced Separated MOTHER TONGUE OF PATIENTS (Appendix Tables L1 & L2) Table 23. Number (#) and relative proportion (%) of cancers by Mother tongue Male (n=6255) Female (n=6243) Total (n=12498) Mother Tongue # % # % # % Malayalam Tamil Others

28 HBCR, Thiruvananthapuram, 2011 ORAL CANCER Table 24a. Oral Cancer (n=1305) ICD_10: C00- C06 Male (n=881) Female (n=424) Rank 2 4 Peak Age Group years years Average Age 58.4 years 61.9 years Minimum Maximum Age years 3-97 years Predominant Sub_site (Tongue) 38.3% 38.0% Male to Female ratio 2.1 : 1 Table 24b: Number (#) and relative proportion (%) of Oral Cancer Demographics details Site & Demographic Variables Male (n=881) Female (n=424) Total (n=1305) # % # % # % Site ( ICD-10) Lip (C00) Base of Tongue (C01) Tongue (C02) Gum (C03) Floor of mouth (C04) Palate (C05) Other Mouth (C06) Age Group 0-14 years years years >=65 years Religion Hindu Muslim Christian Education <5 years Illiterate Literate Up to Primary Up to middle school Up to secondary Technical/College Unknown Marital Status Single Married Widowed / Divorced / Separated Mother Tongue Malayalam Tamil Others

29 HBCR, Thiruvananthapuram, 2011 Table 24c. Number (#) and relative proportion (%) of Oral cancers by clinical extent of disease (excluding previously treated patients) Clinical extent of disease Male (n=744) Female (n=375) Total (n=1119) # % # % # % Localized Regional Lymphnode Distant Metastasis Table 24d: Number (#) and relative proportion (%) of Oral Cancer Stage at Diagnosis & Treatment details Patients Received Treatment From RCC Stage at diagnosis and Treatment Details 1 st Treatment at RCC 1 st Treatment Elsewhere Total (n=1305) Group (n=1119) Group (n=186) # % # % # % Stage at diagnosis Intention to Treat Treatment at RCC Stage I Stage II Stage III Stage IV Unknown Palliative Radical Pain relief only Symptomatic No treatment Received Not Received Not Accepted Incomplete Type of Treatment Surgery (S) Radiotherapy (R) Chemotherapy (C) S+R S+C R+C S+R+C R+H Others No treatment

30 HBCR, Thiruvananthapuram, 2011 PHARYNGEAL CANCER Table 25a :Pharyngeal Cancer (n=353) ICD_10: C09-C10, C12-C14 Male (n=302) Female (n=51) Rank 6 >10 Peak Age Group years years Average Age 60.6 years 50.2 years Minimum Maximum Age years years Predominant Sub_site Oropharynx (37.4%) Hypopharynx (72.5%) Male to Female ratio 5.9 : 1 Table 25b: Number (#) and relative proportion (%) of Pharyngeal Cancer Demographics details Site and Demographic Variables Male (n=302) Female (n=51) Total (n=353) # % # % # % Site ( ICD-10) Tonsil (C09) Oropharynx (C10) Pyriform Sinus (C12) Hypopharynx (C13) Pharynx, unspecified (C14) Age Group years years >=65 years Religion Hindu Muslim Christian Education Marital Status Illiterate Literate Up to Primary Up to Middle Up to Secondary College & Technical Single Married Widowed / Divorced / Separated Mother Tongue Malayalam Tamil Others

31 HBCR, Thiruvananthapuram, 2011 Table 25c. Number (#) and relative proportion (%) of Pharyngeal cancers by clinical extent of disease (excluding previously treated patients) Male (n=271) Female (n=44) Total (n=315) Clinical extent of disease # % # % # % Localized Regional Lymphnode Distant Metastasis Table 25d: Number (#) and relative proportion (%) of Pharyngeal Cancer Stage at Diagnosis & Treatment details Stage at diagnosis and Treatment Details Patients Received Treatment From RCC 1 st Treated at RCC 1 st Treatment Group (n=315) elsewhere Group (n=38) Total (n=353) # % # % # % Stage at diagnosis Stage I Stage II Stage III Stage IV Unknown Intention to Treat Palliative Radical Pain relief only Symptomatic No treatment Unknown Treatment at RCC Received Not Received Not Accepted Incomplete Type of Treatment Surgery (S) Radiotherapy (R) Chemotherapy (C) S+R S+C R+C S+R+C Others No treatment

