Nepal Journal of Biotechnology. D e c . 2 0 1 6 Vol. 4, No. 1:54-60 ISSN 2091-1130(Print)/ISSN 2467-9319 (online) CASE STUDY ©NJB, Biotechnology Society of Nepal 54 Nepjol.info/index.php/njb Pattern of Cancer in Nepal from 2003 to 2011 Sunil Kumar Sah1, Naval Kishor Yadav2, Roshan Kurmi3, Ramanuj Rauniyar3, Krishna Das Manandhar4, Birendra Prasad Gupta4* 1Department of Pathology, BP Koirala Memorial Cancer Hospital , Bharatpur, Chitwan Nepal 2Department of Biochemistry, Manipal Medical College, Nepal 3Bhawani Hospital, Birgunj, Parsa, Nepal 4Central Department of Biotechnology, Tribhuvan University, Kirtipur, Kathmandu, Nepal Abstract Cancer is global burden of disease in developed and developing countries. It is one of the main causes of death. The environmental factor and life styles are major causes of cancer. This hospital based retrospective study was carried out using data retrieved from the register maintained at seven cancer centers. The most common basis of diagnosis were microscopic (histopathological and cytopathological examination). The diagnosis was also based on clinical examination, radiological examination, endoscopy, biochemical and immunological tests. Most of the cancer cases were diagnosed at BPKMCH (23908) followed by BPKIHS (9668) and BH (5959) and few cases from KCH (518) in 2003 to 2011. The total number of cancer cases were increasing from 2003 to 2011 and it become double in 2011.. Out of 75 district of Nepal, more number of cancer cases was found in Kathmandu, Sunsari, Morang, Chitwan, Lalitpur, Jhapa, Kaski, Nawalparasi, Rupendehi and Kavrepalchowk in 2010. Similarly, in 2011 more number of cancer cases was found in Kathmandu, Morang, Jhapa, Sunsari, Chitwan, Lalitpur, Rupendehi, Kaski, Saptari, Bhaktapur. Lung cancer was the common cancer and similarly, other prevalent cancers were cervical, breast, stomach, ovarian and colo-rectum cancer in 2003 to 2011. The common cancers were lung, cervical, breast, stomach, ovarian and colo-rectum. The number of patients is increasing, which may be due to change in life style and lack of education. Key words: Cancer, Nepal, 2003-2011, Kathmandu, *Corresponding Author Email:- birendraphd@gmail.com Introduction Cancer is characterized by uncontrolled growth and spread of abnormal cells with multi-factorial etiology [1]. It is one of the most dreaded non- communicable diseases that have become the important contributor to the global burden of disease [2]. The causes of cancer is not only genetic factor, which contribute 5-10%, while environmental factor and life styles cover 90-95% [3,4]. The lifestyle factors include cigarette smoking, diet (fried foods, red meat), alcohol, sun exposure, environmental pollutants, infections, stress, obesity, and physical inactivity [5,6] In 2012, new cancer cases were 14.1 million and with 8.2 million deaths. The lung cancer was the most common cancer 16.7% of all new cases in men and breast cancer 25.2% in women [7]. According to estimates from the International Agency for Research on Cancer (IARC), the global burden is expected to grow to 21.4 million new cancer cases and 13.2 million cancer deaths by 2030. [8] In developed countries, most common diagnosed cancers were prostate, lung and bronchus, and colorectal among men while breast, colorectal, and lung among women. Similarly, lung, stomach, and liver cancer in men while breast, cervix uteri, and lung in women in developing countries [9]. Nepal is a developing country where cancer cases are increasing day by day. The aim of this study is to see the pattern of cancer cases from 2003 to 2011 in Nepalese people. Materials and Methods This hospital based retrospective study was carried out using data retrieved from the register maintained at seven cancer centers of Nepal from 2003 to 2011. The cancer centers were B.P. Koirala Memorial Cancer Hospital (BPKMCH) Bharatpur, Chitwan, Bhaktapur Cancer Hospital (BCH) Bhaktpur, Bir Hospital (BH) Kathmandu, TU Teaching Hospital (TUTH) Kathmandu, Kanti Children’s Hospital (KCH) Kathmandu, B.P.Koirala Institute of Health Sciences (BPKIHS) Dharan and Manipal Teaching Hospital (MTH), Pokhara, Nepal. The most common basis of diagnosis were microscopic (histopathological and cytopathological examination). The diagnosis was also based on clinical examination, radiological Nepal Journal of Biotechnology. D e c . 