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Transcript of Pattern of Cancer in Adolescent and Young Adults1
8/6/2019 Pattern of Cancer in Adolescent and Young Adults1
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Dr.Kalyani R. MD 1
Pattern Of Cancer InPattern Of Cancer InAdolescent And YoungAdolescent And YoungAdults InAdults In INDIAINDIA: With: With A NoteA Note
On Bone CancerOn Bone Cancer
Doctor Kalyani MDDoctor Kalyani MD M.D.(Path), FICP,M.D.(Path), FICP,
FIAMS, MNAMS.FIAMS, MNAMS.
Professor of PathologyProfessor of Pathology
Sri Devaraj Urs Medical CollegeSri Devaraj Urs Medical College
Sri Devaraj Urs Academy Of Higher Education And ResearchSri Devaraj Urs Academy Of Higher Education And Research(Deemed to be university)(Deemed to be university)
Kolar. Karnataka. India.Kolar. Karnataka. India.
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Dr.Kalyani R. MD 2
The following is the talkpresented at an Internationalconference organized by EPS
Global Medical Developmentform on 18th April 2011 at Yangzhou, China
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Dr.Kalyani R. MD 3
The Present Study is Undertaken atSri R.L Jalappa Hospital
and Research Institute Kolar INDIA
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Dr.Kalyani R. MD 4
The Present Study isSupported with a
Mission… Mission of Sri DevarajUrs Medical collegeshall strive to be anInstitution of excellence in the fieldof Medical Educationwith continued
improvement of systems and process.
To serve thepoor in and
around Kolar
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Dr.Kalyani R. MD 5
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Dr.Kalyani R. MD 6
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Dr.Kalyani R. MD 7
Ø Cancer pattern in adolescent and young
adults (AYA) is different from those inchildren & older adults.
Ø The incidence is increasing faster thanthe increase in either children or older adults.
Ø When diagnosed, AYA suffer from
adverse psychosocial effects asmost of their potential years of lifeahead of them has to be spent witheffects of cancer or its treatment.
Introduction
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Dr.Kalyani R. MD 8
Ø These cancer are more likely related to
genetic predisposition and specific
health behavior & life style amongyoung people exposing themselves tonew causative agent before the old doand also the short period of exposurebetween the beginning of life andcancer diagnosis.
Ø The shift of non-epithelial cancers inchildren to epithelial cancers in olderadults occurs through several years in
AYA age group.
Introduction
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Dr.Kalyani R. MD 9
Epidemiology helps to
track HenceEpidemiological
study helps toknow theincidence, age /gender / site
distribution &the probablerisk factorsresponsible for
cancer.
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Dr.Kalyani R. MD 10
Ø A ten year retrospective study from
January 1997 to December 2006 was
undertaken at department of Pathology
Ø All histopathology and FNAC casesreported between 15 – 44 years were
included in this study.Ø Multiple Specimens of a patient,
where FNAC was done and later followed by histopathology were
considered as one case.
Methodology
Adopted
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Dr.Kalyani R. MD 11
Cases of FNAC …..
FNAC cases
which werenot followedby biopsy
werecountedSeparately
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Dr.Kalyani R. MD 12
Ø The relevant history and clinical findings
of each case were retrieved from
department / hospital records.Ø The diagnosis of each case were critically
revised, confirmed and the cumulativedata was then categorized and coded
accordingly to ICD 10 WHO ISCD1994 1.
Ø The metastatic cancers of unknown primary were grouped
separately.
