Pattern Of Cancer In Adolescent And Young Adults1


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Pattern Of Cancer In Adolescent And Young Adults In INDIA: With A Note On Bone Cancer : 

Pattern Of Cancer In Adolescent And Young Adults In INDIA: With A Note On Bone Cancer Doctor Kalyani MD M.D.(Path), FICP, FIAMS, MNAMS. Professor of Pathology Sri Devaraj Urs Medical College Sri Devaraj Urs Academy Of Higher Education And Research (Deemed to be university) Kolar. Karnataka. India. Dr.Kalyani R. MD 1

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Dr.Kalyani R. MD The following is the talk presented at an International conference organized by EPS Global Medical Development form on 18th April 2011 at Yangzhou, China 2

The Present Study is Undertaken at Sri R.L Jalappa Hospital and Research Institute Kolar INDIA : 

The Present Study is Undertaken at Sri R.L Jalappa Hospital and Research Institute Kolar INDIA Dr.Kalyani R. MD 3

The Present Study is Supported with a Mission… : 

The Present Study is Supported with a Mission… Mission of Sri Devaraj Urs Medical college shall strive to be an Institution of excellence in the field of Medical Education with continued improvement of systems and process. To serve the poor in and around Kolar India… Dr.Kalyani R. MD 4

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Dr.Kalyani R. MD 5

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Dr.Kalyani R. MD 6

Introduction : 

Cancer pattern in adolescent and young adults (AYA) is different from those in children & older adults. The incidence is increasing faster than the increase in either children or older adults. When diagnosed, AYA suffer from adverse psychosocial effects as most of their potential years of life ahead of them has to be spent with effects of cancer or its treatment. Introduction Dr.Kalyani R. MD 7

Introduction : 

These cancer are more likely related to genetic predisposition and specific health behavior & life style among young people exposing themselves to new causative agent before the old do and also the short period of exposure between the beginning of life and cancer diagnosis. The shift of non-epithelial cancers in children to epithelial cancers in older adults occurs through several years in AYA age group. Introduction Dr.Kalyani R. MD 8

Epidemiology helps to track : 

Epidemiology helps to track Hence Epidemiological study helps to know the incidence, age / gender / site distribution & the probable risk factors responsible for cancer. Dr.Kalyani R. MD 9

Methodology Adopted : 

A ten year retrospective study from January 1997 to December 2006 was undertaken at department of Pathology All histopathology and FNAC cases reported between 15 – 44 years were included in this study. Multiple Specimens of a patient, where FNAC was done and later followed by histopathology were considered as one case. Methodology Adopted Dr.Kalyani R. MD 10

Cases of FNAC ….. : 

Cases of FNAC ….. FNAC cases which were not followed by biopsy were counted Separately Dr.Kalyani R. MD 11

Methodology : 

The relevant history and clinical findings of each case were retrieved from department / hospital records. The diagnosis of each case were critically revised, confirmed and the cumulative data was then categorized and coded accordingly to ICD 10 WHO ISCD 1994 1. The metastatic cancers of unknown primary were grouped separately. Methodology Dr.Kalyani R. MD 12

The Cases were Analyzed.. …. : 

The Cases were Analyzed.. …. The cases were analyzed for age / gender / year / site distribution by descriptive analysis and the findings compared with other similar studies. Dr.Kalyani R. MD 13

Results : 

Results Table-1 Cases Reported at Dept. of Pathology SDUMC (Jan 1997 to Dec. 2006) Dr.Kalyani R. MD 14

results : 

results Table-2 : Site distribution of various cancers (ICD – 10 – WHO ISCD 1994) Dr.Kalyani R. MD 15

Results : 

Results Table-3 Cancer in various Age Groups in relation to Sex Dr.Kalyani R. MD 16

Cancer in various Age Groups in relation to Sex : 

Cancer in various Age Groups in relation to Sex Dr.Kalyani R. MD 17

Results : 

Results Table-4 Year wise distribution of Cancer with Sex Dr.Kalyani R. MD 18

Results : 

Results Table-5 Top Ten Cancers in Males, Females and Combined in present study. Dr.Kalyani R. MD 19

