ITiiiT1111 ":':CANCER SURVIVAL IN NEW ZE~LAND. ..Tuniours reg~stered 19:p8-70. ~ce~j

Transcription

1 ". ISSN X c ;,~ j DEPARTME~~T Q HEALTH ~ce~j SPECIAL REPORT SERIES ":':CANCER SURVIVAL IN NEW ZE~LAND Tuniours reg~stered 19:p8-70 : < ;" ;!.. :. ; J. ;; Issued by the National Health Statistics Centre Department of Health, Wellington New Zealand {(/JDt " v\ A 0 4 A 84 ITiiiT

2 ISSN X DEPARTMENT O HEALTH CANCER SURVIVAL IN NEW ZEALAND Tumours registered by J. RASER DHA National Health Statistics Centre Department ofhealth Wellington s... SPECIAL REPORT No. 69 Issued by the National Health Statistics Centre -- - Department ofhealth, Welling ron 1984

3 OREWORD This publication presents information about a crucial aspect of cancer treatment in New Zealand which has not been available for a number of years. The chances of survival differ greatly according to the specific site of cancer and the stage of development of the disease at the time of treatment. This information is of particular interest to both clinician and patient. It also provides the basis for international comparison which can be made between New Zealand and those countries who also publish survival information. The computerisation of registry data has been instrumental in the production of this report which I hope will be the fore-runner of regular reports in future. Several staff members of NHSC have contributed to the completion of this report,in particular James raser, Senior Statistician in charge of the cancer registration programme. I should like to congratulate him for his work in designing and writing this report. rank oster Chief Health Statistician

4 ACKNOWLEDGMENTS I am grateful to rank oster for his advice and encouragement throughout this project. I should also like to thank Jackie Auld and the staff of the National Cancer Registry, past and present, whose efforts made this project possible. Thanks are also due to Mr Papps of.the Department of Statistics for. supplying life expectancy data; to Hamish leming who wrote the computer programs and to Hazel Gerrard who typed the report.

5 DISCLAIMER The comments expressed in this report are those of the author and do not necessarily reflect the views of the Department of Health.

6 CONTENTS., oreword., Acknowledgments Disclaimer Introduction Lip Tongue Salivary gland loor of mouth Total pharynx Oesophagus Stomach Large intestine, except rectum Caecum, appendix and ascending colon Transverse colon Descending colon Sigmoid colon Rectum and rectosigmoid junction Liver and intrahepatic bile ducts, primary Gallbladder and bile ducts Pancreas Larynx Trachea, bronchus and lung Bone Connective and other soft tissue Melanoma of skin Breast (emale only) Cervix uteri Corpus uteri Ovary Prostate Testis -Bladder Kidney... Page ' B

7 CONTENTS Page Eye 62 Brain 64 Thyroid gland.. ~ 66 Lymphomas. 68 Total leukaemia 70 Comparison of five-year relative survival rates. New Zealand and the United states of America 72 * * * *

8 1 INTRODUCTION This is the first major publication of New.Zealand Cancer Survival Data since the Report of the Medical Statistician on Cancer Morbidity and Mortality in New Zealand published in Source and presentation of data: This report presents the 3 and 5 year survival experience of cancer patients registered by the New Zealand National Cancer R~gistry in the years Data for 34 specific primary sites and types of cancer, classified according to the Eighth Revision of the International Classification of Diseases, are presented. Cases excluded: Cases for which the only source of information was a death certificate or autopsy report were excluded. Cause of death: Some studies have attempted to exclude cases where the underlying cause of death was something other than cancer but it is not common practice..the relative survival rate in fact provides the necessary adjustment for expected mortality from causes other than the specific cancer under review. cases: The classification of treatment was related to procedures initiated within six months after initial registration and was limited to tumourdirected therapy. No attempt has been made to distinguish between curative and palliative treatment in this report. "Crude" or ob survival rate: This is a measure of the proportion of patients alive at the end of a specified interval observation after registration. This measure is generally regarded as being of limited value because it takes no account of ~he-ages patien~s and therefore makes no ~arlowance-for normal life expectancy. There is no formal presentation of crude rates in this report but brief mention may be made in the text.

9 2 Relative survival rate: The relative survival rate can be described as the survival rate adjusted for normal life expectancy. It is defined as the ratio of observed survival to expected survival for a group of people in the general population similar to the patient group in terms of sex, age and period of observation. Expected survival in this report was calculated using 3 and 5 year expected survival rates based on Li Tables. Standard errors: The standard error of a survival rate provides a measure of the confidence with which it can be regarded and interpreted.