2 0 1 6 Vol. 4, No. 1:54-60 Kurmi et al. ©NJB, Biotechnology Society of Nepal 55 Nepjol.info/index.php/njb examination, endoscopy, biochemical and immunological tests. The collected variables are age, sex, occupation, religion, ethnicity, region of residence and type of cancer. The data were analysed using Excel 2007. Results Most of the cancer cases were diagnosed at BPKMCH (23908) followed by BPKIHS (9668) and BH (5959) and few cases from KCH (518) in 2003 to 2011 (Figure 1). Figure 1: The number of total cancer between 2003 to 2011 from seven cancer reporting institute of Nepal. The total number of cancer cases were increasing from 2003 to 2011 and it became double in 2011 (Figure 2). Figure 2: This data represents total number of cancer cases and sex wise distribution of cancer from 2003 to 2011. Cancer cases were more in female than male in all the years (Table 2). Most of the cancer patients were married (Table 3) and Hindu religion followed by Buddhist religion (table 4). More cancer patients were illiterate followed by literate (Table 5). Agriculture was main occupation of most cancer patients followed by housework (table 6). Most of cancer cases were prevalent in age group 40-75 years. Less number of cancer cases was found in age group below 15 years (Table 7). Biopsy and histology were the major method for the diagnosis of cancer cases followed by cytology and haematology. The clinical examination and biochemical/immunological test were help to identified only few cancer cases. (Table 8). Out of 75 district of Nepal, more number of cancer cases was found in Kathmandu, Sunsari, Morang, Chitwan, Lalitpur, Jhapa, Kaski, Nawalparasi, Rupendehi and Kavrepalchowk in 2010 (figure 4). Similarly, in 2011 more number of cancer cases was found in Kathmandu, Morang, Jhapa, Sunsari, Chitwan, Lalitpur, Rupendehi, Kaski, Saptari, Bhaktapur (figure 5). Lung cancer was the common cancer and similarly, other prevalent cancers were cervical, breast, stomach, ovarian and colo-rectum cancer in 2003 to 2011(figure 5). Discussion Nepal is a developing country and divided into beautiful three region terai, mountain and Himalayan. People of different region have their own language, religion, festival and source of income to run the family. This study reveals, diagnosed cancer cases were mostly from terai region and most of them were working in field. The second occupation was housework as cancer cases diagnosed high in female compare to male. More than half of the cancer cases were illiterate. Most of cancer cases were prevalent in age group 40-75 years. Less number of cancer cases was found in age group below 15 years. The study conducted in india in 1994 and 1955 showed prevalence of cancer in same age group [11]. It may be due to decreases in immune system, iliteracy and exposure to cance causing agents in environmet. The most diagnosed cancer cases were hindus followed by buddhist, Islam and Christians. This is due to high number of population were Hindus in Nepal as we know Nepal were Hindu country in world. In Nepal, among all diagnosed cancer cases, the common cancer were lung, cervical, breast, stomach, ovarian and colo-rectum [12]. The report by WHO showed common cancers was lung, breast and colo-rectum in the world [13]. Some studies showed similar finding for these common cancers 0 2000 4000 6000 8000 N u m b e r Years Total cancer cases Male Female 0 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 22000 24000 Nepal Journal of Biotechnology. D e c . 2 0 1 6 Vol. 4, No. 1:54-60 Kurmi et al. ©NJB, Biotechnology Society of Nepal 56 Nepjol.info/index.php/njb [13, 14, 15]. The lung cancer was estimated a total of 239,320 new cases in US in 2010 [16]. The lung cancer is due to maximum use of tobacco which can be seen mainly in 25-60 yrs. age group in Nepal. Tobacco smoking [16] and tobacco uses were higher in mid-western, rural, far western and mountainous areas of Nepal [17]. Conclusion The cancer is becoming a major problem in Nepal with the number rising continuously. All this may be due to environmental factors and life style changes i.e. tobacco use, food habits, alcohol use and physical inactivity. 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D e c . 