Results : 

Results Table-6 Top five cancer sites in different age groups Dr.Kalyani R. MD 20

Results – Bone cancer : 

Results – Bone cancer Total malignancies in AYA 730 Total bone malignancies in AYA 33 (4.52%) Males 13 (39.3%) Females 20 (60.6%) Male: Female 1:1.5 Dr.Kalyani R. MD 21

Discussion – Place of Study : 

Discussion – Place of Study Kolar District shares the borders of Andra Pradesh and Tamil Nadu which has influenced the food habits and lifestyle of the people. The food is very spicy Rice and Ragi are the staple food There is increase use of Tobacco and alcohol in both genders with onset of this habit at very young age especially in low socioeconomic group Our Hospital caters to the local population and also neighboring districts. Majority of our patients belong to low socioeconomic group with rural background Dr.Kalyani R. MD 22

Discussion – Incidence : 

Discussion – Incidence The incidence of AYA cancers reported is 8.7%2. Each year 500 males & 350 females are diagnosed in California 2. The incidence increase in males by 0.7% / year and in females 0.5% / year in Bangladesh 3. Cancer of AYA is 2.7 times more common than cancer of less than 15 years and less common than cancer in older age groups 4. The incidence in our study is 26.6% of total cancers with a steady rise in number of cases over 10 years. Dr.Kalyani R. MD 23

Discussion - Age : 

Discussion - Age Mean age of cancer in AYA reported is 34.47 + 6.33 years 3. Non-Hodgkin’s Lymphoma increase and Sarcomas decrease with age 2. Germ cell tumors peaks between 30-34 years 2. The risk factors responsible in this age group is infection, adolescent growth spurts, hormones, growth and development factors associated with genetic predisposition 5. This is the age of crossover from a predominance of non-epithelial cancer in childhood to predominance of epithelial cancers in older adults 6 . In this study maximum cases were seen between 35-39 years in both gender. Dr.Kalyani R. MD 24

Discussion- Gender : 

Discussion- Gender Majority of the studies show Female preponderance with incidence in males of 38-42% & females 57-62% because of more female cancers of female genital organs, breast and thyroid 2,3,6. Male : Female ratio reported 0.75 : 1.0 / 1:2 3,5. Male : Female ratio is reported to decrease linearly from 10-14 years age group to 40-44 years age group 7. The transition of male predominance in childhood to female predominance in middle years of life occurs during late adolescent & early adulthood with maximum cases in males between 15-29 years 7. Our study also showed female preponderance (in all age group) with male : female ratio 1:2. Dr.Kalyani R. MD 25

Discussion - Geography : 

Discussion - Geography Top ten cancer sites in males in various studies compared to present study Dr.Kalyani R. MD 26

Discussion - Geography : 

Discussion - Geography Top ten cancer sites in females in various studies compared to present study Dr.Kalyani R. MD 27

Discussion - Geography : 

Discussion - Geography Top ten cancer sites in various studies compared to present study Dr.Kalyani R. MD 28

Discussion - Cancer type : 

Discussion - Cancer type Epithelial cancers predominate in males > 40 years and in female > 25 years (younger age) 6. The Predominance of epithelial or non-epithelial cancers give clue to etiology 6 . Non-Epithelial cancer risk factors: viral infection, radiation, genetic and environmental carcinogens 6. Epithelial cancer risk factors: Lifestyle factors such as tobacco use, alcohol consumption & dietary factors 6. Dr.Kalyani R. MD 29

Discussion – Cancer type : 

However family history of cancer and genetic predisposition may shorten latency and increase likelihood of early onset of epithelial cancers 6. In our study cancers in different age group showed early onset of epithelial cancer especially in females which began in 20-25 years. The striking feature is oral cancer which predominates in both gender followed by stomach cancer. In females cervical cancer predominates. Discussion – Cancer type Dr.Kalyani R. MD 30

Discussion – Bone cancer : 