32 HBCR, Thiruvananthapuram, 2011 OESOPHAGEAL CANCER Table 26a :Oesophageal Cancer (n=320) Male (n=232) ICD_10: C15 Female (n=88) Rank 9 >10 Peak Age Group years years Average Age 60.4 years 59.0 years Minimum Maximum Age years years Male to Female ratio 2.6 : 1 Table 26b: Number (#) and relative proportion (%) of Oesophageal Cancer Demographics details Site & Demographic Variables Male (n=232) Female (n=88) Total (n=320) # % # % # % Site ( ICD-10) Cervical oesophagus (C15.0) Thoracic oesophagus (C15.1) Upper 3 rd of oesophagus (C15.3) Middle 3 rd of oesophagus (C15.4) Lower 3 rd of oesophagus (C15.5) Overlapping Lesion (C15.8) Oesophagus, unspecified (C15.9) Age Group years years >=65 years Religion Hindu Muslim Christian Education Illiterate Literate Up to Primary Up to Middle Up to Secondary College & Technical Unknown Marital Status Single Married Widowed / Divorced / Separated Mother Tongue Malayalam Tamil Others

33 HBCR, Thiruvananthapuram, 2011 Table 26c. Number (#) and relative proportion (%) of Oesophageal cancers by clinical extent of disease (excluding previously treated patients) Clinical extent of disease Male (n=209) Female (n=77) Total (n=286) # % # % # % Localized Regional Lymphnode Distant Metastasis Table 26d: Number (#) and relative proportion (%) of Oesophageal Cancer : Stage at Diagnosis & Treatment details Treatment details Intention to Treat Patients Received Treatment From RCC 1 st Treatment at RCC Group (n=286) 1 st Treatment Elsewhere Group (n=34) Total (n=320) # % # % # % Palliative Radical Pain relief only Symptomatic No treatment Unknown Treatment at RCC Received Not Received Not Accepted Incomplete Type of Treatment Surgery (S) Radiotherapy (R) Chemotherapy (C) S+R S+C R+C S+R+C Others No treatment

34 HBCR, Thiruvananthapuram, 2011 STOMACH CANCER Table 27a: Stomach Cancer (n=460) ICD_10: C16 Male (n=332) Female (n=128) Rank 5 >10 Peak Age Group years years Average Age 58.9 years 52.1 years Minimum Maximum Age years years Male to Female ratio 2.6 : 1 Table 27b: Number (#) and relative proportion (%) of Stomach Cancer Demographics details Site and Demographic Variables Male (n=332) Female (n=128) Total (n=460) # % # % # % Site ( ICD-10) Cardia, NOS (C16.0) Fundus of Stomach (C16.1) Pylorus (C16.4) (C16.8) Stomach, unspecified (C16.9) Age Group 0-14 years years years >=65 years Religion Hindu Muslim Christian Education Illiterate Literate Up to Primary Up to Middle Up to Secondary College & Technical Unknown Marital Status Single Married Widowed / Divorced / Separated Mother Tongue Malayalam Tamil Others

35 HBCR, Thiruvananthapuram, 2011 Table 27c. Number (#) and relative proportion (%) of Stomach cancers by clinical extent of disease (excluding previously treated patients) Male (n=254) Female (n=98) Total (n=352) Clinical extent of disease # % # % # % Localized Regional Lymphnode Distant Metastasis Table 27d: Number (#) and relative proportion (%) of Stomach Cancer Treatment details Treatment details 1 st Treatment at RCC Group (n=352) 1 st Treatment elsewhere Group Total (n=460) # % # (n=108) % # % Intention to Treat Palliative Radical Pain relief only Symptomatic No treatment Unknown Treatment at RCC Received Not Received Not Accepted Incomplete Type of Treatment Surgery (S) Radiotherapy (R) Chemotherapy (C) S+R S+C R+C S+R+C Others Unknown

36 HBCR, Thiruvananthapuram, 2011 RECTAL CANCER Table 28a : Rectal Cancer (n=401) ICD_10: C19 C20 Male (n=235) Female (n=166) Rank 8 9 Peak Age Group years years Average Age 59.7 years 58.9 years Minimum Maximum Age years years Male to Female ratio 1.4 : 1 Table 28b: Number (#) and relative proportion (%) of Rectal Cancer Demographics details Site and Demographic Variables Male (n=235) Female (n=166) Total (n=401) Site ( ICD-10) Age Group Religion Education Marital Status # % # % # % Rectosigmoid junction (C19) Rectum (C20) years years >=65 years Hindu Muslim Christian Illiterate Literate Up to Primary Up to Middle Up to Secondary College & Technical Unknown Single Married Widowed / Divorced / Separated Mother Tongue Malayalam Tamil Others