Methodology
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Dr.Kalyani R. MD 14
Results
.otal No of Cases Reported in 10 Years 19615
Histopathology 15307
FNAC 4308
otal malignancies reported ( . %)744 13 98
otal malignancies in AYA ( . %)30 26 6
Males ( . %)42 33 1
Females ( . %)88 66 8
:ale Female : 2
:alignancies
; ( ) + ( ) = .ith known primary site Males 200 Females 441 641: ( ) + ( ) =ith unknown primary site Males 42 Females 47 89
-able 1. (ases Reported at Dept of Pathology SDUMC Jan
. )997 to Dec 2006
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Dr.Kalyani R. MD 16
Results
. .l No ge Group Males Females : F
1 -5 19 9 10 : .1 1
2 -0 24 20 31 : .1 5
3 -5 29 32 40 : .1 25
4 -0 34 24 73 : .3 04
5 -5 39 80 147 : .1 85
6 -0 44 77 86 : .2 41
TOTAL 242 488 :2
-able 3 ancer in various Age Groups in relation to
ex
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Dr.Kalyani R. MD 17
ancer in various Age Groups in elation to Sex
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Dr.Kalyani R. MD 20
Results-able 6
op five cancer sites in different
ge groups
-5 19 -0 24 -5 29 -0 34 -5 39 -0 44 +5
Males
’odgkin s lym alivary
land
MouthPenisLung
BoneMouthThyroid
ColonLiver
StomachTestisMouth
BoneColon
Testis’odgkin s
.ym
PenisMouthBone
MouthStomachTestis
PenisBone
MouthStomachNHL
Colon alivaryGland
MouthStomachEsophagus
ProstateBladder
Females
ThyroidBone
’odgkin s lymRectum
ThyroidMouth
BoneStomachBreast
ThyroidCervix
MouthBoneStomach
BreastThyroid
MouthCervixStomach
MouthCervix
BreastThyroidBone
MouthCervix
BreastEsophagusStomach
MouthCervix
BreastStomachEsophagus
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Dr.Kalyani R. MD 21
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
Age Males Females M:F Totalgroup
15-19 01 02 1:2 0320-24 04 03 1:0.7 07
25-29 02 04 1:2 0630-34 01 02 1:2 0335-39 04 06 1:1.5 1040-44 01 03 1:3 04
Total 13 20 1:1.5 33
Histological type Males Females M:F Total
Synovial sarcoma 05 04 1:0.8 09Osteogenic sarcoma 03 05 1:1.6 08Ewing’s sarcoma 01 04 1:4 05
Chondrosarcoma 03 01 1:0.6 04Chondroblastoma 00 01 01Metastatic (Secondary) 1 05 1:5 06
Total 13 20 1:1.5 33
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Dr.Kalyani R. MD 22
Discussion – Place of
StudyØ Kolar District shares the borders of Andra
Pradesh and Tamil Nadu which hasinfluenced the food habits and lifestyle of
the people.Ø The food is very spicy
Ø Rice and Ragi are the staple food
Ø There is increase use of Tobacco and alcohol inboth genders with onset of this habit at very
young age especially in low socioeconomicgroup
Ø Our Hospital caters to the local population and alsoneighboring districts.
Ø Majority of our patients belong to low
socioeconomic group with ruralback round
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Dr.Kalyani R. MD 24
Discussion - Age
Ø Mean age of cancer in AYA reported is 34.47 + 6.33 years 3.
Ø Non-Hodgkin’s Lymphoma increase and Sarcomasdecrease with age 2.
Ø Germ cell tumors peaks between 30-34 years 2.
Ø The risk factors responsible in this age group isinfection, adolescent growth spurts, hormones,growth and development factors associated withgenetic predisposition 5.
Ø This is the age of crossover from a predominance of non-epithelial cancer in childhood to predominance of epithelialcancers in older adults 6 .
Ø In this study maximum cases were seen
between 35-39 years in both gender.
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Dr.Kalyani R. MD 25
Discussion- Gender
Ø Majority of the studies show Female preponderance withincidence in males of 38-42% & females 57-62%because of more female cancers of female genital
organs, breast and thyroid 2,3,6 .Ø Male : Female ratio reported 0.75 : 1.0 / 1:2
3,5 .Ø Male : Female ratio is reported to decrease linearly from
10-14 years age group to 40-44 years age group 7.Ø The transition of male predominance in childhood to
female predominance in middle years of life occursduring late adolescent & early adulthood withmaximum cases in males between 15-29 years 7.
Ø Our study also showed femalepreponderance (in all age group) with
male : female ratio 1:2.Ø
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Disc ssion
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Dr.Kalyani R. MD 27
Discussion -Geography op ten cancer sites in females in various studies
ompared to present study
.l ngland 20109
ndia 2010 9 resent Study
1 Melanoma Breast Mouth
2 Cervix Leukemia Cervix3 ’Hodgkin s lym Ovary Breast
4 Breast Thyroid Thyroid
5 Ovary CNS Stomach
6 Thyroid &Bones Jt Bone
7 Leukemia NHL Esophagus
8 CNS Cervix Ovary
9 NHL Colorectal Rectum
10 Colorectal Soft tissue ’Hodgkin s lym
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Dr.Kalyani R. MD 29
Discussion - Cancer
typeØEpithelial cancers predominate in
males > 40 years and in female
> 25 years (younger age)6
.Ø The Predominance of epithelial or
non-epithelial cancers give clue toetiology 6 .
