Pattern of Cancer in Nepal from 2003 to 2011

©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.


Introduction
Cancer is characterized by uncontrolled growth and spread of abnormal cells with multi-factorial etiology [1].It is one of the most dreaded noncommunicable 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.

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).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 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

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 (Figure2).

Figure 2 :
Figure 2: This data represents total number of cancer cases and sex wise distribution of cancer from 2003 to 2011.

Figure 3 :
Figure 3: Showed the sex wise distribution of cancer cases in different district of Nepal in 2010

Figure 4 :
Figure 4: Showed the sex wise distribution of cancer cases in different district of Nepal in 2011 The collected variables are age, sex, occupation, religion, ethnicity, region of residence and type of cancer.The data were analysed using Excel 2007.

Table 1 :
Total cancer cases from seven reporting institute in 2003 to 2011 ©NJB, Biotechnology Society of Nepal 57 Nepjol.info/index.php/njb

Table 2 :
Distribution of cancer cases based on marital status in 2010 to 2011

Table 3 :
Distribution of cancer cases based on the Religion in 2010 to 2011

Table 4 :
Distribution of cancer cases based on the education status in 2010 to 2011

Table 5 :
Distribution of cancer cases based on occupational status in 2010 to 2011

Table 6 :
Distribution of cancer cases based on the age group in 2010 to 2011 ©NJB, Biotechnology Society of Nepal 59 Nepjol.info/index.php/njb

Table 7 :
Distribution of cancer cases based on type of diagnosis in 2010 to 2011 ©NJB, Biotechnology Society of Nepal 60 Nepjol.info/index.php/njb