10 3 RESULTS

11 SITE LI P A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE Stage of Disease ~ Sex Total - Under 30 Age in years Localised M Regional and/or M node involvement Remote or diffuse M metastases Not 1. Localised M Regional and/or M - - " node involvement Remote or diffuse M metastases Cancer of the _lip accounts for approximately 1 percent of tumours registered in New Zealand. Of the 144 cases reviewed, 127 or 88 percent were male. Cancers of the lip are associated with cigarette smoking which probably accounts for the male predominance. Nearly 37 percent of patients were aged under 50 years at the time of registration. This is high when compared with the most common cancers which tend to be associated more with older ages. Most cases (92 percent) were registered and treated when the lesion was localised. As a consequence, the survival of these cases was comparatively very good.

12 5, SITE LIP,, B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TREATMENT STATUS '" Treat~d.. Not '. ',,,,.. 3' year S year 3 year S Sex year Survival Survival Survival Surviva,.. 1. Localised M ; Regional and/or M.... node involvement Remote or diffuse M.... metastases All stages M , " No cases in study Standard error 10 percent or greater The small number of female cases precludes the calculation of reliable survival rates for females but for males with a treated can'cer '8'8 percent were still alive after 3 years and 7~percent survived,5 years. The relative survival rates were 97 percent at 3 years and 94 percent at 5 years...

13 6 SITE TONGUE A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX. AGE. Stage of Disease Sex Total Under 30 Age in years Localised M Regional and/or M node involvement Remote or diffuse M metastases Not 1. Localised M Regional and/or M node involvement , Remote or diffuse M metastases This site, which is strongly associated with cigarette smoking, accounts for less than 1 percent of tumours registered in New Zealand. Nearly 80 percent of the 86 cases reviewed were males. percent were aged 60 or over. Sixty-four Only 51 percent of male cases were first treated when the tumour was localised compared with 78 percent of female cases. our cases were untreated.

14 " --, SITE TONGUE B. RELATIVE SURVIVAL RATES BY STAGE, O DISEASE, SEX 'AND TREATMENT STATUS, " Not, Sex 3 year 5 year 3 year 5 year Survival 'Survival Survival Survival 1. Localised M 53* 52* Regional and/or M C, node involvement Remote or diffuse M metastases All stages M 40* 39* o * No cases in study No survivors Standard error between 5 and 10 percent Standard error 10 percent or greater The small number of female cases (18) precluded the calculation of reliable ~~rvival tates for females. or maies the crude survival rate at 3 years for treated cases was 35 percent and at 5 years it was 30 percent. The relative survival rates for treated males were 40 percent and 39 perc~nt at 3 and 5 years respectively.

15 8 SITE SALIVARY GLAND A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE Stage of Disease' Sex Total Under 30 Age in years Localised M Regional and/or M node involvement a Remote or diffuse M metastases Not l. Localised M Regional and/or -M node involvement Remote or diffuse M metastases This site accounts for less than 1 percent of tumours registered in New Zealand. ifty-seven percent of the 82 cases reviewed were males. percent were aged 60 years or over. ifty-two A greater proportion of female cases (66 percent) were first treated when the tumour was localised than were male cases (53 percent).

16 SITE SALIVARY GLAND B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TREATMENT STATUS Not.. -- Sex 3 year Survival 5 year Survival 3 year Survival 5 year Survival 1. Localised M 2. Regional and/or node involvement 3. Remote or diffuse metastases o All stages No survivors M M 89* * Standard error between 5 and 10 percent Standard error 10 percent or greater M 78* 85* 91* * 89* The crude survival rates at 3 and 5 years for treated males were 67 percent and 60 percerit respectively. or females the figure was 81 percent at both 3 and 5 years. Relative survival rates for treated males were 78 percent for both 3 and 5 years and for females they were 85 percent and 89 percent. /

17 10 SITE LOOR O MOUTH A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE,' SEX, AGE Stage of disease Sex Total " Under 30 Age in years Localised M Regional and/or M node involvement Remote or diffuse M metastases Not 1. Localised M Regional and/or M node involvement Remote or diffuse M - metastases ,, Almost two-thirds of the 47 cases reviewed were males..this site is another which is strongly linked with cigarette smoking and this possibly explains the excess of male cases. Approximately 62 percent of cases were aged 60 years or over at the time of registration. Only 36 percent of cases were treated when the tumour was localised, the remaining 64 percent were treated when there was regional or node involvement.

18 11 SITE LOOR O MOUTH B. RELATIVE SURVIVAL RATES BY STAGEcO DISEASE~ SEX AND TREATMENT STATUS Not, -Sex -- " 3 year 5 year 3 year 5 year Survival Survival Survival Survival 1. Localised M r 2. Regional and/or M.... node involvement Remote or diffuse M metastases All stages M 59* 40*., 78* 77* - No cases in study * Standard error between 5 and 10 percent Standard error 10 percent or greater or treated males the crude survival rates at 3 and 5 years respectively were 52 percent-and 32 percent and for females the rat~s were 69 percent and 63 percent. The relative survival rat~s for males were 59 percent and 40, percent at 3 and 5 years and for females the'rates were 78 percent and 77 percent. Because of the very small number of cases, care should be exercised when interpreting these rates.

