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

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

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 - 695011, Kerala, India. Telephone: +91 471 252 2249, Fax: +91 471 2550782

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 2011. 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

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

CONTENTS Sl.No. Title Page no. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 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 1 3 5 5 5 6 8 9 13 15 15 16 17 20 20 20 20 21 21

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 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 67

HBCR, Thiruvananthapuram, 2011 1. 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 15-34 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 35-64 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

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

HBCR, Thiruvananthapuram, 2011 2. 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 2011. 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 6255 6243 12,498 In-situ 4 45 49 Borderline Malignancy 79 128 207 Benign Tumours 59 201 260 Non-Neoplastic * 212 279 491 Diagnosis not confirmed 263 283 546 Total 6872 7179 14,051 *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

HBCR, Thiruvananthapuram, 2011 Figure 1: Annual number of patient attendance, Regional Cancer Centre, Thiruvananthapuram (1982-2011) Figure 2: Annual number of cancer patients, Hospital-Based Cancer Registry, Thiruvananthapuram (1982-2011) 4

HBCR, Thiruvananthapuram, 2011 3. 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

HBCR, Thiruvananthapuram, 2011 6. 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 895 14.3 1 C00-06 Oral Cavity (lip, tongue, mouth) 881 14.1 2 C91-95 Leukaemia 521 8.3 3 C81-85,C96 Lymphoma (HD & NHL) 438 7.0 4 C16 Stomach 332 5.3 5 C09-10,12-14 Pharynx (nasopharynx excluded) 302 4.8 6 C32 Larynx 261 4.2 7 C19-20 Rectum 235 3.8 8 C15 Oesophagus 232 3.7 9 C73 Thyroid 224 3.6 10 C00-C96 All Sites 6255 69.1% Table 2b: Number (#) and proportion (%) of ten leading sites of cancer (Female) ICD-10 Site # % Rank C50 Breast 1772 28.4 1 C73 Thyroid 811 13.0 2 C53 Cervix Uteri 502 8.0 3 C00-06 Oral Cavity (lip, tongue, mouth) 424 6.9 4 C56 Ovary 370 5.9 5 C91-95 Leukaemia 358 5.7 6 C81-85,C96 Lymphoma (HD & NHL) 241 3.9 7 C54 Corpus Uteri 196 3.1 8 C19-20 Rectum 166 2.7 9 C33-34 Lung 164 2.6 10 C00-C96 All Sites 6243 80.2% 6

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

HBCR, Thiruvananthapuram, 2011 Table 3: Male to Female ratio of leading cancer sites ICD-10 Site Male (#) Female (#) M to F ratio C32 Larynx 261 17 15.4 : 1 C09-10,12-14 Pharynx 302 51 5.9 : 1 C33-34 Lung 895 164 5.5 : 1 C15 Oesophagus 232 88 2.6 : 1 C16 Stomach 332 128 2.6 : 1 C01-02 Tongue 396 167 2.4 : 1 C03-06 Mouth 467 244 1.9 : 1 C81-85, C96 Lymphoma 438 241 1.8 : 1 C71-72 Brain & nervous system 185 127 1.5 : 1 C19-20 Rectum 235 166 1.4 : 1 C91-95 Leukemia 521 358 1.5 : 1 C73 Thyroid 224 811 0.3 : 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 2.1 20.0 Oral Cavity & Pharynx 8.4 3.6 Thyroid 13 19.5 Respiratory System 3.4 0.3 Breast 28.4 9.0 Esophagus & Stomach 3.5 11.0 Other Digestive Organs 6.5 3.8 Urinary tract 1.0 4.6 Reproductive System 18.0 4.5 Bone, Conn.tissue & Skin 3.1 10.7 Leukemia & Myeloma 7.1 7.1 Lymphoma 3.8 2.8 All Others 8. CANCER SITES BY AGE AND GENDER 1.7 8

HBCR, Thiruvananthapuram, 2011 8. CANCER SITES BY AGE AND SEX a. Age distribution The peak age group at diagnosis was 60-64 years in males and 45-49 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 # % # % # % 0-4 117 1.9 114 1.8 231 1.9 5-9 75 1.2 57 0.9 132 1.1 10-14 101 1.6 61 1.0 162 1.3 15-19 95 1.5 101 1.6 196 1.6 20-24 98 1.6 129 2.1 227 1.8 25-29 121 1.9 200 3.2 321 2.6 30-34 179 2.9 323 5.2 502 4.0 35-39 236 3.8 464 7.4 700 5.6 40-44 336 5.4 602 9.6 938 7.5 45-49 523 8.4 799 12.8 1322 10.6 50-54 676 10.8 721 11.6 1397 11.2 55-59 904 14.5 759 12.2 1663 13.3 60-64 966 15.4 729 11.7 1695 13.6 65-69 749 12.0 504 8.1 1253 10.0 70-74 560 9.0 352 5.6 912 7.3 75+ 519 8.3 328 5.3 847 6.8 b. Distribution of sites by broad age groups 58% of males and 65.3% of females are in the age group of 35-64 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 15-34 years, leading cancer sites were leukemia in males (26.4%) and thyroid cancer in females (37.7%). In 35-64 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) # % # % # % 0-14 293 4.7 232 3.7 525 4.2 15-34 493 7.9 753 12.1 1246 10.0 35-64 3641 58.2 4074 65.3 7715 61.7 65+ 1828 29.2 1184 19.0 3012 24.1 9

