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Thursday 12 January 2012

Cancer Scenario in India and North East

Cancer Scenario in India and North East

Cancer or in other words ‘Silent Killer’ is the most scared diseases of all. Globally it is responsible for second highest deaths after the heart diseases. The heart diseases are limited to the heart only, but cancer has no limit or boundary. It can form anywhere and can spread everywhere in the body. In the present time it is one of the major health hazard in the world and a leading health problem in India. Cancer accounts for 8% of the deaths in India. Over 1 million cancer cases are detected in India every year.
Cancer Scenario in the North East Region of India is different from others. From last decade this region has become a leading stock house of cancer. The most common cancer in North East India is the Head and Neck Cancer. In a developed country like the USA, 30,000 cases of head and neck cancer are detected every year. In India around 200,000 cases of head and neck cancer occur annually. The increasing numbers of head and neck cancer cases is associated with high morbidity and mortality.
Women are the major victims of cancer in India than men. As per data 30% of the cancer cases in India are related to cervix. The second spot if occupied by the breast cancer that is 20%. Another major cancer in Indian women is the ovarian cancer. Annually 5% cases of ovarian cancer are detected in India. Lung and esophageal Cancer is common both in men and women. Cancer in liver, gall bladder and pancreas are more in men than women in India. Cases like testicular and prostate cancer are rare in Indian men but still exist. Over one third of all cancer in India occurs in the head and neck region. The most common head and neck cancer in India is the oropharyngeal cancer with 28.6% in the graph. The diagnosed cases of cancer in the oral cavity in India are the 19.4%. The involvement of cancer in the tongue is 32.7% where as 20% of the cases are related to cheek and tonsil.
The head and neck cancer includes cancer in the oral cavity, larynx, pharynx, oropharynx, hypopharynx, nasopharynx, nose and PNS and salivary glands. The oral cavity consists of the lip, anterior tongue, buccal mucosa, floor of the mouth, upper and lower gingiva, reteromoral trigone and hard palate. The larynx is divided into three parts supraglottis, glottis and subglottis. Oropharynx includes base of the tongue, tonsillar region and pharyngeal walls. Looking at gender distribution, males develop head and neck cancer more frequently compared to females at the ratio 3:1.
In North East India, from the year 2008 to 2011, 3784 cases of cancer were detected in a private institute. Among the detected cases 2336 cases that are 59.1% were males where as 1548 cases that are 40.9% were females. The detected head and neck cancer cases in the institute were 857 with 84.36% or 723 of males and 15.63% or 134 of females. Assam occupies the top most spot in the list of head and neck cancer patients with 677 (78.99%) cases followed by Meghalaya 108 (12.60%), Nagaland 45 (5.25%), Arunachal Pradesh 12 (1.40%), Manipur 8 (0.93%), Mizoram 6 (0.70%) and Tripura 1 (0.11%) of cases. Divided into age group the highest number of cases 263 (0.68%) are found between the age group from 51 years to 60 years. In the age groups between 11-20 years 2 (0.23%), 21-30 years 23 (2.68%), 31-40 years 88 (10.26%), 41-50 years 196 (22.87%), 61-70 years 188 (21.93%), 71-80 years 73 (8.41%) and above 81 years 24 (2.80%) cases were found.
The most common head and neck cancer in North East India is the cancer in hypopharynx with 260 or 30.33% cases. The second place is occupied by the oral cancer with 191 (22.28%) of cases. The situations of other head and neck cancers were nasopharynx 55 (6.41%), oropharynx 220 (25.67%), larynx 66 (7.70%), nose and PNS 13 (1.50%) and salivary glands 7 (0.8%). In the oral cavity 89 or 46.59 cases were related to the buccal mucosa. The other sites of oral cancers were lips 43 (2.09%), tongue 43 (22.51%), floor of mouth 11 (5.75%), hard palate 4 (2.09%), reteromoral trigone 17 (8.90%) and gingiva 23 (12.04%). In the oropharynx the most common site of cancer was the base of the tongue with 99 or 45% cases followed by tonsil 92 (41.81%), pharyngeal wall 17 (7.72%) and soft palate 12 (5.45%). In the cancer of hypopharynx 233 or 89.61% of cases are related to AEF or PFS whereas 23 or 8.84% and 4 or 1.53% of cases were related to post pharyngeal wall and post cricoids respectively. The laryngeal cancer is another common head and neck cancer in the northeastern zone of India where 37 (56.06%), 15 (22.72%) and 14 (21.20%) were related to supraglottis, glottis and subglottis respectively.
