NATIONAL CANCER REGISTRY PROGRAME Hospital Based Cancer Registry 10 Yrs. Consolidated Report ( AD)

Transcription

1 B.P. KOIRALA MEMORIAL CANCER HOSPITAL NATIONAL CANCER REGISTRY PROGRAME Hospital Based Cancer Registry 10 Yrs. Consolidated Report ( AD) TU Teaching Hospital Kathmandu Kanti Children's Hospital, Kathmandu Bir Hospital Kathmandu Bhaktapur Cancer Hospital, Bhaktapur Manipal Teaching Hospital, Pokhara B.P. Koirala Memorial Cancer Hospital, Chitwan B.P. Koirala Institute of Health Science Dharan al=kl=sf]o/fnf d]df]l/on SofG;/ c:ktfn 2049BS/1992AD BPKMCH,NEPAL B. P. Koirala Memorial Cancer Hospital Cancer Prevention, Control & Research Department Bharatpur, Chitwan, Nepal

2 B.P. KOIRALA MEMORIAL CANCER HOSPITAL NATIONAL CANCER REGISTRY PROGRAMME Hospital Based Cancer Registry AD National Cancer Registry Committee Advisor : Dr. Prakash Raj Neupane, PhD (Oncosurgery) Chairman, B.P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan, Nepal Programme Director : Dr. Bijaya Chandra Acharya, MD (Gynaeoncology) Executive Director B.P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan, Nepal Dr. Prakash Raj Neupane Member Hospital Director Surgical Oncologist Bhaktapur Cancer Hospital Dr. Bijaya Chandra Acharya Co-ordinator Executive Director B.P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan Dr. Kailash Prasad Sah,MD Member Pediatric Oncologist Kanti Children Hospital Kathmandu Principal Investigator : Kishore Kumar Pradhananga, MPH Head, Cancer Prevention, Control & Research Dept. B.P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan, Nepal Public Health Officer : Dr. Krishna Subedi, MPH Cancer Prevention, Control & Research Dept. B.P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan, Nepal Dr. Bishnu D. Poudel, MD Member Medical Oncologist Bir Hospital, Kathmandu Dr. Anjani Kumar Jha, MD Member Radiation Oncologist B.P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan Dr. Yogendra P. Singh, PhD Member Surgical Oncologist TU Teaching Hospital Kathmandu al=kl=sf]o/fnf d]df]l/on SofG;/ c:ktfn 2049BS/1992AD BPKMCH,NEPAL Dr. Sangita Bhandari, MS Member Head & Neck Specialist BPKIHS Dr. B.M. Nagpal, MD Member Dean Manipal Medical College & Teachning Hospital, Pokhara Kishore Kumar Pradhananga, MPH Member Secretary Cancer Prevention, Control & Research Dept. B.P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan, Published Date : 2074 Ashwin 10 ii iii