HBCR, Thiruvananthapuram, 2011 4 Table 6. Number (#) and relative proportion (%) of childhood cancers (0-14 years) ICD-10 Site Male (293) Female (232) Total (525) # % # % # % C00 Lip 0 0.0 1 0.4 1 0.2 C07 Salivary gland 3 1.0 1 0.4 4 0.8 C16 Stomach 1 0.3 0 0.0 1 0.2 C22 Liver 8 2.7 3 1.3 11 2.1 C38 Heart & mediastinum 6 2.1 2 0.9 8 1.5 C40 Bone of limbs 17 5.8 9 3.9 26 5.0 C41 Other bone 5 1.7 7 3.0 12 2.3 C44 Skin 1 0.3 0 0.0 1 0.2 C47 Peripheral nervous system 1 0.3 3 1.3 4 0.8 C48 Retroperitoneum 1 0.3 0 0.0 1 0.2 C49 Connective tissue 7 2.4 12 5.2 19 3.6 C52 Vagina 0 0.0 1 0.4 1 0.2 C56 Ovary 0 0.0 7 3.0 7 1.3 C62 Testis 3 1.0 0 0.0 3 0.6 C64 Kidney 10 3.4 15 6.5 25 4.8 C69 Eye 5 1.7 11 4.7 16 3.1 C71 Brain 34 11.6 35 15.1 69 13.1 C72 Spinal cord 2 0.7 2 0.9 4 0.8 C73 Thyroid gland 6 2.1 3 1.3 9 1.7 C74 Adrenal gland 15 5.1 7 3.0 22 4.2 C75 Other endocrine gland 1 0.3 2 0.9 3 0.6 C76 III defined sites 0 0.0 1 0.4 1 0.2 C80 Unknown primary 1 0.3 1 0.4 2 0.4 C81 Hodgkins disease 16 5.5 3 1.3 19 3.6 C83 Diffuse NHL 12 4.1 2 0.9 14 2.7 C85 Other NHL 1 0.3 0 0.0 1 0.2 C91 Leukemia, lymphoid 105 35.8 75 32.3 180 34.3 C92 Leukemia, myeloid 19 6.5 22 9.5 41 7.8 C93 Leukemia, monocytic 5 1.7 4 1.7 9 1.7 C94 Other specific leukaemia 1 0.3 1 0.4 2 0.4 C95 Leukemia, unspecified 6 2.1 2 0.9 8 1.5 C96 Other lymphoid neoplasm 1 0.3 0 0.0 1 0.2 Total All sites 293 100.0 232 100.0 525 100.0 10

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 # % 0-14 1 leukemia 136 46.4 1 Leukemia 104 44.8 2 Brain & other NS 36 12.3 2 Brain & other NS 37 15.9 3 Lymphoma 30 10.2 3 Bone& conn.tissue 31 13.4 4 Bone & conn.tissue 30 10.2 4 Kidney 15 6.5 5 Adrenal Gland 15 5.1 5 Eye 11 4.7 Total 247 84.3 Total 198 85.3 15-34 1 All sites leukemia 293 100 130 26.4 1 All sites Thyroid 232 100 284 37.7 2 Lymphoma 76 15.4 2 Breast 117 15.5 3 Bone & conn.tissue 48 9.7 3 Leukemia 81 10.8 4 Thyroid 47 9.5 4 Ovary 55 7.3 5 Brain & other NS 46 9.3 5 Lymphoma 43 5.7 Total 347 70.4 Total 580 77.0 All sites 493 100 All sites 753 100 35-64 1 oral cavity 587 16.1 1 Breast 1425 35.0 2 Lung 561 15.4 2 Thyroid 471 11.6 3 Lymphoma 234 6.4 3 Cervix Uteri 355 8.7 4 Stomach 209 5.7 4 Ovary 241 5.9 5 Pharynx 184 5.1 5 Oral cavity 216 5.3 Total 1775 48.8 Total 2708 66.5 65+ 1 2 3 4 5 All sites Lung Oral Cavity Prostate Pharynx Stomach 3641 100 All sites 4074 100 326 17.8 1 Breast 230 19.4 270 14.8 2 Oral Cavity 199 16.8 137 7.5 3 Cervix Uteri 137 11.6 114 6.2 4 Ovary 67 5.7 114 6.2 5 Thyroid 53 4.5 Total 961 52.6 Total 686 58.0 All sites 1828 100 All sites 1184 100 11

65+ yrs 35-64 yrs 15-34 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

HBCR, Thiruvananthapuram, 2011 9. 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 60-64 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