Divided into the stages highest numbers of patients were found to be in the IVth or last stage. Patients detected in the IVth stage were 536 or 62.54%. Number of patients in the Ist, IInd and IIIrd stage were 12 (1.4%), 93 (10.85%) and 216 (25.20%) respectively.
Over a third of all cancers are related to tobacco. Head and neck cancers are related to consumption of tobacco in various forms, lime and raw tobacco with betel leaf, betel nut and smoking habit. India the habit of tobacco is not only a habit today. It has become a tradition and religion for the people in India. In North East India chewing of raw betel nut, betel leaf with lime and raw tobacco is practiced very widely mainly in the states of Assam and Meghalaya. Betel nut has been recognized as a major cancer causing agent by the National Cancer Institute, USA. Urbanization of the society is leading the women also to pick up the habit of tobacco as like the men. Following the western culture or adults many teenagers and school going students are seen to be adopting the habit of tobacco at young ages. Alcohol also contributes causing the cancer in head and neck region. If alcohol is consumed with tobacco its ability to cause cancer becomes double. In many occasions poor hygiene and viral infections from human pappiloma virus (HPV) and herpes are also found responsible specially causing oral cancer.
The choices of treatment of head and neck cancers are radiation therapy, surgery, chemotherapy and concomitant chemo radiation therapy. In the field of head and neck cancer radiation therapy is known called as ‘Soul Treatment’. A high doses ionizing radiation is used to kill the cancer cells and shrink tumors. It is used as neo adjuvant or pre operative, adjuvant or post operative, curative and palliative treatments. Surgery is another choice of treatment in head and neck cancer. It means the complete removal of the tumor along with the surrounding affected tissues and lymph nodes. Chemotherapy means the treatment of cancer using drugs. High toxic drugs are given through veins or orally those attack the cancer cells and inhibit their growth. In case of head and neck cancer chemotherapy is hardly advised mostly used for palliative purposes. Concomitant chemo radiation therapy is also widely advised in the cases related to head and neck cancer. In this treatment chemotherapy is given parallel to the radiation therapy as supportive. Chemotherapy act as the fuel and the radiation therapy act as the fire in these cases. Highest number of cases were treated using concomitant chemo radiation therapy (348 or 40.60%) where as 316 (36.87%), 163 (19.20%) and 30 (3.50%) were treated through radiation therapy, surgery and chemotherapy respectively. There are other necessary managements also like diet management, pain and palliative management, psychological management, symptomatic management of side effects etc.
Oral cancer is easily detectable and healable of all cancers but still most of the patients come to know of it at the 3rd or 4th stages. At the initial stage nobody pays attention towards it. To detect an abnormal formation in the oral cavity or tonsil, people need only a mirror and sunlight. Any type can be treated if detected in the early stages and can be uprooted. It clearly indicates that the common people in North East India are still unaware of cancer. In tribal belts all over India people prefers to go after rural or traditional treatments that cannot cure a cancer. Lack of cancer related NGOs is also a reason due to which people cannot reach to the knowledge of cancer. Illiteracy is also a common cause and poverty makes the treatment incomplete. Change in voice, difficulty while talking or swallowing, unmanageable throat pain, fish bone sensation in the throat can be warning signs of throat cancer or laryngeal cancer.
When a patient questions a doctor, ‘How did I get cancer?’ The doctor’s answer use to be ‘Bad Luck’ because cancer is an old disease whose root cause is yet to be known. It exists in this world since from the time of Dinosaurs. It is not predictable but preventable. It is inevitable but its sufferings are optional. Today the science has made many progresses and the diseases believed to be incurable can be cured today. If cancer is a curse to the mankind, medical science is the boon.
(Reference: Dr. D.K. Nath, Consultant Head and Neck Surgeon)

Dr. Gitartha Roymedhi, MD
Consultant and in charge,
                                                                      Dept. of Social and Preventive Oncology,
                                                         North East Cancer Hospital and Research Institute,
11th Mile, Jorabat, Guwahati, Assam.

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