3 B. P. Koirala Memorial Cancer Hospital (BPKMCH) ACKNOWLEDGEMENTS Dr. Bijaya Chandra Acharya Executive Director B.P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan Dr. Binuma Shrestha, MD Member HoD, Surgical Oncology Dept. BPKMCH Dr. Suresh Shrestha, MD Member HoD, Radiation Oncology Dept. BPKMCH Cancer Registry Committee Dr. Nirmal Lamichhane Deputy Director B.P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan Dr. Jaya Shrestha Member HoD, Medical Oncology Dept. BPKMCH Dr. Gyan Bahadur Shrestha Member HoD, Radio-Diagnosis, Imaging & Medicine Dept. BPKMCH Dr. Shivaji Poudel Academic Co-ordinator B.P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan Dr. Sadina Shrestha,MD Member HoD, Pathology Dept. BPKMCH Kishore Kumar Pradhananga,MPH Member Secretary Cancer Prevention Control & Research Dept. The Hospital Based Cancer Registry of B.P. Koirala Memorial Cancer Hospital, Cancer Prevention, Control and Research Department, Bharatpur, Chitwan express its sincere gratitude to the following institutions/ individuals for supporting and promoting the activities of the registry. CHIEF NAME AND ADDRESS OF PARTICIPATING INSTITUTION 1. B. P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan, Nepal Dr. Bijaya Chandra Acharya Executive Director 2. T.U. Teaching Hospital Maharajgunj, Kathmandu, Nepal Dr. Dipak Mahara Hospital Director 3. Bir Hospital Mahaboudha, Kathmandu, Nepal Dr. Bhupendra Basnet Hospital Director 4. Kanti Children's Hospital Maharajgunj, Kathmandu, Nepal Dr. Ganesh Gurung Hospital Director 5. Bhaktapur Cancer Hospital Bhaktapur, Nepal Dr. Prakash Raj Neupane Med. Director 6. B.P. Koirala Institute of Health Prof. Dr. Gauri Shankar Shah Dharan, Sunsari, Nepal Sciences Hospital Director 7. Manipal Teaching Hospital Phulbari, Pokhara, Kaski, Nepal Prof. Dr. P.K. Chakraborty Medical Director. Name of staffs involved in cancer data abstraction/collection /coding process in different hospitals: 1. Bir Hospital, Kathmandu Dr. Bibek Acharya, MD (Radiation Oncologist) Ms. Laxmi K.C ( Sister) Mr. Baburaja Maharjan ( Medical Record) Mr. Damodar Pradhananga (Medical Record) 2. B. P. K. Institute of Health Sciences, Dharan Dr. DharanidharBaral( Biostatistician) Mr. Salamuddin Ansari( Medical Record) Mr. Sunil Parajuli( Medical Record) 3. Manipal Teaching Hospital, Pokhara Dr. Rishi Serchan,MD (Radiation Oncologist) Mr. Prages Shah ( Technologist) Ms.Madhu Dhungana ( Medical Record) 4. Bhaktapur Cancer Hospital, Bhaktapur Dr. Sudip Shrestha,MD (Medical Oncologist) Mr. Prem Sujakhu( Medical Record) 5. Tribhuvan University, Teaching Hospital, Kathmandu Dr. Yogendra Prasad Singh, Phd (Surgical Oncologist), Mrs. Nilam Pokhrel (Medical Record) Mr. Janak Neupane (Medical Record) Mr. Shiva Bahadur Magar (Medical Record) 6. Kanti Children's Hospital, Kathmandu Dr. Kailash Prasad Sah, MD (Paed.Oncologist) Ms. Meera Jha (Medical Record) Ms.Sudha Thakur (Medical Record) 7. B. P. Koirala Memorial Cancer Hospital, Bharatpur Dr. Nirmal Lamichhane (Surgical Oncologist) Dr. Sadina Shrestha, MD (Pathologist) Mr. Kishore Kumar Pradhananga Dr. Krishna Subedi Mr. Bhola Siwakoti Ms. Sarmila Neupane Ms. Manju Sharma Ms. Tara Dawadi Mr. Kamala Adhikari Mr. Punya Ghimire iv v

4 Message Message I am highly pleased to know about the publication of Hospital Based Cancer Registry Report based on 10 years data from 2003 to 2012 AD of major hospitals of Nepal which involved cancer diagnosis and treatment. BP Koirala Memorial Cancer Hospital (BPKMCH) is a National Cancer Centre providing quality care covering all aspects of cancer prevention including, diagnosis, treatment and rehabilitation to the people of Nepal as well as from neighbouring countries. Cancer is increasing life style change related issues and habits of consuming tobacco. There is a greater need from the policy making to know about the disease to make a control over it. This report shows the data of population suffering from cancer during period of Hospital based Cancer Registry Report is a pioneer work accomplished on cancer prevention, control and research with support of several staffs of major hospitals of Nepal. We all are dedicated to provide high quality standards of healthcare to cancer patients. This report will be showing the trends of cancer incidences and patterns during period of 2003 AD to 2012 AD in Nepal. This will provide a baseline data in policy making of the cancer control in the country. With affection and appreciation, I extend my sincere gratitude to each and every staffs of cancer registry team, medical record staffs of the concerned hospitals who have worked diligently. Wishing every one a very safe, healthy life and birghter future. I would like to extend my heartfelt gratitude to the medical record staffs for providing cancer data and cancer registry staffs for their effort to publish this 10 yrs. cancer registry report. Dr. Prakash Raj Neupane, MS, PhD Chairman Governing Committee, BPKMCH Coordinator, National Cancer Registry Program Dr. Bijaya Chandra Acharya, MD Executive Director B.P.Koirala Memorial Cancer Hospital Bharatpur, Chitwan, Nepal Dr. Chin Bahadur Pun, MD Former Executive Director B.P.Koirala Memorial Cancer Hospital Bharatpur, Chitwan, Nepal vi vii