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 18 0.7 13 1.7 31 0.9 C01 Base of Tongue 59 2.2 6 0.8 65 1.9 C02 Other Tongue 337 12.5 161 21.2 498 14.4 C03 Gum 126 4.7 68 9.0 194 5.6 C04 Floor of mouth 57 2.1 12 1.6 69 2.0 C05 Palate 40 1.5 22 2.9 62 1.8 C06 Other mouth 244 9.0 142 18.7 386 11.2 C09 Tonsil 46 1.7 3 0.4 49 1.4 C10 Oropharynx 113 4.2 5 0.7 118 3.4 C12 Pyriform sinus 70 2.6 4 0.5 74 2.1 C13 Hypopharynx 67 2.5 37 4.9 104 3.0 C14 Pharynx, unspecified 6 0.2 2 0.3 8 0.2 C15 Oesophagus 232 8.6 88 11.6 320 9.3 C32 Larynx 261 9.7 17 2.2 278 8.0 C33-C34 Lung 895 33.2 164 21.6 1059 30.6 C67 Urinary Bladder 129 4.8 15 2.0 144 4.2 Table 9: Number (#) and proportion (%) of tobacco related cancers by age Male (n=2700) Female (n=759) Total (n=3459) Age (years) # % # % # % 0-4 0 0.0 1 0.1 1 0.0 20-24 4 0.2 2 0.3 6 0.2 25-29 7 0.3 3 0.4 10 0.3 30-34 29 1.1 20 2.6 49 1.4 35-39 47 1.7 24 3.2 71 2.1 40-44 94 3.5 40 5.3 134 3.9 45-49 219 8.1 75 9.9 294 8.5 50-54 352 13.0 72 9.5 424 12.3 55-59 469 17.4 103 13.6 572 16.5 60-64 523 19.4 127 16.7 650 18.8 65-69 410 15.2 114 15.0 524 15.2 70-74 284 10.5 82 10.8 366 10.6 75+ 262 9.7 96 12.7 358 10.4 14

HBCR, Thiruvananthapuram, 2011 10. 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 # % # % # % 2011 5462 87.3 5499 88.1 10961 87.7 2010 512 8.2 473 7.6 985 7.9 Previous years 281 4.5 271 4.3 552 4.4 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 4664 74.6 3940 63.1 8604 68.6 New-Old 1591 25.4 2303 36.9 3894 31.2 11. 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

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 5860 93.7 5993 96.0 11853 94.8 X-ray and other imaging 293 4.7 150 2.4 443 3.5 Others * 22 0.4 15 0.2 37 0.3 Clinical 80 1.3 85 1.4 165 1.3 * 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 868 14.8 388 6.5 1256 10.6 Blood film 22 0.4 16 0.3 38 0.3 Bone marrow 635 10.8 427 7.1 1062 9.0 Primary histology 4137 70.6 5088 84.9 9225 77.8 Secondary histology 198 3.4 74 1.2 272 2.3 12. 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 316 6.8 588 14.9 904 10.5 Regional Lymphnode 2430 52.1 2228 56.6 4658 54.1 Distant Metastasis 818 17.5 434 11.0 1252 14.6 Others* 963 20.6 626 15.9 1589 18.5 Unknown primary 138 3.0 64 1.6 202 2.4 * Others mainly refers to lymphomas and leukaemias which are staged differently 16

HBCR, Thiruvananthapuram, 2011 13. 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 630 10.1 952 15.3 1582 12.7 Prior treatment & treatment at RCC 916 14.6 1301 20.8 2217 17.7 Treatment only at RCC 3491 55.8 3191 51.1 6682 53.5 No cancer directed treatment 100 1.6 619 9.9 719 5.8 Unknown 218 3.5 180 2.9 398 3.2 Total 6255 100.0 6243 100.0 12498 100.0 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

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 30.2 17.6 24.4 24.5 12.7 17.5 28.7 15.8 22.3 Radical 58.8 73.9 65.8 53.8 66.3 61.2 57.6 71.1 64.3 Pain relief 1.5 0.5 1.1 3.0 1.3 2.0 1.9 0.8 1.4 Symptomatic 2.8 1.8 2.3 2.5 1.6 2.0 2.7 1.7 2.2 No treatment 0.5 0.5 0.5 8.9 13.4 11.5 2.6 5.2 3.9 Unknown 6.2 5.7 6.0 7.3 4.8 5.8 6.5 5.4 5.9 Total 4665 3940 8605 1590 2303 3893 6255 6243 12498 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 73.4 80.1 76.4 57.0 56.0 56.4 69.2 71.2 70.2 19.2 13.9 16.8 36.8 39.3 38.3 23.7 23.3 23.5 5.9 5.1 5.5 5.7 4.2 4.8 5.9 4.8 5.3 1.5 0.9 1.2 0.6 0.5 0.5 1.3 0.8 1.0 Total 4665 3940 8605 1590 2303 3893 6255 6243 12498 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