37 HBCR, Thiruvananthapuram, 2011 Table 28c. Number (#) and relative proportion (%) of Rectal cancers by clinical extent of disease (excluding previously treated patients) Clinical extent of Male (n=167) Female (n=106) Total (n=273) disease # % # % # % Localized Regional Lymphnode Distant Metastasis Table 28d: Number (#) and relative proportion (%) of Rectal Cancer Treatment details Patients Received Treatment From RCC Treatment details 1 st Treatment at RCC Group (n=273) 1 st Treatment elsewhere Group (n=128) Total (n=401) # % # % # % Intention to Treat Palliative Radical Pain relief only Symptomatic No treatment Unknown Treatment at RCC Received Not Received Not Accepted Incomplete Type of Treatment Surgery (S) Radiotherapy (R) Chemotherapy (C) S+R S+C R+C S+R+C Others No treatment

38 HBCR, Thiruvananthapuram, 2011 LARYNGEAL CANCER Table 29a : Laryngeal Cancer (n=278) ICD_10: C32 Male (n=261) Female (n=17) Rank 7 >10 Peak Age Group years years Average Age 62.4 years 54.1 years Minimum Maximum Age years years Predominant Sub_site: Glottis 34.5% 41.2% Male to Female ratio 15.3 : 1 Table 29b: Number (#) and relative proportion (%) of Laryngeal Cancer Demographics details Site and Demographic Variables Male (n=261) Female (n=17) Total (n=278) Site ( ICD-10) Age Group Religion Education Marital Status # % # % # % Glottis (C32.0) Supraglottis (C32.1) Larynx, unspecified (C32.9) years >=65 years Hindu Muslim Christian Illiterate Literate Up to Primary Up to Middle Up to Secondary College & Technical Unknown Single Married Widowed / Divorced / Separated Mother Tongue Malayalam Tamil Others

39 HBCR, Thiruvananthapuram, 2011 Table 29c. Number (#) and relative proportion (%) of Laryngeal cancers by clinical extent of disease (excluding previously treated patients) Male (n=227) Female (n=16) Total (n=243) Clinical extent of disease # % # % # % Localized Regional Lymphnode Table 29d: Number (#) and relative proportion (%) of Laryngeal Cancer Stage at Diagnosis & Treatment details Stage at diagnosis & Treatment details Stage at diagnosis 1 st Treatment at RCC Group (n=243) Patients Received Treatment From RCC 1 st Treatment elsewhere Group (n=35) Total (n=278) # % # % # % Stage I Stage II Stage III Stage IV Unknown Intention to Treat Palliative Radical Symptomatic No treatment Unknown Treatment at RCC Received Not Received Not Accepted Incomplete Type of Treatment Surgery (S) Radiotherapy (R) Chemotherapy (C) S+R R+C S+R+C No treatment

40 HBCR, Thiruvananthapuram, 2011 LUNG CANCER Table 30a : Lung Cancer (n=1059) ICD_10: C33-C34 Male (n=895) Female (n=164) Rank 1 >10 Peak Age Group years years Average Age 60.7 years 57.5 years Minimum Maximum Age years years Male to Female ratio 5.5 : 1 Table 30b: Number (#) and relative proportion (%) of Lung Cancer Demographics details Demographic Variables Male (n=895) Female (n=164) Total (n=1059) Age Group # % # % # % years years Religion Education >=65 years Hindu Muslim Christian Illiterate Literate Up to Primary Up to Middle Up to Secondary College & Technical Marital Status Unknown Single Married Widowed/ Divorced / Separated Mother Tongue Malayalam Tamil Others

41 HBCR, Thiruvananthapuram, 2011 Table 30c. Number (#) and relative proportion (%) of Lung cancers by clinical extent of disease (excluding previously treated patients) Clinical extent of disease Male (n=807) Female (n=145) Total (n=952) # % # % # % Localized Regional Lymphnode Distant Metastasis Table 30d: Number (#) and relative proportion (%) of Lung Cancer Treatment details Treatment details 1 st Treatment at RCC Group (n=952) 1 st Treatment elsewhere Group (n=107) Total (n=1059) # % # % # % Intention to Treat Palliative Radical Pain relief only Symptomatic No treatment Unknown Treatment at RCC Received Not Received Not Accepted Incomplete Type of Treatment Surgery (S) Radiotherapy (R) Chemotherapy (C) S+R R+C S+R+C No treatment

42 HBCR, Thiruvananthapuram, 2011 FEMALE BREAST CANCER Table 31a: Female Breast Cancer (n=1772) ICD_10: C50 Rank 1 Peak Age Group Average Age Minimum Maximum Age years 51.1 years years Table 31b: Number (#) and relative proportion (%) of Female Breast Cancer (n=1772) Demographics details Demographic Variables # % Age Group years years >=65 years Religion Hindu Muslim Christian Education Illiterate Literate Up to Primary Up to Middle Up to Secondary College & Technical Marital Status Unknown Single Married Mother Tongue Widowed / Divorced / Separated Malayalam Tamil Others