19 12 SITE TOTAL PHARYNX A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE Age in years Stage of disease Sex Total r-=-~ Under Localised M Regional and/or M node involvement Remote or diffuse M 1 1 metastases 1 1 Not 1. Localised M Regional and/or M node involvement Remote or diffuse M metastases Male cases outnumbered female cases by almost 3 to 1. Two-thirds of the cases reviewed were aged 60 years and over at the time of registration. Only 30 percent of the 87 cases were first treated when the tumour was localised whereas 68 percent were first treated when there was regional and/or node involvement.

20 13 SITE TOTAL PHARYNX B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE,. SEX AND TREATMENT STATUS _.., Not Sex 3 year 5 year 3 year 5 year Survival survival Survival survival 1. Localised M Regional and/or M 38* 30* node involvement Remote or diffuse -M metastases All stages M 45* 39* o No cases in study No survivors * standard error between 5 and 10 percent Standard error 10 percent or greater Once again the small number of female cases precluded the calculation of reliable survival rates for females. orty percent of males with a treated cancer were still alive 3 years after registration and 31 percent after 5 years. The relative survival rates for males were 45 percent and 39 percent at 3 and 5 years respectively..

21 ~ 14 SITE OESOPHAGUS A. NUMBER O' CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE Stage of disease Sex Total Under 30 Age in years Localised within M organ of origin Throughout organ of M origin(nodes not involved) 3. Regional spread M (Local lymph nodes) Other organs or with M distant metastases Not 1. Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread M (Local lymph nodes) Other organs or with M distant metastases i Cancers of the oesophagus account for approximately 2 percent of the tumours registered in ~ew Zealand. This is another cancer site which is strongly linked with cigarette smoking which may help to account for the fact that male cases outnumbered females by 61 percent to 39 percent. At the time of registration 78 percent of the 267 cases were aged 60 years or over. Only 21 percent of the tumours were registered while still localised whereas in 57 percent there was either regional spread or spread to other organs. Thirty-two percent of the tumours were untreated.

22 «15 SITE OESOPHAGUS B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TREATMENT STATUS Not Sex 3 year 5 year 3, year 5 year Survival Survival SUrvival Survival 1. Localised within M 25* organ of origin Throughout organ of M origin(nodes not 20* 17* 0 0 involved) 3. Regional spread M (Local lymph nodes) Other organs or with M 0 0 6* 7* distant metastases All stages M , * 10* o No survivors * Standard error between 5 and 10 perc~nt Standard error 10 percent or greater Overall survival was poor. Only 12 percent of treated males and 2 percent of untreated males were still alive 3 years after registration. In the case of females the crude survival figures were 13 percent (treated) and 7 percent (untreated),at the end of 3 years. Relative survival rates were also poor. or treated males the rates were 14 percent and',ll percent at 3 and 5 years respectively and for females the rates were 15 percent and 13 percent...

23 16 SITE STOMACH A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE stage of disease Sex Total Under 30 Age in years Localised within M organ of origin Throughout organ of M origin(nodes not involved) Regional spread M (Local lymph nodes) Other organs or with M distant metastases Not 1. Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread M (Local lymph nodes) Other organs or with M distant metastases Stomach cancer ranks among the ten most common sites of cancer in New Zealand and accounts for approximately 5 percent of all tumours registered.. In the cases reviewed males outnumbered females by more than 2 to 1. At the time of registration 75 percent of the 1077 cases were aged 60 years or over. Nineteen percent of tumours had spread regionally and a further 45 percent showed spread to other organs or already had distant metastases when registered. Only 40 percent of the cases reviewed received some treatment' to their tumour. This proportion was obviously influenced by the extent of disease at registration.

24 17 SITE STOMACH B. RELATIVE SURVIVAL RATES BY STAGE O' DISEASE, SEX AND TREATMENT STATUS.f,Not ' \ Sex,3 year SUrvival 5 year Survival 3 year Survival.5 year, Survival 10 Localised within M 51* 49* 15* 7* organ of origin..... '0.. 0 ".. Q " 2" Throughout organ of M 38* 38* 0 0 origin (Nodes not Q".. "... 6* 8* involved) 3 0 Regional spread M (Local lymph nodes) 14* 13* 6 3 4", Other organs or with M distant metastases 0 0 3' 2 All stages M o No survivors * Standard error between 5 and 10 percent Standard error 10 percent or greater Overall survival was poor. Only 19 percent of treated male cases and 15 percent of treated female cases were alive after 3 years and only 15 percent and 12 percent after 5 years. or untreated cases survival was even poorer. Three percent of male cases survived 3 years and 2 percent 5 years. or females the crude survival rates were 4. percent at both 3 and 5 years. Relative survival rates were also poor. or treated males the rates were 23 percent and 19 percent at 3 and 5 years respectively and for females the figures were 17 percent and 14 percent. The rates for,untreated c,a.ses wer13 much poorer again. Male untreated cases had 3 percent relative survival rates at both 3 and 5 years while the female rates were 5 percent at both 3 and 5 years.