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 14.4 25.7 20.6 11.6 17.2 15.2 13.8 23.5 19.3 Radiotherapy 38.9 26.1 31.9 41.3 33.3 36.2 39.3 28.0 32.9 Chemotherapy 45.3 40.2 42.5 42.9 39.2 40.5 44.8 40.0 42.1 Hormone therapy 1.5 7.9 5.0 4.3 10.3 8.1 2.0 8.5 5.7 Total 4652 5629 10281 1120 1991 3111 5772 7620 13392 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) 4.9 7.0 5.9 5.6 5.3 5.4 5.1 6.4 5.8 Radiotherapy (R) 17.6 9.6 13.9 15.3 13.4 14.2 17.0 11.0 14.0 Chemotherapy (C) 26.4 20.7 23.8 18.8 14.2 16.1 24.5 18.3 21.4 S+R 3.9 4.0 4.0 1.7 1.0 1.3 3.4 2.9 3.1 S+C 1.9 9.4 5.3 0.6 3.3 2.2 1.6 7.2 4.4 R+ C 13.3 11.3 12.4 10.2 7.9 8.8 12.5 10.0 11.3 S+ R+ C 3.5 6.5 4.9 0.3 1.8 1.2 2.7 4.8 3.7 Hormonetherapy (H) 0.9 0.5 0.7 1.5 0.9 1.1 1.1 0.6 0.9 S+H 0.0 0.9 0.4 0.0 0.5 0.3 0.0 0.8 0.4 R+H 0.4 0.1 0.3 1.2 0.6 0.8 0.6 0.3 0.4 C+H 0.0 0.8 0.4 0.0 1.5 0.9 0.0 1.1 0.5 S+R+H 0.0 0.3 0.1 0.0 0.2 0.1 0.0 0.2 0.1 S+C+H 0.0 3.2 1.5 0.0 1.3 0.8 0.0 2.5 1.3 R+C+H 0.0 0.2 0.1 0.3 2.6 1.7 0.1 1.1 0.6 S+R+C+H 0.1 5.3 2.5 0.0 1.3 0.8 0.0 3.9 2.0 Others 1.9 1.0 1.5 2.0 0.7 1.2 1.9 0.9 1.4 No treatment 25.1 19.1 22.4 42.5 43.5 43.1 29.5 28.1 28.8 Total 4665 3940 8605 1590 2303 3893 6255 6243 12498 19

HBCR, Thiruvananthapuram, 2011 14. 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 3746 59.9 3938 63.1 7684 61.5 Muslim 1396 22.3 1186 19.0 2582 20.7 Christian 1113 17.8 1119 17.9 2232 17.9 15. 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 117 1.9 114 1.8 231 1.9 Illiterate 382 6.1 521 8.4 903 7.2 Literate 652 10.4 646 10.4 1298 10.4 Primary 1261 20.2 1077 17.3 2338 18.7 Middle 1744 27.9 1454 23.3 3198 25.6 Secondary 1292 20.7 1336 21.4 2628 21.0 College & Technical 782 12.5 1078 17.3 1860 14.9 Unknown 25 0.4 17 0.3 42 0.3 16. 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 667 10.7 528 8.5 1195 9.6 Married 5380 86.0 4301 68.9 9681 77.5 Widowed 176 2.8 1297 20.8 1473 11.8 Divorced 18 0.3 109 1.8 127 1.0 Separated 14 0.2 8 0.1 22 0.2 17. 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 5370 85.9 5425 86.9 10795 86.4 Tamil 801 12.8 729 11.7 1530 12.2 Others 84 1.3 89 1.4 173 1.4 20

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 60-64 years 65-69 years Average Age 58.4 years 61.9 years Minimum Maximum Age 21-89 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) 18 2.0 13 3.1 31 2.4 Base of Tongue (C01) 59 6.7 6 1.4 65 5.0 Tongue (C02) 337 38.3 161 38.0 498 38.2 Gum (C03) 126 14.3 68 16.0 194 14.9 Floor of mouth (C04) 57 6.5 12 2.8 69 5.3 Palate (C05) 40 4.5 22 5.2 62 4.8 Other Mouth (C06) 244 27.7 142 33.5 386 29.6 Age Group 0-14 years 0 0.0 1 0.2 1 0.1 15-34 years 24 2.7 8 1.9 32 2.5 35-64 years 587 66.6 216 50.9 803 61.5 >=65 years 270 30.6 199 46.9 469 35.9 Religion Hindu 606 68.8 290 68.4 896 68.7 Muslim 107 12.1 90 21.2 197 15.1 Christian 168 19.1 44 10.4 212 16.2 Education <5 years 0 0.0 1 0.2 1 0.1 Illiterate 79 9.0 110 25.9 189 14.5 Literate 108 12.3 101 23.8 209 16.0 Up to Primary 189 21.5 75 17.7 264 20.2 Up to middle school 247 28.0 83 19.6 330 25.3 Up to secondary 181 20.5 34 8.0 215 16.5 Technical/College 73 8.3 19 4.5 92 7.0 Unknown 4 0.5 1 0.2 5 0.4 Marital Status Single 31 3.5 7 1.7 38 2.9 Married 808 91.7 232 54.7 1040 79.7 Widowed / Divorced / Separated 42 4.8 185 43.6 227 17.4 Mother Tongue Malayalam 737 83.7 371 87.5 1108 84.9 Tamil 130 14.8 44 10.4 174 13.3 Others 14 1.6 9 2.1 23 1.8 21

