Geographic mapping of head and neck cancers in Nanded, Maharashtra, India: A hospital based study

Namdhari BH 1, Deshpande SA2

1Dr Balkrishna Harishchandrarao Namdhari, Associate Professor, 2Shubha Arvind Deshpande, Professor and Head, all authors are affiliated with Department of Pathology, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra State, India

Address for Correspondence: Dr Balkrishna Harishchandrarao Namdhari, 213, Sanman Towers, 3-1-783 Vazirabad, Nanded, Maharashtra State, India. Email: namdhari@writeme.com

Abstract

Background: Head and neck cancers are most common in developing countries. It is the most common cancer of males in India and fifth in females. India is classified as a lower middle income group country by World Bank. Nanded, Maharashtra, India is a district place where this government medical college and hospital is situated; this is a tertiary medical care centre and caters nearby districts like Parbhani, Hingoli, Yavatmal and Adilabad. Methods: This is cross sectional study of 18 months. Cases are selected with superficially palpable head and neck lesions referred to Cytology OPD, and hospital ward with clinical diagnosis of any head and neck neoplastic lesions. An FNAC smear in the Cytology section of CCL and in ward finally the microscopic verification is done by biopsies with histopathological confirmation is done and confirmed cases are included in this study. Geographical mapping done by making the master chart of patient’s permanent addresses. Patients categorized as per codes by NCRP used for Atlas of cancer of India. Results: Relative proportion percentage of head and neck cancers is 88.33 were from Nanded district, followed by Hingoli, Parbhani, Yavatmal from Maharashtra state and Adilabad districts from Telangana state. Conclusions: This centre caters more than five districts including Maharashtra and Telangana state, in this hospital based ‘head and neck cancer registry’ of microscopically confirmed cancers, maximum cases are from Nanded district. This institute does not cover the geographic area mentioned in the literature of highest and lowest relative proportion percentage of head and neck cancers.

Key words: Cancer Registry, District Data, Geographic Pathology, Head and Neck Cancers

Manuscript received: 12th September 2016, Reviewed: 25th September 2016
Author Corrected: 10th October 2016, Accepted for Publication: 25th October 2016

Introduction

Head and neck cancers form only 1-4 % of all cancers in the western world and are common cancers in South and East Asian countries. Oral cancers are most predominant form of head and neck squamous cell carcinomas in India, Pakistan, and South East Asian countries. Oropharyngeal and tongue cancers are common in western world. Head and neck cancers are most common cancers in developing countries. It is most common cancer of males in India and fifth in females [1].

Europe and United States of America reports of head and neck cancers are increasing among the young particularly in tongue. Oral cancers formed the majority of head and neck cancers with predilection for tongue except in rural males in whom pharynx was predominant sub site. Incidence of head and neck squamous cell carcinomas are reducing and is attributed to decrease in the prevalence of tobacco use. The increase in incidence of tongue cancers may suggest factors other than tobacco and alcohol in genesis [2].

India is classified as a lower middle income group country by World Bank. Ninety per cent of oral cancer patients in rural India belong to the lower middle socioeconomic class and 36% are below poverty line. Indian Council of Medical Research has shown the incidence of various cancers in different parts of India (Table 1) [1], a pan India study of microscopically diagnosed cancers in 2001-2002 from 68 districts across India shown in (Table. 2) [4]. PBCR data shows MAAR is the highest for following topography sites (Table 3).

Nanded, Maharashtra, India is a district place where this government medical college and hospital is situated, this is a tertiary medical care centre, and this centre caters nearby districts like Parbhani, Hingoli, Yavatmal from Maharashtra state and Adilabad district from Telangana state. Nanded city is situated on the river side of Godavari is also called as ‘dakshin ganga’ previously it was a part of Nizam State .Now this district is a part of Marathwada division of Maharashtra state of India. There is a famous Gurdwara of the 10th Guru of Sikh religion Shree Guru Gobind Singh Ji.

Methods

This is a tertiary care and the referral centre caters more than five districts including Maharashtra and Telangana state, as this activity belongs to hospital based head and neck cancer registry of microscopically confirmed cancers which are having highest accuracy of diagnosis.

The present study was undertaken in the department of Pathology, Government Medical College and Hospital, Nanded, India which is a leading histopathology laboratory in the city. This is a prospective & cross-sectional study over the period of 18 months from January 2008 to June 2009. The inclusion criteria were as below.

1. Sample collection method was the patients collection presented with superficially palpable head and neck lesion referred to cytology OPD.

2. Also samples of patient’s admitted in hospital ward of this institute with clinical diagnosis of any head and neck neoplastic lesions.

3. Above selected patients with head and neck lesions the FNAC smears were taken and cytologically positive patients referred for biopsy procedures.

4. Microscopic verification done by biopsy histopathology examination (HPE) so in this way the histopathological confirmation done on cytologically    suspected cases for malignancies. These confirmed cases were included in present study.