25 SITE LARGE INTESTINE, EXCEPT RECTUM 18 A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE, Age in years Stage of disease Sex Total Under Loqalised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread M Other organs or with M distant metastases Not 1. Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread M Other organs or with M ,. 27 distant metastases This is the third highest ranking site of cancer in New zealand, after lung cancer and cancer of the female breast, accounting for approximately 10 percent of all tumours registered. A total of 2035 cases were included in this review of which 46 percent were males and 54 percent females. Altogether 33 percent of the cases were under 60 years of age at the time of registration. Only 15 percent of tumours were registered while localised within the organ of origin compared with 56 percent which had already undergone regional spread or spread to other organs. About 26 percent of tumours were untreated. This is largely attributable to the advanced stage of tumour development at the time of registration. Sixty percent of males with a treated, localised tumour were still alive 3 years after registration compared with 73 percent of females. The relative survival rates for treated localised tumours were 82 percent for males at 3 years and 91 percent for females; at five years the rates were 77 percent and 86 percent respectively.

26 19 SITE LARGE INTESTINE, EXCEPT RECTUM B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TREATMENT STATUS Not Sex 3 year 5 year 3 year 5 year Survival Survival Survival Survival l. Localised within M organ of origin * Throughout organ of M * 7* origin (Nodes not * 16* involved) 3. Regional spread M Other organs or with M distant metastases o All stages M No survivors * Standard error between 5 and 10 percent Standard error 10 percent or greater The table shows how relative survival rates deteriorate as tne stage of disease at treatment becomes more widespread. Only 5 percent of males whose tumours had undergone spread to other organs or had distant metastases at the time of treatment were alive after 5 years; the female rate was 6 percent. The relative survival rates for these tumours were 6 and 7 percent for males and females respectively._.. The overall 5 year crude survival rates were 39 percent for treated males and 46 percent for treated females. Information about subsites within the large intestine are presented in the following pages.

27 20 SITE CAECUM, APPENDIX AND ASCENDING COLON A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE., stage of disease Sex Total Under 30 Age in years Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread M Other organs or with M distant metastases Not treated l. Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread M Other organs or with M distant metastases vl Tumours of these subsites accounted for 576 cases or 28 percent of the total colon tumours included in the study. emales outnumbered males by a ratio of 1.4 : 1 which was greater than the sex difference for total large bowel cancers. Thirty percent of cases were under 60 years of age at the time of registration. Only 14 percent of cases were registered while confined to the organ of origin compared with 59 percent which had already undergone regional spread or spread to other organs. About 26 percent of tumours were untreated. This is in line with data relating to the colon in total.

28 21 SITE CAECUM, APPENDIX AND ASCENDING COLON B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TREATMENT STATUS -" Not. Sex 3 year 5 year 3 year 5 year Survival Survival Survival Survival 1. Localised within M 78* 79* 0 0 organ of origin Throughout organ of M 83* 70*.. 0 origin (Nodes not 77* 70*..... involved) 3. Regional spread M 52* 46* 0 39* 38* Other organs or with M distant metastases 15* 10* 4 5 o All stages M No survivors * Standard error between 5 and 10 percent Standard error 10 percent or greater.. ifty-two percent of treated male and female cases.were still alive after 3 years and 42 percent of treated males and 44 percent of treated females were alive after 5 years. The all stages relative survival rates for treated cases at 5 years were 54 percent for males and 53 percent for females. '.

29 22 SITE TRANSVERSE COLON A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE Stage of disease Sex Total Under 30 Age in years l. Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread. M Other organs or with M distant metastases Not l. Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread M Other organs or with M distant metastases The 377 tumours of the transverse colon represent 18 percent of the total tumours the colon included in the study. emales outnumbered males by a ratio of 1.3 : 1 which was similar to the total colon sex differential. Sixty-four percent of cases were aged 60 years or over at registration. Only 84 cases were untreated and most of these had advanced disease at registration. Of the 293 treated tumours, more than 52 percent had already experienced regional spread or spread to other organs or had distant metastases at the time of treatment.

