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.



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



Dr.Kalyani R. MD 3

The Present Study is Undertaken atSri R.L Jalappa Hospital

and Research Institute Kolar INDIA



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



Dr.Kalyani R. MD 5



Dr.Kalyani R. MD 6



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



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



Dr.Kalyani R. MD 9

Epidemiology helps to

track HenceEpidemiological

study helps toknow theincidence, age /gender / site

distribution &the probablerisk factorsresponsible for

cancer.



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



Dr.Kalyani R. MD 11

Cases of FNAC …..

FNAC cases

which werenot followedby biopsy

werecountedSeparately



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



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



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



Dr.Kalyani R. MD 17

ancer in various Age Groups in elation to Sex



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



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



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



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.



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



Disc ssion



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



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



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



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



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



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.



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.



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.



Dr.Kalyani R. MD 37

pattern of cancer in adolescent and young adults1

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