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 102 13.7 58 15.5 160 14.3 Regional Lymphnode 637 85.6 313 83.5 950 84.9 Distant Metastasis 5 0.7 4 1.1 9 0.8 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 138 12.3 14 7.5 152 11.6 Stage II 136 12.2 7 3.8 143 11.0 Stage III 249 22.3 19 10.2 268 20.5 Stage IV 518 46.3 41 22.0 559 42.8 Unknown 78 7.0 105 56.5 183 14.0 Palliative 158 14.1 50 26.9 208 15.9 Radical 926 82.9 96 51.6 1022 78.3 Pain relief only 4 0.4 11 5.9 15 1.2 Symptomatic 3 0.3 7 3.8 10 0.8 No treatment 3 0.3 15 8.1 18 1.4 Received 893 79.8 85 45.7 978 74.9 Not Received 120 10.7 78 41.9 198 15.2 Not Accepted 79 7.1 21 11.3 100 7.7 Incomplete 27 2.4 2 1.1 29 2.2 Type of Treatment Surgery (S) 154 13.8 22 11.8 176 13.5 Radiotherapy (R) 244 21.8 14 7.5 258 19.8 5Chemotherapy (C) 141 12.6 16 8.6 157 12.0 S+R 199 17.8 18 9.7 217 16.6 S+C 9 0.8 4 2.2 13 1.0 R+C 85 7.6 9 4.8 94 7.2 S+R+C 86 7.7 1 0.5 87 6.7 R+H 1 0.1 0.0 1 0.1 Others 1 0.1 3 1.6 4 0.3 No treatment 199 17.8 99 53.2 298 22.8 22

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 55-59 years 60-64 years Average Age 60.6 years 50.2 years Minimum Maximum Age 26-85 years 22-74 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) 46 15.2 3 5.9 49 13.9 Oropharynx (C10) 113 37.4 5 9.8 118 33.4 Pyriform Sinus (C12) 70 23.2 4 7.8 74 21.0 Hypopharynx (C13) 67 22.2 37 72.5 104 29.5 Pharynx, unspecified (C14) 6 2.0 2 3.9 8 2.3 Age Group 15-34 years 4 1.3 7 13.7 11 3.1 35-64 years 184 60.9 37 72.5 221 62.6 >=65 years 114 37.7 7 13.7 121 34.3 Religion Hindu 219 72.5 25 49.0 244 69.1 Muslim 41 13.6 17 33.3 58 16.4 Christian 42 13.9 9 17.6 51 14.4 Education Marital Status Illiterate 29 9.6 6 11.8 35 9.9 Literate 50 16.6 6 11.8 56 15.9 Up to Primary 72 23.8 14 27.5 86 24.4 Up to Middle 97 32.1 12 23.5 109 30.9 Up to Secondary 44 14.6 9 17.6 53 15.0 College & Technical 10 3.3 4 7.8 14 4.0 Single 7 2.3 5 9.8 12 3.4 Married 275 91.1 34 66.7 309 87.5 Widowed / Divorced / Separated 20 6.6 12 23.5 32 9.1 Mother Tongue Malayalam 233 77.2 35 68.6 268 75.9 Tamil 68 22.5 14 27.5 82 23.2 Others 1 0.3 2 3.9 3 0.8 23

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 5 1.8 1 2.3 6 1.9 Regional Lymphnode 261 96.3 41 93.2 302 95.9 Distant Metastasis 5 1.8 2 4.5 7 2.2 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 3 1.0 1 2.6 4 1.1 Stage II 22 7.0 1 2.6 23 6.5 Stage III 73 23.2 7 18.4 80 22.7 Stage IV 162 51.4 9 23.7 171 48.4 Unknown 55 17.5 20 52.6 75 21.2 Intention to Treat Palliative 55 17.5 12 31.6 67 19.0 Radical 247 78.4 13 34.2 260 73.7 Pain relief only 1 0.3 5 13.2 6 1.7 Symptomatic 1 0.3 1 2.6 2 0.6 No treatment 0 0.0 3 7.9 3 0.9 Unknown 11 3.5 4 10.5 15 4.3 Treatment at RCC Received 227 72.1 15 39.5 242 68.6 Not Received 43 13.6 20 52.7 63 17.8 Not Accepted 34 10.8 3 7.9 37 10.5 Incomplete 11 3.5 0 0.0 11 3.1 Type of Treatment Surgery (S) 1 0.3 1 2.6 2 0.6 Radiotherapy (R) 122 38.7 5 13.2 127 36.0 Chemotherapy (C) 16 5.1 2 5.3 18 5.1 S+R 2 0.6 0 0.0 2 0.6 S+C 1 0.3 0 0.0 1 0.3 R+C 93 29.5 4 10.5 97 27.5 S+R+C 3 1.0 0 0.0 3 0.8 Others 0 0.0 3 7.9 3 0.8 No treatment 77 24.4 23 60.5 100 28.3 24