30 23 SITE TRANSVERSE COLON B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TR.EATMENT STATUS. Not <i " 'Sex 3 year Survival 5 year Survival 3 year Survival 5 year Survi,val 1. Localised within M 89* 78* organ of origin 94* 92* Throughout organ of M 70* 75* 0 0 origin (Nodes not 82* 81* 0 0 involved) 3. Regional spread M 46* 36* * 47* Other organs or with M 11* 11* 0 0 distant metastases 9* 10* 0 0 All stages a o No survivors * Standard error between 5 and 10 percent Standard error 10 percent or greater The all stages 5 year crude survival rates (38 percent male and 47 percent female) for treated cases were similar to the total rates for colon. The. corresponding relative survival rates were 47 and 57 percent for males and females respectively.

31 24 SITE DESCENDING COLON A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE. Age in years Stage of disease Sex Total Under 30.' Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread M Other organs or with M distant metastases ' Not 1. Localised within M organ of origin Throughout organ of M origin(nodes not involved) 3. Regional spread M Other organs or with M distant metastases The 155 tumours of the descending colon represented only 8 percent of all the colon tumours included in the study. The sex distribution was 49 percent males and 51 percent females; this cannot be considered to differ significantly from the sex distribution of all colon tumours. ifty-nine percent of cases were aged 60 years or over at registration. Only 29 cases (19 percent) were untreated and most of these had advanced disease at the time of registration. Of the 126 treated tumours 43 percent had already experienced regional spread or spread to other organs or had distant metastases at the time of treatment.

32 25 SITE DESCENDING COLON Bo RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND' TREATMENT STATUS Not Sex 3 year 5.year 3 year 5 year Survival Survival Survival Survival 1. Localised within M organ of origin 95* 94* Throughout organ of M origin (Nodes not involved) 3. Regional spread M Other organs or with M distant metastases o All stages M 45* 39* 0 '0 59* 54* 0 0 No survivors * Standard error between 5 and 10 percent Standard error 10 percent or greater The all stages crude 5 year survival rates for treated cases were 32 percent males and 46 percent females. The corresponding relative survival rates were 39 and 54 percent respectively.

33 26 SITE SIGMOID COLON A. NUMBER O CASES INCLUDED ln STUDY: TREATMENT STATUS X STAGE, SEX, AGE Stage of disease Sex Total Under 30 Age in years ,Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regiona'l spread M ' Other organs or with l distant metastases ' 3 Not 1. Localised within M or'gan of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread M Other organs or with M distant metastases The 694 tumours of the sigmoid colon represented 34 percent of all the colon tumours included in the study. The sex distribution was almost evenly divided with 349 males and 345 females. Sixty-eight percent of cases were aged 60 years or over at registration. There were 139 untreated cases and 78 percent of these were at an advanced stage at the time of registration. Of the 555 treated tumours 237 (43 percent) had already experienced regional spread to other organs or had distant metastases at the time of treatment.

34 27 SITE SIGMOID COLON B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TREATMENT STATUS Not 3 year 5 year 3 year Sex 5 year Survival Survival Survival Survival 1. Localised within M 88* 81*.. 0 organ of origin 78* 70* o.. 2. Throughout organ of M 73 65* origin (Nodes not involved) Regional spread M 45* 30* * 41* Other organs or with M distant metastases 15* All stages M < o * No survivors Standard error between 5 and 10 percent Standard error 10 percent or greater The all stages 5 year crude survival rates for treated cases were 36 percent male and 46 percent female. The corresponding 5 year relative survival rates were 47 and 55 percent respectively.

35 28 SITE RECTUM AND RECTOSIGMOID JUNCTION A. NU~IBER O CASES INCLUDED IN STUDY: TREATMENT STATUS, X STAGE, SEX, AGE Stage of disease Sex Total Under 30 Age in years l. Localised within M organ of origin '. Throughout organ of M ( origin (Nodes not involved). 3. Regional spread M Other organs or with M distant metastases Not 1. Localised within M organ of origin Throughout organ of M origin (Nodes not l' 10 involved) 3. Regional spread M Other organs or with M distant metastases Cancer of the rectum is the fourth highest ranking site of cancer in New Zealand accounting for approximately 6 percent of all new cases registered. A total of 1122 cases were included in this study of which 649 (58 percent) were males and 473 (42 percent) were females. Two-thirds of the cases were aged 60 years or over at registration. Only 22 percent of tumours were registered while still localised within the rectum compared with 50 percent which had undergone regional spread or had spread to other organs. Approximately 18 percent of tumours were untreated. This was chiefly attributable to age and advanced stage of tumour development.