5. Exclusion criteria were dropping the benign tumors and tumor like lesions from the Head and Neck Neoplastic Lesions.

Thus remaining the head and neck cancer cancers were included for geographical mapping, in which their permanent addresses are categorized as per codes mentioned in the reference quoted as similar type of study conducted by NCRP for Atlas of cancer of India [4]. All these cases in specified period were studied prospectively in the department of Pathology, Government Medical College and Hospital, Nanded, Maharashtra, India. Statistical method used was the district wise mapping done by calculating percentage of head and neck cancers in the hospital catering the districts in the Maharashtra state and nearby Telangana state.

Results

In the present study, the geographic mapping of cases of histopathologically confirmed head and neck malignancy was done, the maximum number of cases of head and neck cancers were from Nanded district (88.33%) followed by Hingoli ,Parbhani ,Yavatmal and Adilabad districts (Table 4).

Table-1: Incidence of head and neck cancers in Indian scenario

Serial

Number

District

State

Portion

Of India

Site

Involving

cancer

Sex

Incidence per

100000 population

Remarks

1

Aizawl

Mizoram

North East

Lower Pharynx

Men

11.5

World’s highest incidence

2

Tongue

Men

07.6

Highest incidence

3

Kohima

Nagaland

Nasopharyngeal cancers

World’s highest incidence

Table-2: Head and Neck cancers, highest incidence Geographical locations 2001-02 [4]

Serial Number

States

Portion of India

Sex- Cancer Site

1

Aizawl

Mizoram

 

 

 

 

North East India

Males-Lower Pharynx

2

Males-Tongue

3

Kohima

Nagaland

 

 

Males-Nasopharyngeal Cancers

 

4

Imphal

Manipur

5

Karnataka

Tamil Nadu

Kerala

 

Southern States in India

 

Males and Females-Mouth

6

Gujarat

Goa

Karnataka

Kerala

Sikkim

Nagaland

Manipur

 

 

 

South west coastal districts and

North East India

 

 

 

Females-Thyroid cancers

Table-3: Leading Topographic sites in the region of Head and Neck cancers Population Based Cancer Registry Data [3]

Sr No

Topographic sites as per ICD 10

Per100000 population

Gender

PBCR

1

Tongue            C01-C02

10.0

 

Males

 

Bhopal

2

Mouth              C03-C06

08.6

3

Naso pharynx  C11

00.7

4

Thyroid            C73

02.6

Females

Bengaluru

Table-4: Geographic Mapping (district wise distribution) of Head and Neck cancers in histopathologically confirmed cases showing relative proportion percentage of

Sr No.

District

State

Geographic Area Code

Number

%

1

Nanded

 

 

Maharashtra State

2715

53

88.33

2

Hingoli

2716

02

03.33

3

Parbhani

2717

02

03.33

4

Yavatmal

2714

02

03.33

5

Adilabad

Telangana State

2801

01

01.68

6

TOTAL

Hospital Based Head & Neck Cancer Registry

60

100.0

Table-5: Comparison of cancer cases in present study and previous study at the same institute [5]

Sr No.

District.

State.

Geographic

Area code.

‘All Cancers’ number in percentage in previous study.

2001-2002 [5].

‘Head and Neck

Cancers’ percentage

in present study

2008-2009.

1

Nanded

Maharashtra

2715

78.7

88.33

2

Hingoli

2716

06.7

03.33

3

Parbhani

2717

04.7

03.33

4

Yavatmal

2714

04.1

03.33

5

Adilabad

Telangana

2801

01.4

01.68

6

Other Districts

-

04.5

00.00

7

TOTAL

Hospital Based Cancer Registry

100.0

100.0

Table-6: Comparisons of Head and Neck cancer geographic mapping in India and Internationally by AAR [4]

Serial Number

Topography

Site

Gender

INDIAN

All World PBCR

Internationally

PBCR

Districts

Leading

AAR

Lowest

AAR

Leading

AAR

Lowest

AAR

Leading

AAR

Lowest

AAR

1

Tongue

Male

 

 

 

 

 

Bhopal

 

 

 

 

 

Barshi

Aizawl

MZ

Imphal West

MR

 

Bhopal

India

 

Qi. County

China

2

Mouth

Male

Wardha

MH

Bhavnagar

GJ

Singapore

Malay

3

Mouth

Female

Kolar

KA

Thrissur

KL

 

Pakistan

South Karachi

Qi. County

China

4

Tonsil

Male

Darrang

AS

Kancheepuram

TN

 

 

Calvados

France

Algiers

Algeria

5

Oro

pharynx

Male

Bengaluru

 

 

 

Mumbai

Barpeta

AS

Dakshin Kannada

KA

 

Costa Rica

6

Naso pharynx

Male

Chennai

Kohima

NL

Thane

MH

Hong Kong

China

Quito

Equador

7

Hypo pharynx

Male

Bhopal

Delhi

Aizawl

MZ

Chamrajnagar

KA

Bas-Rhin

Fran.