2 0 1 6 Vol. 4, No. 1:54-60 Kurmi et al. ©NJB, Biotechnology Society of Nepal 57 Nepjol.info/index.php/njb Table 1: Total cancer cases from seven reporting institute in 2003 to 2011 Name of Hospital 2003 2004 2005 2006 2007 2008 2009 2010 2011 BPKMCH 1869 (57.5%) 1815 (43.2%) 2154 (49.0%) 2564 (52.2%) 3261 (54.03%) 2936 (49.4%) 2772 (44.1%) 3216 (47.5%) 3320 (46.8%) BCH 328 (10.0%) 952 (22.7%) 1008 (22.9%) 1086 (22.1%) 1138 (18.85%) 1253 (21.1%) 1289 (20.8%) 1253 (18.5%) 1361 (19.2%) BPKIHS 418 (12.9%) 457 (10.9%) 702 (16.0%) 613 (12.5%) 640 (10.6%) 655 (11.0%) 660 (10.6%) 553 (8.2%) 512 (7.2%) BH 127 (4.0%) 385 (9.2%) 206 (4.7%) 350 (7.1%) 696 (11.53%) 798 (13.4%) 1228 (19.8%) 1173 (17.3%) 1005 (14.2%) MTH 215 (6.6%) 307 (7.3%) 162 (3.7%0 172 (3.5%) 192 (3.18%) 153 (2.6%) 79 (1.3%) 77 (1.1%) 160 (2.1%) TUTH 248 (7.6%) 190 (4.5%) 134 (3.0%) 89 (1.8%) 68 (1.12%) 91 (1.5%) 188 (3.0%) 392 (5.9%) 648 (9.1%) KCH 46 (1.4%) 95 (2.3%) 31 (0.7%) 34 (0.7%) 40 (0.6%) 63 (1.1%) 23 (0.4%) 104 (1.1%) 82 (1.2%) Total 3251 4201 4397 4908 6035 5949 6199 6773 7088 Table 2: Distribution of cancer cases based on marital status in 2010 to 2011 Marital status 2010 2011 Male Female Total Male Female Total Unmarried 132 111 243 127 92 219 Married 2678 3084 5762 2773 3243 6016 Widow 68 172 240 70 199 269 Divorced 3 4 7 1 4 5 Separated 5 1 6 4 3 7 Not Available 106 107 213 131 135 266 Not Applicable 1 0 1 189 117 306 Total 2993 3479 6472 3295 3793 7088 Table 3: Distribution of cancer cases based on the Religion in 2010 to 2011 Religion 2010 2011 Male Female Total Male Female Total Hindu 2735 3057 5792 2683 3093 5776 Buddhist 217 254 471 301 358 659 Islam 51 53 104 57 59 116 Christian 16 32 48 24 26 50 Others 63 85 148 160 191 351 Not Available 110 100 210 70 66 136 Total 3192 3581 6773 3295 3793 7088 Nepal Journal of Biotechnology. D e c . 2 0 1 6 Vol. 4, No. 1:54-60 Kurmi et al. ©NJB, Biotechnology Society of Nepal 58 Nepjol.info/index.php/njb Table 4: Distribution of cancer cases based on the education status in 2010 to 2011 Education 2010 2011 Male Female Total Male Female Total Literate 1346 1118 2464 1342 1068 2410 Illiterate 1291 1936 3227 1494 2233 3727 Not Applicable 25 17 42 397 466 863 Not Available 476 479 955 62 26 88 Total 3138 3550 6688 3295 3793 7088 Table 5: Distribution of cancer cases based on occupational status in 2010 to 2011 Occupation 2010 2011 Male Female Total Male Female Total Agriculture 1769 1154 2923 1757 1082 2839 Business 172 83 255 202 182 384 Housework 206 1790 1996 265 1895 2160 Office Work 256 77 333 251 105 356 Others 291 158 449 328 150 478 Not Applicable 8 5 13 303 262 565 Not Available 441 363 804 189 117 306 Total 2993 3479 6773 3295 3793 7088 Table 6: Distribution of cancer cases based on the age group in 2010 to 2011 Age Group 2010 2011 (Years) Male Female Total Male Female Total 0-4 54 31 85 62 26 88 5-9 66 39 105 52 41 93 10-14 79 32 111 75 50 125 15-19 70 75 145 74 63 137 20-24 74 96 170 93 84 177 25-29 77 117 194 78 120 198 30-34 91 159 250 103 155 258 35-39 128 241 369 141 251 392 40-44 154 328 482 205 380 585 45-49 228 439 667 234 439 673 50-54 293 491 784 295 464 759 55-59 319 362 681 404 474 878 60-64 459 414 873 426 449 875 65-69 427 304 731 381 359 740 70-74 351 228 579 333 232 565 75-79 193 132 325 210 138 348 80 + 129 93 222 129 68 197 Total 3192 3581 6773 3295 3793 7088 Nepal Journal of Biotechnology. D e c . 2 0 1 6 Vol. 4, No. 1:54-60 Kurmi et al. ©NJB, Biotechnology Society of Nepal 59 Nepjol.info/index.php/njb Figure 3: Showed the sex wise distribution of cancer cases in different district of Nepal in 2010 Table 7: Distribution of cancer cases based on type of diagnosis in 2010 to 2011 2010 2011 Male Female Total Male Female Total Clinical Examination 3 1 4 23 25 48 Endoscopy 36 12 48 37 17 54 Biopsy/Histology 1699 2151 3850 1648 2296 3944 Cytology/Haematology 812 834 1646 860 816 1676 Exploratory Surgery 2 2 4 0 0 0 Biochemical/Immunological test 0 7 7 1 15 16 Radiology 239 225 464 300 274 574 Death certificate 2 3 5 3 6 9 Not available 399 346 423 344 767 Total 3192 3581 6773 3295 3793 7088 Nepal Journal of Biotechnology. D e c . 2 0 1 6 Vol. 4, No. 1:54-60 Kurmi et al. ©NJB, Biotechnology Society of Nepal 60 Nepjol.info/index.php/njb Figure 4: Showed the sex wise distribution of cancer cases in different district of Nepal in 2011