36 29 SITE RECTUM AND RECTOSIGMOID JU~CTION B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TREATMENT STATUS.-, Not Sex 3 year Survival 5 year Survival 3 year Survival 5 year Survival l. Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread M * 9* *.. 4. Other organs or with M distant metastases All stages M * Standard error between 5 and 10 percent Standard error 10 percent or greater ifty-seven percent of males with a treated, localised tumour were still alive 5 years after 'registration compared with 71 percent of females. The corresponding 5 year relative survival rates were 74 percent for males and 85 percent for females. The table shows how relative survival rates deteriorate as the stage of disease at treatment becomes more widespread. Only 3 percent of treated males whose tumours had undergone spread to other organs or which had distant metastases were alive after 5 years; the female rate was 6 percent. The relative survival rates for these tumours were 3 and 7 percent for males and females respectively. The overall all stages 5 year crude survival rates were 39 percent for treated males and 46 percent for treated females. The corresponding relative survival rates were 51 and 55 percent respectively.

37 30 SITE LIVER AND INTRAHEPATIC BILE.DUCTS, PRIMARY A. NUMBER O CASES INCLUDED IN. STUDY: TREATMENT STATUS X STAGE,.SEX, AGE ptage of disease Sex Total Under 30 Age in years Localised M Regional and/or M node involvement Remote or diffuse M metastases Not 1. Localised M Regional and/or M node involvement Remote or diffuse M metastases Primary liver cancer accounts for less than 1 percent of tumours registered in New Zealand. Of the 126 cases included in this study 68 percent were males and 32 percent females. ifty-five percent of cases were aged 60 years or over at registration. The most striking feature about primary liver cancer was the large proportion of tumours which were untreated (88 percent)

38 31 SITE LIVER AND INTRAHEPATIC BILE DUCTS, PRIMARY B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TREATMENT STATUS. Not Sex 3 year 5 year 3 year 5 year.survival. Survival Survival Survival 1. Localised M * 28* 20* 23* 2. Regional and/or M node involvement Remote or diffuse M 28* 30* 0 0 metastases All stages M 12* 13* * 18* 10 7 o No cases in study No survivors * Standard error between 5 and 10 percent Standard error 10 percent or greater The numbers of cases were small and consequently the relative survival rates are unstable. Nevertheless the figures indicate that prognosis was poor whether treated or untreated.

39 32 SITE GALLBLADDER AND BILE DUCTS A. NUt~BER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE stage of disease,- Sex Total Under, 30 Age in years Localised M Regional and/or M node involvement , Remote or diffuse M metastases Not 1. Localised M ' Regional and/or M node involvement Remote or diffuse M metastases This site accounts for approximately 1 percent of tumours registered in New Zealand. A total of 177 cases were included in this review of which 36 percent were males and 64 percent females. Seventy-seven percent of the cases were aged 60 years or over at registration. Approximately 63 percent of the tumours were untreated which can be attributed chiefly to the extent of disease at the time of registration.

40 33 SITE GALLBLADDER AND BILE DUCTS B. RELATIVE SURVIVAL RATES.BY STAGE O DISEASE, SEX AND TREATMENT STATUS,... Sex,. Not 3 year 5 year 3 year 5 year Survival Survival Survival. Survival 1. Localised M Regional and/or M node ihvolvement 8* 9* Remote or diffuse M metastases 10* 0 0 o All stages M 29* * 27* 0 0 No survivors * Standard error between 5 and 10 percent Standard error, 10 percent or greater.... The numbers of treated cases were small and consequently the relative survival rates were not statistically very reliable but they do. indicate that sqrvival was poor. None of the untreated cases survived 3 years.

41 34 SITE PANCREAS A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE Stage of disease Sex Total, Under 30 Age in years l. Localised M Regional and/or M '3 1 2 node involvement Remote or diffuse M ' 3 3 metastases Not 1. Localised M Regional and/or M node involvement Remote or diffuse M metastases This site accounts for approximately 3 percent of tumours registered in New Zealand. Of the 531 cases included in this review 60 percent were males and 40 percent females. Seventy-five percent were aged 60. ~ears or over at registration. Over 90 percent of the tumours were untreated which can largely be attributed to the extent of disease at registration.

42 35 SITE PANCREAS B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TREATMENT STATUS Not 1. Localised 2. Regional and/or node involvement 3 year Sex Survival M M 5 year Survival year 5 year Survival Surviva 12* 11* 5 5* Remote or diffuse metastases M ~ o All stages M 17* 18* No survivors * Standard error between 5 and 10 percent standard error 10 percent or greater 11* The numbers of treated cases available in this review were too small to produce very reliable survival rates but the indications were that survival was poor.

43 36 SITE LARYNX A. NUMBER O CASES INCLUD~D IN STUDY: TREATM~NT STAT~S X STAGE, SEX, AGE, stage of disease Sex Total Under 30 Age in years " l. Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread M (Local lymph nodes) Other organs or wi.th M distant metastases Not l. Localised within M organ of origin Throughout organ of M origin (Nodes not involved) 3. Regional spread (Local lymph nodes) Other organs or with t distant metastases Cancer of the larynx is a predominantly male disease. Of the 156 cases included in this review 139 or 89 percent were male. Tumours of this site are strongly linked with cigarette smoking and this possibly explains the excess of male cases. Sixty percent of cases were aged 60 years or over at registration. Only 8 percent of tumours were untreated.