Bamako

Mali

8

Pharynx

Male

Mumbai

Chennai

Anand

GJ

Vadodara

GJ

Somme

France

Algiers

Algeria

9

Larynx

Male

Delhi

 

 

Barshi

 

Imphal West

MR

Villupuram

TN

Spain

Zaragoza

The

Gambia

10

Thyroid

Female

Bengaluru

Imphal East

MR

 

East Godavari

AP

USA

Filipino

Qi. County

China

Discussion

When compared with geographical data of same institute data of ‘all cancers’ is somewhat comparable [4]. The cases of head and neck cancers are more than all other cancers hence it may be stated that the incidence of head and neck cancers may be more than Nanded district, it may be emergence of head and neck cancers in Adilabad district of Telangana state in recent years .The data of head and neck cancers in the previous study is not available while the data of all cancers is available in relation with the same geographical area (Table 5).

In 82 districts pan India study of 2001-2002 highlights some topographic sites with gender showing highest incidence of geographical locations in India and internationally are in (Table 6) [4].

Bhopal, Bengaluru, Chennai, Mumbai and Delhi PBCR data is showing the highest incidence of head and neck cancers in which, Bhopal covers maximum topographic sites in the region of head and neck include Males-Tongue, Males-Mouth, Males-Tonsil and Males-hypo pharynx, Females-Mouth, Bengaluru PBCR covers Male-Oropharynx Females-Thyroid, Chennai PBCR covers Males- Naso pharynx, Mumbai PBCR covers Males-Pharynx and Delhi PBCR covers Males-Larynx. Internationally Bhopal PBCR is having highest incidence in the world in the topographic sites of Male-Tongue and Male-Mouth [4].

District wise data shows highest incidence in India, Aizawl MZ shows the topographic site Males-Tongue, and Male-Hypo pharynx, Imphal west MR the site is Male-Larynx, Imphal east MR the site is Female-Thyroid, Anand GJ the site is Male-Pharynx, Kohima NL the site is Male-Naso Pharynx, Barpeta AS the site is Male-Oropharynx, Darrang AS the site is Male-Tonsil, Kolar KA Female-Mouth and Wardha MH the site is Male –Mouth [4].
Conclusions
This tertiary care referral centre caters more than five districts including Maharashtra and Telangana state, as this activity belongs to hospital based head and neck cancer registry of microscopically confirmed cancers which is having highest accuracy of diagnosis and maximum cases are from Nanded district of Maharashtra state which is followed by Hingoli district. Very small population of Telangana state by this tertiary care centre is covered. This institute does not cover any geographic area mentioned in the literature of highest and lowest proportion percentage of head and neck cancers [4] [6].
Acknowledgements: I sincerely express my thanks to my post graduate student Dr Amit U. Maniyar Green Cross Path Lab Ahmadabad who has created such data for his dissertation for M.D. (Pathology) (MUHS) (2010) and also express my thanks to Dr A. Nandakumar, NCRP Bengaluru, India, who has created ‘An Atlas of Cancer of India’ with the support of World Health Organization from whom I received an inspiration for this project.

Abbreviations

AAR    : Age Adjusted Rate/100000
CCL    : Central Clinical Laboratory
FNAC    : Fine Needle Aspiration Cytology
MAAR    : Microscopic Age Adjusted Rate/100000
NCRP    : National Cancer Registry Program
OPD    : Out Patient Department
PBCR    : Population Based Cancer Registry
WHO    : World Health Organization

Funding: Nil, Conflict of interest: None initiated.
Permission from IRB: Yes

References

1. Joshi P, Dutta S, Chaturvedi P, Nair S. Head and neck cancers in developing countries, Rambam Maimonides Med J 2014; 5(2).e0009.doi:10.5041/RMMJ.10143. [PubMed]

2. Elango JK ,Gangadharan P ,Sumithra S ,Kuriakose MA .Trends of head and neck cancers in urban and rural India ,Asian Pac J Cancer Prev.2006;7,108-112. [PubMed]

3. Nandkumar A , Gupta PC, Gangadharan P ,Visweswara RN ,Parkin DM .Geographic pathology revisited: development of an atlas of cancer in India. Int J Cancer.2005 Sep 20; 116(5):740-54.DOI:10.1002/ijc.21109. [PubMed]  

4. Nandakumar A, Gupta PC, Gangadharan, Visweswara RN. Development of an atlas of cancer in India, A project of the national cancer registry programme (Indian council of medical research) supported by World Health Organization ,First all India report : 2001-2002 Mapping patterns of cancer, Information technology in medicine-Measuring burden of disease, Volume I, Bengaluru, India: National Cancer Registry Programme (ICMR) ; 2004.

5. Nandakumar A, Gupta PC, Gangadharan, Visweswara RN. Development of an atlas of cancer in India, A project of the national cancer registry programme (Indian council of medical research) supported by World Health Organization ,First all India report : 2001-2002 Mapping patterns of cancer, Information technology in medicine-Measuring burden of disease, Volume II, Bengaluru, India: National Cancer Registry Programme (ICMR) ; 2004.

6. Maniyar AU, Study of cytodiagnosis of head and neck neoplastic lesions and mapping patterns of head and neck cancers [MD thesis], Nanded: Maharashtra University of Health Sciences, Nashik, India; 2010.

How to cite this article?

Namdhari BH, Deshpande SA. Geographic mapping of head and neck cancers in Nanded, Maharashtra, India: A hospital based study.Trop J Path Micro 2016;2(3):99-103.doi: 10.17511/jopm.2016.i3.04.