Discussion – Bone cancer The incidence of Primary bone cancer reported is 3% of all cancers in AYA and the incidence between 15-19 years is 8%.2,7 The incidence reported in males is almost double compared to that in females. Among the histological variants, osteosarcoma is the commonest constituting about 47% followed by Ewing’s sarcoma (27%) and chondrosarcoma (15%). 2,7 The risk factors reported are ionizing radiation, alkylating agents, Paget disease, multiple hereditary exostoses, etc. The role of fluoride in bone cancer is equivocal. 2,7 Dr.Kalyani R. MD 31

Discussion – Bone cancer : 

The mortality due to bone cancer in AYA is higher in males than in females. 2,7 In this study primary bone cancer accounted for 4.52% of all cancers in AYA with female preponderance. Among the histological types, synovial sarcoma was commonest, followed by osteosarcoma, Ewing’s sarcoma and chondrosarcoma. Kolar district has many pockets of fluorosis, which may have impact on incidence of bone cancer and has to be proved. Discussion – Bone cancer Dr.Kalyani R. MD 32

Discussion - Prognosis : 

Discussion - Prognosis Overall prognosis is bad 7. Males have a worse prognosis than females 7. Delay in diagnosis especially of bone & brain cancers in which professional delay is always longer than patient symptoms delayed Poor outcome is because of mix of tumor types seen in this age group, having different biology of cancer, high risk prognostic cytogenetic features, more resistant form of cancer, low clinical trial participation and treatment not yet fully adopted to the tumor biology and is not tailored for cancers of AYA 8. In our study no follow-up of cases was done to comment on prognosis. Dr.Kalyani R. MD 33

Conclusion : 

Conclusion Trends and pattern of cancers in AYA define risk factors. In the present study incidence is high (26.6%) with female preponderance (in all age groups). Predominance of epithelial cancers than non-epithelial cancers was seen in both gender at early age compared to other studies which can be correlated to lifestyle & dietary habits of the people. This study provide leads for further etiological research and identify cancers that have the greatest impact in these age groups. This epidemiologic study helps to take-up cancer preventive measures and screening programmes in early detection of cancer. Dr.Kalyani R. MD 34

References : 

References Nanda Kumar A, Gupta PC, Gangadhar P, Visweshwara R.N. Development of an atlas of cancer in India : First all India Report : 2001-2002. National Cancer Registery programme (ICMR), Bangalore, India. 2004. Cancer in adolescents & young adults, Department of health sciences, California. Yalukder MH, Jabeen S, Shaheen S, Islam MJ, Haque M. Pattern of cancers in young adults at National Institute of Cancer research and hospital (NICRH), Bangladesh. Mymensingh Med J, 2007 ; 16 (2) : 528-33. Cancer incidence in young adults special topic from Canadian cancer statistics 2002. More young adults being diagnosed with cancer – First Canadian research in this area Canadian cancer statics 2002 by Canadian cancer society. Xiachengwu Wu, Frank D Groves, Collenc Mclanghlin et al. Cancer incidence patterns among adolescents and young adults in the united states. Cancer causes and control 2005 ; 16 : 309 -320. Archie Blefer, Aaron Viny, Ronald Barr, Cancer in 15 to 29 years olds by primary site. The oncologist 2006 ; 11 (6) : 590 – 601. Conrad V Fernandez, Ronald D Barr. Adolescents and young adults with cancer : An orphane. Paediatric Child Health 2006 ; 11 (2) 103 – 106. Ramandeep s, Robert D Alston, Tim OB Eden, et al. Cancer at ages 15-29 years: The contrasting incidence in India and England. Pediate Blood Cancer @ 2010 Wiley-Liss.Inc. Dr.Kalyani R. MD 35


ACKNOWLEDGMENT I thank Honorable Vice-Chancellor Prof. S. Chandrasekhar Shetty, Sri Devaraj Urs Academy Of Higher Education And Research (Deemed to be university) for the constant encouragement. I thank Dr. M. L. Harendra Kumar, Prof & HOD, Dept. of Pathology, Dr. Subhahish Das, co-author, my colleague staffs and technical staffs for constant support. I thank Dr. T. V. Rao, Prof of Microbiology for formatting this presentation. This work is published in Asian Pacific Journal of cancer Prevention 2010;11:655-659. Dr.Kalyani R. MD 36

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