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 60-64 years 60-64 years Average Age 60.4 years 59.0 years Minimum Maximum Age 32-90 years 31-93 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) 1 0.4 1 1.1 2 0.6 Thoracic oesophagus (C15.1) 5 2.2 2 2.3 7 2.2 Upper 3 rd of oesophagus (C15.3) 21 9.1 7 8.0 28 8.8 Middle 3 rd of oesophagus (C15.4) 52 22.4 31 35.2 83 25.9 Lower 3 rd of oesophagus (C15.5) 76 32.8 18 20.5 94 29.4 Overlapping Lesion (C15.8) 6 2.6 0 0.0 6 1.9 Oesophagus, unspecified (C15.9) 71 30.6 29 33.0 100 31.3 Age Group 15-34 years 2 0.9 2 2.3 4 1.3 35-64 years 154 66.4 57 64.8 211 65.9 >=65 years 76 32.8 29 33.0 105 32.8 Religion Hindu 152 65.5 59 67.0 211 65.9 Muslim 39 16.8 20 22.7 59 18.4 Christian 41 17.7 9 10.2 50 15.6 Education Illiterate 25 10.8 7 8.0 32 10.0 Literate 35 15.1 21 23.9 56 17.5 Up to Primary 50 21.6 22 25.0 72 22.5 Up to Middle 65 28.0 22 25.0 87 27.2 Up to Secondary 42 18.1 11 12.5 53 16.6 College & Technical 14 6.0 5 5.7 19 5.9 Unknown 1 0.4 0 0.0 1 0.3 Marital Status Single 4 1.7 2 2.3 6 1.9 Married 217 93.5 51 58.0 268 83.8 Widowed / Divorced / Separated 11 4.7 35 39.8 46 14.4 Mother Tongue Malayalam 196 84.5 71 80.7 267 83.4 Tamil 33 14.2 14 15.9 47 14.7 Others 3 1.3 3 3.4 6 1.9 25

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 11 5.3 8 10.4 19 6.6 Regional Lymphnode 143 68.4 53 68.8 196 68.5 Distant Metastasis 55 26.3 16 20.8 71 24.8 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 119 41.6 10 29.4 129 40.3 Radical 155 54.2 11 32.4 166 51.9 Pain relief only 0 0.0 2 5.9 2 0.6 Symptomatic 2 0.7 1 2.9 3 0.9 No treatment 0 0.0 5 14.7 5 1.6 Unknown 10 3.5 5 14.7 15 4.7 Treatment at RCC Received 221 77.3 17 50.0 238 74.4 Not Received 40 13.9 15 44.1 55 17.2 Not Accepted 14 4.9 1 2.9 15 4.7 Incomplete 11 3.8 1 2.9 12 3.8 Type of Treatment Surgery (S) 7 2.4 1 2.9 8 2.5 Radiotherapy (R) 84 29.4 8 23.5 92 28.8 Chemotherapy (C) 44 15.4 2 5.9 46 14.4 S+R 1 0.3 0 0.0 1 0.3 S+C 11 3.8 0 0.0 11 3.4 R+C 79 27.6 5 14.7 84 26.3 S+R+C 5 1.7 0 0.0 5 1.6 Others 1 0.3 2 5.9 3 0.9 No treatment 54 18.9 16 47.1 70 21.9 26

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 55-59 years 60-64 years Average Age 58.9 years 52.1 years Minimum Maximum Age 13-83 years 22-80 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) 78 23.5 26 20.3 104 22.6 Fundus of Stomach (C16.1) 1 0.3 0 0.0 1 0.2 Pylorus (C16.4) 4 1.2 1 0.8 5 1.1 (C16.8) 4 1.2 0 0.0 4 0.9 Stomach, unspecified (C16.9) 245 73.8 101 78.9 346 75.2 Age Group 0-14 years 1 0.3 0.0 1 0.2 15-34 years 8 2.4 18 14.1 26 5.7 35-64 years 209 63.0 82 64.1 291 63.3 >=65 years 114 34.3 28 21.9 142 30.9 Religion Hindu 197 59.3 88 68.8 285 62.0 Muslim 87 26.2 21 16.4 108 23.5 Christian 48 14.5 19 14.8 67 14.6 Education Illiterate 26 7.8 12 9.4 38 8.3 Literate 44 13.3 19 14.8 63 13.7 Up to Primary 73 22.0 33 25.8 106 23.0 Up to Middle 112 33.7 28 21.9 140 30.4 Up to Secondary 54 16.3 26 20.3 80 17.4 College & Technical 22 6.6 10 7.8 32 7.0 Unknown 1 0.3 0.0 1 0.2 Marital Status Single 4 1.2 5 3.9 9 2.0 Married 314 94.6 89 69.5 403 87.6 Widowed / Divorced / Separated 14 4.2 34 26.6 48 10.4 Mother Tongue Malayalam 270 81.3 90 70.3 360 78.3 Tamil 60 18.1 37 28.9 97 21.1 Others 2 0.6 1 0.8 3 0.7 27

