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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 13-16

Head and neck cancers: Regional trends in Kashmir


1 Department of ENT and HNS, Hamdard Institute of Medical Sciences, HAHC Hospital, New Delhi, India
2 Department of ENT, Max Hospital, New Delhi, India
3 Department of ENT, Government Medical College and Associated Hospital, Srinagar, Jammu and Kashmir, India

Date of Web Publication27-Jul-2017

Correspondence Address:
Shahid Rasool
Department of ENT and HNS, Hamdard Institute of Medical Sciences Associated with HAHC Hospital, New Delhi - 110 062
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jhnps.jhnps_32_16

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  Abstract 

Background: The current study is a prospective study conducted in the department of otorhinolaryngology Government Medical College and associated Hospitals Srinagar, Jammu and Kashmir for 1½ year. The aim of the study was to study the loco-regional pattern of head and neck cancers (HNCs) in our society which is different from the rest of the country with its unique environment, different sociocultural habits and customs. Material and Methods: All patients of HNCs who reported to our department were enrolled in the study. Metastatic carcinomas to head and neck from other sites and carcinoma with unknown primary were excluded from the study. Results: A total of 99 cases of HNCs were received at our tertiary care institute. The most common tumor encountered was thyroid cancer. The most common thyroid cancer was papillary carcinoma of thyroid, constituting 35% of total HNCs. Thyroid cancers were followed by head and neck squamous cell cancers (HNSCCs). Seventy percent of thyroid cancer patients presented with symptoms of neck swelling while as only 35% had lymph node metastasis, all of papillary thyroid cancer type. The majority of thyroid cancers (86%) belonged to stage 1st irrespective of cancer type (43/50), six patients (12%) were stage 2nd, and only one patient (2%) had stage 3rd. There was no stage 4th tumor in any patient with thyroid cancer. Squamous cell carcinoma of larynx (20.40%) was most common HNSCC. It was observed that the most of the patients of HNSCC had advanced stages of disease at presentation, with almost 60% of patients having T3-T4 stage and more than half of patients (53.84%) had palpable neck nodes. Conclusion: The study pointed out about the influence of environmental factors, local customs, and cultural habits on the nature and type of cancers and thus different cancer incidences and prevalences in different geographical areas.

Keywords: Carcinoma larynx, head and neck cancers, head and neck squamous cell carcinomas, thyroid cancers


How to cite this article:
Rasool S, Hussain T, Pampori RA, Patigaroo SA. Head and neck cancers: Regional trends in Kashmir. J Head Neck Physicians Surg 2017;5:13-6

How to cite this URL:
Rasool S, Hussain T, Pampori RA, Patigaroo SA. Head and neck cancers: Regional trends in Kashmir. J Head Neck Physicians Surg [serial online] 2017 [cited 2021 Mar 2];5:13-6. Available from: https://www.jhnps.org/text.asp?2017/5/1/13/211728


  Background Top


Of all malignancies diagnosed annually 5% are head and neck carcinomas. They are heterogeneous group of malignancies classified into different subgroups based on primary tumor site and histological type. Overall 57.5% global head and neck cancers (HNCs) (excluding esopharyngeal cancers) for both sexes occur in Asia, especially in India.[1]

Although the cancers of the thyroid gland are uncommon, they are the most common malignancies of the endocrine system. They account for about 1%–1.5% of all cancers. During the past decade, increase in the incidence of thyroid cancers has been seen in many countries. 95% of this increase is because of papillary thyroid carcinoma (PTC) which accounts for more than 80% of all thyroid cancers.[2]

Squamous cell carcinoma (SCC) is the most common HNC that involves the squamous epithelium of the oral cavity, oropharynx, hypopharynx, and larynx, excluding the nasopharynx. It accounts to almost 6% of all new cases and constitutes the sixth most common type of cancer.[3] Head and neck SCCs (HNSCCs) are thought to account for an estimated 650,000 new cancer cases and 350,000 cancer deaths worldwide per year.[3] Approximately, 75% of HNSCC have been ascribed to consumption of alcohol and smoking tobacco.[4],[5] Other well-known risk factors for HNSCC are chewing tobacco or betel quid.[6]


  Materials and Methods Top


The current study is a prospective observational study conducted in the department of ENT, head and neck surgery Government Medical College Srinagar and associated Hospitals, Jammu and Kashmir, a tertiary care hospital. It was studied for 1½ year from December 2013 to May 2015. The aim of the study was to study the locoregional pattern of HNCs in our society which is different from the rest of the country with its unique environment and different sociocultural habits and customs.