ØNon-Epithelial cancer risk factors:viral infection, radiation, geneticand environmental carcinogens 6.
ØEpithelial cancer risk factors:
Lifestyle factors such as tobacco
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Dr.Kalyani R. MD 31
Discussion – Bone
cancerØ The incidence of Primary bone cancer reported
is 3% of all cancers in AYA and the incidencebetween 15-19 years is 8%.2,7
Ø The incidence reported in males is almostdouble compared to that in females.
Ø Among the histological variants, osteosarcomais the commonest constituting about 47%followed by Ewing’s sarcoma (27%) and
chondrosarcoma (15%). 2,7
Ø The risk factors reported are ionizing radiation,alkylating agents, Paget disease, multiplehereditary exostoses, etc. The role of fluoridein bone cancer is equivocal. 2,7
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Dr.Kalyani R. MD 32
Ø The mortality due to bone cancer in AYA
is higher in males than in females. 2,7
ØIn this study primary bone canceraccounted for 4.52% of all cancers in
AYA with female preponderance.Ø Among the histological types, synovial
sarcoma was commonest, followed by
osteosarcoma, Ewing’s sarcoma andchondrosarcoma.
Ø Kolar district has many pockets of fluorosis, which may have impacton incidence of bone cancer andhas to be proved.
Discussion – Bone
cancer
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Dr.Kalyani R. MD 33
Discussion -
PrognosisØ Overall prognosis is bad 7.
Ø Males have a worse prognosis than females 7.
Ø Delay in diagnosis especially of bone & brain cancers in
which professional delay is always longer than patientsymptoms delayed
Ø Poor outcome is because of mix of tumor types seen inthis age group, having different biology of cancer, highrisk prognostic cytogenetic features, more resistant
form of cancer, low clinical trial participation andtreatment not yet fully adopted to the tumor biologyand is not tailored for cancers of AYA 8.
Ø In our study no follow-up of cases was done tocomment on prognosis.
Ø
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Dr.Kalyani R. MD 34
Conclusion
Ø Trends and pattern of cancers in AYA define risk factors.Ø In the present study incidence is high (26.6%) with female
preponderance (in all age groups).Ø
Predominance of epithelial cancers than non-epithelialcancers was seen in both gender at early agecompared to other studies which can be correlated tolifestyle & dietary habits of the people.
Ø This study provide leads for furtheretiological research and identify
cancers that have the greatestimpact in these age groups.
Ø This epidemiologic study helps to take-upcancer preventive measures andscreening programmes in early
detection of cancer.
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Dr.Kalyani R. MD 35
References1) 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 CancerRegistery programme (ICMR), Bangalore, India. 2004.
2) Cancer in adolescents & young adults, Department of health sciences,California.
3) Yalukder MH, Jabeen S, Shaheen S, Islam MJ, Haque M. Pattern of cancers inyoung adults at National Institute of Cancer research and hospital (NICRH),
Bangladesh. Mymensingh Med J, 2007 ; 16 (2) : 528-33.4) Cancer incidence in young adults special topic from Canadian cancer statistics
2002.
5) More young adults being diagnosed with cancer – First Canadian research inthis area Canadian cancer statics 2002 by Canadian cancer society.
6) Xiachengwu Wu, Frank D Groves, Collenc Mclanghlin et al. Cancer incidencepatterns among adolescents and young adults in the united states. Cancer
causes and control 2005 ; 16 : 309 -320.7) Archie Blefer, Aaron Viny, Ronald Barr, Cancer in 15 to 29 years olds by primary
site. The oncologist 2006 ; 11 (6) : 590 – 601.
8) Conrad V Fernandez, Ronald D Barr. Adolescents and young adults with cancer :An orphane. Paediatric Child Health 2006 ; 11 (2) 103 – 106.
9) 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.
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Dr.Kalyani R. MD 36
ACKNOWLEDGMENT
I thank Honorable Vice-Chancellor Prof. S.Chandrasekhar Shetty, Sri Devaraj Urs AcademyOf 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, mycolleague staffs and technical staffs for constantsupport.
I thank Dr. T. V. Rao, Prof of Microbiology forformatting this presentation.
This work is published in Asian Pacific Journal of cancer Prevention 2010;11:655-659.