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 3 1.2 1 1.0 4 1.1 Regional Lymphnode 205 80.7 74 75.5 279 79.3 Distant Metastasis 46 18.1 23 23.5 69 19.6 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 147 41.8 46 42.6 193 41.9 Radical 143 40.6 35 32.4 178 38.7 Pain relief only 8 2.3 4 3.7 12 2.6 Symptomatic 19 5.4 10 9.3 29 6.3 No treatment 1 0.3 8 7.4 9 1.9 Unknown 34 9.7 5 4.6 39 8.5 Treatment at RCC Received 197 56.0 57 52.8 254 55.2 Not Received 109 30.9 47 43.6 156 33.9 Not Accepted 43 12.2 4 3.7 47 10.2 Incomplete 3 0.9 0 0.0 3 0.7 Type of Treatment Surgery (S) 11 3.1 0 0.0 11 2.4 Radiotherapy (R) 8 2.3 4 3.7 12 2.6 Chemotherapy (C) 111 31.5 34 31.5 145 31.5 S+R 3 0.9 0 0.0 3 0.7 S+C 27 7.7 0 0.0 27 5.9 R+C 12 3.4 16 14.8 28 6.1 S+R+C 17 4.8 1 0.9 18 3.9 Others 11 3.1 2 1.9 13 2.8 Unknown 152 43.2 51 47.2 203 44.1 28

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 65-69 years 60-64 years Average Age 59.7 years 58.9 years Minimum Maximum Age 27-90 years 20-85 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) 47 20.0 26 15.7 73 18.2 Rectum (C20) 188 80.0 140 84.3 328 81.8 15-34 years 5 2.1 4 2.4 9 2.2 35-64 years 140 59.6 107 64.5 247 61.6 >=65 years 90 38.3 55 33.1 145 36.2 Hindu 127 54.0 111 66.9 238 59.4 Muslim 66 28.1 31 18.7 97 24.2 Christian 42 17.9 24 14.5 66 16.5 Illiterate 9 3.8 20 12.0 29 7.2 Literate 20 8.5 23 13.9 43 10.7 Up to Primary 49 20.9 26 15.7 75 18.7 Up to Middle 69 29.4 50 30.1 119 29.7 Up to Secondary 57 24.3 27 16.3 84 20.9 College & Technical 31 13.2 19 11.4 50 12.5 Unknown 0 0.0 1 0.6 1 0.2 Single 6 2.6 2 1.2 8 2.0 Married 219 93.2 108 65.1 327 81.5 Widowed / Divorced / Separated 10 4.3 56 33.7 66 16.5 Mother Tongue Malayalam 213 90.6 153 92.2 366 91.3 Tamil 18 7.7 12 7.2 30 7.5 Others 4 1.7 1 0.6 5 1.2 29

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 2 1.2 4 3.8 6 2 Regional Lymphnode 132 79.0 83 78.3 215 132 Distant Metastasis 33 19.8 19 17.9 52 33 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 50 18.3 32 25.0 82 20.5 Radical 209 76.6 76 59.4 285 71.1 Pain relief only 0 0.00 6 4.7 6 1.5 Symptomatic 1 0.4 5 3.9 6 1.5 No treatment 0 0.0 2 1.6 2 0.5 Unknown 13 4.8 7 5.5 20 4.9 Treatment at RCC Received 228 83.5 86 67.2 314 78.3 Not Received 24 8.8 32 25 56 14 Not Accepted 17 6.2 10 7.8 27 6.7 Incomplete 4 1.5 0 0.0 4 1.0 Type of Treatment Surgery (S) 19 7.0 2 1.6 21 5.2 Radiotherapy (R) 14 5.1 15 11.7 29 7.2 Chemotherapy (C) 37 13.6 26 20.3 63 15.7 S+R 3 1.1 0 0.0 3 0.7 S+C 16 5.9 0 0.0 16 4.0 R+C 59 21.6 37 28.9 96 23.9 S+R+C 83 30.4 4 3.1 87 21.7 Others 1 0.4 2 1.6 3 0.7 No treatment 41 15.0 42 32.8 83 20.7 30

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 60-64 years 60-64 years Average Age 62.4 years 54.1 years Minimum Maximum Age 35-89 years 34-74 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) 90 34.5 7 41.2 97 34.9 Supraglottis (C32.1) 82 31.4 6 35.3 88 31.7 Larynx, unspecified (C32.9) 89 34.1 4 23.5 93 33.5 15-34 0 0.0 1 5.9 1 0.4 35-64 years 154 59.0 13 76.5 167 60.1 >=65 years 107 41.0 3 17.6 110 39.6 Hindu 160 61.3 12 70.6 172 61.9 Muslim 49 18.8 2 11.8 51 18.3 Christian 52 19.9 3 17.6 55 19.8 Illiterate 22 8.4 2 11.8 24 8.6 Literate 31 11.9 0 0.0 31 11.2 Up to Primary 57 21.8 7 41.2 64 23.0 Up to Middle 82 31.4 3 17.6 85 30.6 Up to Secondary 48 18.4 2 11.8 50 18.0 College & Technical 20 7.7 3 17.6 23 8.3 Unknown 1 0.4 0 0.0 1 0.4 Single 6 2.3 1 5.9 7 2.5 Married 245 93.9 12 70.6 257 92.4 Widowed / Divorced / Separated 10 3.8 4 23.5 14 5.0 Mother Tongue Malayalam 234 89.7 14 82.4 248 89.2 Tamil 25 9.6 3 17.6 28 10.1 Others 2 0.8 0 0.0 2 0.7 31