All patients of HNCs who reported to our department were enrolled in the study. Metastatic carcinomas to head and neck from other sites and carcinoma with unknown primary were excluded from the study. All enrolled patients were evaluated in detail and full ENT work up was done. Besides, routine investigations special investigations such as contrast enhanced computed tomography/magnetic resonance imaging/ultrasonography/fibro-optic laryngoscopy/direct laryngoscopy/sinonasal endoscopy and fine needle aspiration cytology were performed as and when required for proper staging and comprehensive management.


  Observations and Results Top


During the study period of 1½ year, total of 99 patients of HNCs presented to our department. In the due course of time, it was seen that thyroid cancers were the most common tumors and almost outnumbered all other HNCs, it was decided to study thyroid cancers separately from the rest of HNCs with respect to age, sex, habitation, addiction, stage at presentation, histology of tumor, and other factors because of their different etiopathogenesis, environmental factors responsible, and different management protocols as evident by much of a literature available.

Thyroid cancers

Thyroid cancer was most common tumor and comprised almost more than half of our study population. They were 50 in number with the majority of patients being females (82%) and maximum within the age group of 20–40 years. Mean age at diagnosis was 32.5 ± 10.16 years with youngest and eldest patient being 17 and 60 years females, respectively. Males comprised only 18% of cases with youngest patient being 19 years and eldest was 50 years with mean age of 31.7 ± 10.3. The male: female ratio in this group was 1:4.5. The lowest frequency of malignancy occurred in patients aged 20 years or younger, and the highest occurred in patients between the ages of 20 and 29 years old. There was a trend of progressive decrease in frequency from the younger to the older patients after the age of 29 years. Maximum number of patients (76%) were from rural areas where the majority of the population resides while as only 24% were from urban areas. The most common type of thyroid cancer was PTC, comprising 80% of all cases. The second most common type was follicular thyroid cancer, which accounted for 10%–20% of all cases. Medullary thyroid cancer represented 6%–8% of all thyroid cancer cases. [Table 1] shows the frequency -type of thyroid cancers as described above.
Table 1: The types of thyroid cancers with their percentage

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The most common presenting symptom of thyroid neoplasm was swelling neck 35/50 (70%). There was only one patient who had a change of voice and one with features of hypothyroidism. None of the patients presented with features of hyperthyroidism or difficulty in breathing. Twenty-four percent of all cases had lymph node involvement at presentation. All patients with lymph node metastasis were having PTC (35% in papillary group). No lymph node metastasis was seen in other types of thyroid cancers.

In the present study, the majority of thyroid cancer patients belonged to stage 1st irrespective of cancer type. Forty-three patients (86%) were stage 1st, six patients (12%) were stage 2nd, and only one patient (2%) was stage 3rd. There was no stage 4th tumor in the study group.

Head and neck cancers

HNC cases comprised of 36 HNSCCs, 10 lymphomas, and 3 lymphoepitheliomas of salivary glands. HNSCC was Second most common (36.36%) type of tumor comprising of SCC of oral cavity (tongue, buccal mucosa, floor of mouth, retromolar trigone, and hard palate), oropharynx, hyphopharynx, laryngeal, and sinonasal cancers. HNSCC group had 27 males and nine females with male female ratio of 3:1. The most common age of presentation was the 4th decade of life with the mean age of 48.54 and median of 57.5 years. About 14.28% of patients were from the urban area while as 85.71% were from rural areas. More than two-third of (69.38%) patients were active tobacco smokers as against the only 30.61% being nonsmokers. None of the study individuals was alcoholic or tobacco chewer. The most common cancer encountered was carcinoma larynx being more than half (55.55%, 20/36) of all HNSCC, It was followed by sinonasal cancers (22.22%, 8/36) and the least common was carcinoma external ear being only one case as shown in [Table 2].
Table 2: The site distribution of tumors

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Most of the patients (63.88%) presented with advanced stages (T3-T4) of disease and more than half of patients (58.33%) had positive neck nodes as depicted in [Table 3].
Table 3: Tumor, node and metastasis staging of head and neck squamous cell carcinomas (head and neck squamous cell cancer group)

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  Discussion Top


Overall, 57.5% of global HNCs (excluding esopharyngeal cancers) occur in Asia especially in India, for both sexes.[1] Ferlay et al. stated that India accounts for a quarter of the world burden of oral cancer.[7] Which is against what we observed in our study of local population. Our study has the highest number of thyroid cancers against the SCCs found mostly in other parts of India. The reason being guthka/tobacco/pan masala/betel nut chewing is not in vogue here in Kashmir valley nor is alcohol consumption. The reason for increased number of thyroid cancer cases remains unknown and needs further studies both at gross as well as molecular/genetic level. There was one more striking difference from the rest of the country in HNSCC cases that instead of oral cavity tumors, laryngeal carcinoma patients was most common HNSCC which was followed by lymphomas, oral cavity tumors were seen in only 5% of our cases. The reason being same as that “gutka and tobacco” chewing is not common vogue in Kashmiri population compared to rest of India. As observed in the present study, heavy smoking especially by young in recent years due to psychological trauma by political disturbance in the region has probably lead to rise of laryngeal carcinoma.