44 37 SITE LARYNX B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TREATfvlENT STATUS I, I Not Sex 3 year 5 year 3 year 5 year Survival survival., 'Survival Survival 1. Localised within 1'1 66.* 68*.... organ of origin Throughout organ of M 72* 64*.. origin(nodes not involved) Regional spread M 0 0 (Local lymph nodes) Other organs or with M distant metastases All stages M o 0 0 o No cases in study No survivors * Standard error between 5 and 10 percent Standard error 10 percent or greater 0 The small number of female cases precluded the calculation of reliable survival rates. or treated males the crude survival rates were 59 and 48 percent at 3 and 5 years respectively. The corresponding relative survival rates were 66 and 59 percent.

45 38 SITE TRACHEA, BRONCHUS AND LUNG A. NUMBER O CASES INCLUDED IN STUDY:. TREATMENT STAT.US X'STAGE, SEX~ AGE Stage of disease Sex Total Under 30 Age in years l. Localise.d M Regional and/or M node involvement Remote or diffuse M metastases Not l. Localised M Regional and/or M node involvement Remote or diffuse M metastases Cancer of the lung is the most frequent~y reported cancer in New Zealand. It ranks highest among male cancers and third highest among female cancers after breast and colon. A total of 2527 cases were included in this review of which 2129 were males and 398 were females. In other words, males outnumbered females by a ratio of more than 5 : 1. The well documented link between cigarette smoking and lung cancer almost certainly explains the excess of male cases. seventy-seven percent of cases were aged 60 years or over at registration. Thirty percent of tumours were registered while still localised compared with 33 percent which had already metastasised. A large proportion (41 percent) of the tumours included in the study were untreated.

46 3Y SITE TRACHEA, BRONCHUS AND LUNG B. RELATIVE SURVIVAL RATES BY, STAGE O DISEASE, SEX AND TREATMENT STATUS Not Sex 3 year 5 year 3 year 5 year Survival Survival Survival Sur-viva 10 Localised M * 23* 13* 16* 2. Regional and/or M node involvement Remote or diffuse M metastases All stages M o No survivors *. Standard error between 5 and 10 percent Survival rates decreased rapidly as the spread of disease became more extensive. None of the 51 females with a treated metastasised tumour survived 3 years and only 4 of the 225 males with similar stage of disease were alive after 3 years. Only 27 percent of males with a treated localised tumour were alive after 3 years and only 20 percent after 5 years. rhe corresponding relative rates were 30 and 25 percent respectively. The all stages 5 year relative survival rates were also low at 13 percent for males and 10 percent for females..

47 40 SITE BONE A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE Stage of disease Sex Total Under 30 Age in years l. Localised M Regional and/or M node involvement Remote or diffuse M metastases Not 1. Localised M Regional and/or M node involvement Remote or diffuse M metastases There were only 81 cases included in this review, 60.percent of whom were males and 40 percent females. Unlike most forms of cancer 33 percent of these tumours occurred in persons under 30 years of age; only 40 percent occurred at ages 60 years and over. Seven percent of cases were untreated.

48 41 SITE BONE 80 RELATIVE SURVIV.AL RATES BY STAG.E O DISEASE, SEX AND TREATMENT STATUS.. <' Not ; 3 year 5 year 3 year Sex 5 year Survival Survival Survival Survival.. 10 Localised M * 93* - 20 Regional and or M o.. 0 node involvement Remote or diffuse M metastases All stages. M 36* 35* * 53* 0 0 o * No cases in study No survivors Standard error between 5 and 10 percent Standard error 10 percent or greater The number of cases included in the study was relatively small which resulted in survival rates being rather unstable. The data does, however, indicate that there is very little difference between 3 and 5 year survival rates. In other words, patients who survive 3 years are very likely to survive 5 years.

49 42 SITE CONNECTIVE AND OTHER SOT TISSUE A. NUMBER O CASES INCLUDED.IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE Stage of disease Sex Total Under 30 Age in years Localised M Regional and/or M node involvement Remote or diffuse M metastases Not 1. Localised M Regional and/or M node involvement I 3. Remote or diffuse M metastases Of the 133 cases included,in this review 55 percent were males and 45 percent females. More than half (56 percent) were aged less than 60 years at registration. Only 10 cases (8 percent) were untreated.