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 66 29.1 6 37.5 72 29.6 Regional Lymphnode 161 70.9 10 62.5 171 70.4 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 76 31.3 5 14.3 81 29.1 Stage II 33 13.6 2 5.7 35 12.6 Stage III 53 21.8 3 8.6 56 20.1 Stage IV 68 28.0 8 22.9 76 27.3 Unknown 13 5.3 17 48.6 30 10.8 Intention to Treat Palliative 22 9.1 8 22.9 30 10.8 Radical 214 88.1 20 57.1 234 84.2 Symptomatic 0 0.0 1 2.9 1 0.4 No treatment 0 0.0 3 8.6 3 1.1 Unknown 7 2.9 3 8.6 10 3.6 Treatment at RCC Received 201 82.7 17 48.6 218 78.4 Not Received 18 7.4 16 45.7 34 12.3 Not Accepted 20 8.2 1 2.9 21 7.6 Incomplete 4 1.6 1 2.9 5 1.8 Type of Treatment Surgery (S) 3 1.2 9 25.7 12 4.3 Radiotherapy (R) 146 60.1 5 14.3 151 54.3 Chemotherapy (C) 7 2.9 0 0.0 7 2.5 S+R 9 3.7 1 2.9 10 3.6 R+C 35 14.4 3 8.6 38 13.7 S+R+C 5 2.1 0 0.0 5 1.8 No treatment 38 15.6 17 48.6 55 19.8 32

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 60-64 years 55-59 years Average Age 60.7 years 57.5 years Minimum Maximum Age 21-88 years 28-84 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 # % # % # % 15-34 years 8 0.9 6 3.7 14 1.3 35-64 years 561 62.7 111 67.7 672 63.5 Religion Education >=65 years 326 36.4 47 28.7 373 35.2 Hindu 462 51.6 104 63.4 566 53.4 Muslim 286 32.0 33 20.1 319 30.1 Christian 147 16.4 27 16.5 174 16.4 Illiterate 77 8.6 22 13.4 99 9.3 Literate 150 16.8 18 11.0 168 15.9 Up to Primary 224 25.0 35 21.3 259 24.5 Up to Middle 240 26.8 41 25.0 281 26.5 Up to Secondary 132 14.7 32 19.5 164 15.5 College & Technical 68 7.6 16 9.8 84 7.9 Marital Status Unknown 4 0.4 0 0.0 4 0.4 Single 14 1.6 2 1.2 16 1.5 Married 859 96.0 107 65.2 966 91.2 Widowed/ Divorced / Separated 22 2.5 55 33.5 77 7.3 Mother Tongue Malayalam 797 89.1 128 78.0 925 87.3 Tamil 86 9.6 34 20.7 120 11.3 Others 12 1.3 2 1.2 14 1.3 33

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 23 2.9 4 2.8 27 2.8 Regional Lymphnode 332 41.1 49 33.8 381 40.0 Distant Metastasis 452 56.0 92 63.4 544 57.1 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 677 71.1 73 68.2 750 70.8 Radical 183 19.2 19 17.8 202 19.1 Pain relief only 15 1.6 6 5.6 21 2.0 Symptomatic 21 2.2 3 2.8 24 2.3 No treatment 2 0.2 1 0.9 3 0.3 Unknown 54 5.7 5 4.7 59 5.6 Treatment at RCC Received 693 72.8 70 65.4 763 72.0 Not Received 198 20.8 28 26.2 226 21.3 Not Accepted 47 4.9 6 5.6 53 5.0 Incomplete 14 1.5 3 2.8 17 1.6 Type of Treatment Surgery (S) 3 1.2 9 25.7 12 4.3 Radiotherapy (R) 146 60.1 5 14.3 151 54.3 Chemotherapy (C) 7 2.9 0 0.0 7 2.5 S+R 9 3.7 1 2.9 10 3.6 R+C 35 14.4 3 8.6 38 13.7 S+R+C 5 2.1 0 0.0 5 1.8 No treatment 38 15.6 17 48.6 55 19.8 34

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 45-49 years 51.1 years 21-90 years Table 31b: Number (#) and relative proportion (%) of Female Breast Cancer (n=1772) Demographics details Demographic Variables # % Age Group 15-34 years 117 6.6 35-64 years 1425 80.4 >=65 years 230 13.0 Religion Hindu 1108 62.5 Muslim 287 16.2 Christian 377 21.3 Education Illiterate 91 5.1 Literate 117 6.6 Up to Primary 290 16.4 Up to Middle 429 24.2 Up to Secondary 444 25.1 College & Technical 397 22.4 Marital Status Unknown 4 0.2 Single 45 2.5 Married 1424 80.4 Mother Tongue Widowed / Divorced / Separated 303 17.1 Malayalam 1538 86.8 Tamil 214 12.1 Others 20 1.1 35