In 2010, about 930,000 deaths were estimated to be attributable to tobacco in India.[8] The high prevalence of tobacco usage has led to increases in disease burden and high health-care costs in developing countries. There is a high incidence of smoking reported among youth from India, Bangladesh, and Indonesia.[9] The Cancer Atlas project by the Indian Council for Medical Research has shown the incidences of various cancers in different parts of India.[10] Aizawl district in the northeastern state of Mizoram has the world's highest incidence of cancers, in men, of the lower pharynx (11.5/100,000 people) and the tongue (7.6/100,000 people). Puducherry has one of the highest incidences of mouth cancer in the world among males (8.9/100,000), and Kohima, the capital city of another northeastern state, Nagaland, has the world's highest incidence of nasopharyngeal cancers.[11],[12]

We found that most of our patients (70%) presented to us in the fourth decade of life which is against the observation of the National Cancer Institute.[13] Who observed that HNCs are diagnosed more often among people over age of 50 years than they are among young people. The early presentation of patients in our study may be because of the fact that in Kashmir heavy smoking by young is on rise due to heavy psychological trauma and may be also because of easy access to the tertiary care hospital (Government Medical College Srinagar) which lies in the heart of valley.

Most of the patients in our study presented with an advanced stage of disease which was in accordance to the study of Krishnatreya et al.[14] on north east Indian patients the reason may be nonspecefic symptoms and anatomical constraints which limit their early detection.


  Conclusion Top


From the study, it is clear that the etiology of cancers is multifactorial with the complex interaction of genetic and environmental factors. Environmental factors, local customs, and cultural habits vary from place to place. Our study pointed out their influence on the nature and type of cancers and thus different incidences and prevalences of cancers in different geographical areas. Hence, it is the responsibility of every concerned authority medical as well as government to try hard and work for modification of local environmental factors responsible for rise in cancers and tackle the cancer burden as per local demands with relevant modification of national and international guidelines.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Chaturvedi P. Head and neck surgery. J Can Res Ther 2009;5:143.  Back to cited text no. 1
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2.
Davies L, Welch HG. Increasing incidence of thyroid cancer in the united states, 1973-2002. JAMA 2006;295:2164-7.  Back to cited text no. 2
    
3.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.  Back to cited text no. 3
    
4.
Blot WJ, McLaughlin JK, Winn DM, Austin DF, Greenberg RS, Preston-Martin S, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988;48:3282-7.  Back to cited text no. 4
    
5.
Zeka A, Gore R, Kriebel D. Effects of alcohol and tobacco on aerodigestive cancer risks: A meta-regression analysis. Cancer Causes Control 2003;14:897-906.  Back to cited text no. 5
    
6.
Nair S, Pillai MR. Human papillomavirus and disease mechanisms: Relevance to oral and cervical cancers. Oral Dis 2005;11:350-9.  Back to cited text no. 6
    
7.
Ferlay J, Parkin DM, Pisani P. GLOBOCAN Cancer Incidence and Mortality World Wide. IARC Cancer Base 3 (on CD ROM). Lyon: IARC; 1998.  Back to cited text no. 7
    
8.
Murray CJ, Lopez AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Boston: Harvard University Press; 1996.  Back to cited text no. 8
    
9.
Jha P, Chaloupka FJ. Curbing the Epidemic: Governments and Economics of Tobacco Control. Washington, DC: World Bank; 1999.  Back to cited text no. 9
    
10.
Nandakumar A. National Cancer Registry Programme. Consolidated Report of the Population Based Cancer Registries. Incidence and Distribution of Cancer: 1990–96. Bangalore, India: National Cancer Registry Programme (ICMR); 2001.  Back to cited text no. 10
    
11.
Mudur G. India has some of the highest cancer rates in the world. BMJ 2005;330:215.  Back to cited text no. 11
    
12.
National Cancer Control Programme – Home: National Portal of India. Available from: http://www.archive.India.Gov.In/sectors/health_family/index.Php?Id=11. [Last accessed on 2014 Apr 13].  Back to cited text no. 12
    
13.
Head and Neck Cancers. National Cancer Institute. Available from: http://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet. [Last accessed on 2013 Feb 1].  Back to cited text no. 13
    
14.
Krishnatreya M, Kataki AC, Sharma JD, Nandy P, Rahman T, Kumar M, et al. Educational levels and delays in start of treatment for head and neck cancers in North-East India. Asian Pac J Cancer Prev 2014;15:10867-9.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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