50 43 SITE CONNECTIVE AND OTHER SOT TISSUE 8. RELATIVE SURVIVAL RATES BY 'STAGE O DISEASE,' SEX AND TREATMENT STATUS, Not " 3 year 5 year 3 year 5 year.,sex, Survival Survival Survival Survival 1. Localised M 80* 72* * Regional and/or M o... node involvement o Remote or diffuse M metastases All stages M 56* 51* * 70* 0 0 o No cases in study No survivors * Standard error between 5 and 10 percent Standard error 10 percent or greater l Once again the numbers of cases were t90 small to produce very! reliable survival rates. However, 51 percent of treated males were alive after 3 years and 43 percent after 5 years. The corresponding female rates were 70 percent and 61 percent. The relative 5 year survival rate for males was 51 percent and for females it was 70 percent. None of the 10 untreated cases survived 3 years.

51 44 SITE MELANOMA O SKIN A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X STAGE, SEX, AGE Stage of disease Sex Total Under 30 Age in years Localised M Regional and/or M node involvement Remote or diffuse M metastases Not 1. Localised M Regional and/or M node involvement Remote or diffuse M metastases In the period covered by this study malignant melanomas of the skin accounted for approximately 3 percent of registrations. Of the 747 cases 39 percent were male and 61 percent female. over half of the cases were under 50 years of age. Just Eighty-seven percent of cases were treated when the tumour was localised and only 18 cases were untreated. Apart from localised treated tumours the numbers of cases were too small to produce very reliable rates.

52 45 SITE MELANOMA O SKIN B. RELATIVE SURVIVAL RATES BY STAGE O DISEASE, SEX AND TREATMENT STATUS Not Sex 3 year 5 year 3 year 5 year Survival Survival Survival Survival 1. Localised M Regional and/or M... 25*... 0 node involvement 71* Remote or diffuse M metastases 10* o All stages M No cases in study No survivors * Standard error between 5 and 10 percent Standard error 10 percent or greater, Seventy-nine percent of males with treated localised tumours were aiive 3 year~ after registration and 65 percent~fter 5 years. The corresponding female figures were 88 percent and 82 percent. The all stages 5 year relativesurvivai rates for treated cases were 65 percent male and 85 percent female. Only 1 of the 18 untreated cases survived 3 years.

53 46 SITE BREAST (EMALE ONLY) A. NUMBER O CASES INCLUDED IN STUDY: TREATMENT STATUS X T.N.M. STAGE AND AGE stage of disease Sex Total Under 30 Age in years Staging description as below: 2. II " " Not II l 2. " " " 1. Tumour of 5 em or less (T1 or T2); no nodes palpable (NO): no distant metastases (MO). 2. Tumour of 5 em or less (T1 or T2); nodes palpable but movable (N!); no distant metastases (MO). 3. Tumour of more than 5 em in diameter (T3 or T4)i nodes fixed (N2 or N3)i and no distant metastases (MO). 4. Distant metastases present (M) regardless of the condition of the primary tumour and regional lymph nodes. Cancer of the breast is the principal site of cancer in females and accounts for approximately 20 percent of all female cancers. A total of 2456 tumours were included in this review. Of these, 68 percent occurred in women aged between 40 and 69 years. orty-four percent of tumours were treated when still stage 1. Of the 98 untreated tumours 64 percent were stage 4.

54 47 SITE BREAST (EMALE ONLY) Bo RELATIVE SURVIVAL RATES BY STAGE O DISEASE, AGE AND TREATMENT STATUS.. Sex Not 3 year 5 year 3 year 5 year Survival Survival Survival Survival 1. Staging description as for Table A 2. " " If All stages o No survivors Standard error 10 percent or greater The table shows how survival deteriorated as the stage of disease became more widespread. Seventy-five percent of women with a stage 1 treated tumour were alive after 5 years compared with 12 percent of women with a stage 4 tumour. The all stages 5 year relative survival rate was 66 percent.

55 48. SITE CERVIX UTERI A. NUMSER O CASES INCLUDED IN STUDY: TREATMENT STATUS X T.N.M. STAGE AND AGE Stage of disease Sex Total Under 30 Age in years Staging description as below: \ 2. " " ( 4 « , Not 1. Staging description as below: " « " Lesion strictly confined to cervix. 2. Lesion encroaches the vaginal wall and/or infiltrates the parametrium. 3. Lesion involves the lower third of the vagina and infiltration of the parametrium has extended into the pelvic wall. 4. Clinical invasion of the bladder or rectum or histologically proved invasion of bladder or rectum,ulceratibnor fistulas. Extension of the carcinoma outside the true pelvis. This site accounts for approximately 6 percent of all female cancers registered in New Zealand. Of the 459 cases included in this study 65 percent were under o Ị e " of age at registration. Over 41 percent of cases were treated while the tumour was confined to the cervix. Only 25 cases were untreated and 19 of these were stage 4 disease at the time of registration.