5 Foreword It is our pleasure to inform that hospital based cancer registry consolidated report of 10 years from 2003 to 2012 AD has been published with the initiation of Cancer Prevention, Control and Research Department, B. P. Koirala Memorial Cancer Hospital Bharatpur, Chitwan. Hospital Based Cancer Registry Program was started with the support of WHO-Nepal since In coordination with major hospitals such as B. P. Koirala Memorial Cancer Hospital Bharatpur, Bhaktapur Cancer Hospital Bhaktapur, Bir Hospital Kathmandu, Teaching Hospital Kathmandu, Kanti Children s Hospital Kathmandu, B.P. Koirala Insitute of Health Sciences Dharan and Manipal Teaching Hospital Pokhara, many cancer patients were diagnosed and treated. This is the first report on National cancer registry, ever published in Nepal which includes data of 7 major hospitals involved in cancer diagnosis and treatment. A total of 56,013 new patients (26,108 males and 29,905 females) were registered during (excluding 1,107 Indian cancer patients) which showed that cancer was found more in female (53.4%) than male(46.6%). Total cancer cases shows that more than 48% cancer was diagnosed at B. P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan followed by 20% at Bhaktapur Cancer Hospital and 12.4% at Bir Hospital. This report helps to know different cancer incidences and patterns of cancer prevalent in Nepal. Moreover, it aids to planning, evaluation and implementation of activities required for cancer prevention, control and research. With affection and appreciation, I extend my sincere gratitude to each and every staffs of cancer registry team, medical record staffs of the concerned hospitals who have worked diligently. Kishore Kumar Pradhananga, MPH Former Head, Cancer Prevention, Control & Reasearch Dept. B. P. Koirala Memorial Cancer Hospital (BPKMCH) Bharatpur, Chitwan Contents Executive Summary 1 About Nepal 3 Methodology 5 Introduction of collaborating 7 hospitals 6 Introduction of Cancer Registry 8 Cancer Problem in world 9 Cancer Problem in Nepal 10 History of Cancer Registry in Nepal 10 HBCR Flow Chart 12 Detail findings of HBCR (7 Hospital) 10 years Consolidated Report ( ) 13 Chapter: 1 Cancer Cases according to Institute from 2003 to 2012 AD 14 Chapter: 2 Cancer Cases according to Gender from 2003 to 2012 AD 15 Chapter: 3 Cancer Cases according to Nationality from 2003 to Chapter: 4 Cancer Cases according to Age group 2003 to Chapter: 5 Top ten common Cancer Cases in both sex (2003 to 2012) 19 Chapter: 6 Cancer Cases according to Broad age group 2003 to Chapter: 7 Cancer Cases according to Marital Status 2003 to Chapter: 8 Cancer Cases according to Religions 2003 to Chapter: 9 Cancer Cases according to Education from 2003 to Chapter: 10 Cancer Cases according to Occupation from 2003 to Chapter: 11 Top Ten Cancer Cases according to Districts ( ) 30 Chapter: 12 Cancer Cases according to Basis of diagnosis in both sex ( ) 32 Chapter: 13 Cancer Cases according to Treatment modalities 34 Chapter: 14 Total Number of Cancer Cases in both sexfrom Chapter: 15 Cancer Cases for 0-14 yrs (Paediatric) in Male 44 Chapter: 16 Number of Cancer Cases for yrs in Male 50 Chapter: 17 Cancer Cases for yrs in Male 55 Chapter: 18 Cancer Cases for age group +65 yrs in Male 61 Chapter : 19 Cancer Cases for age +75yrs (Geriatric) in Male 67 Chapter: 20 Tobacco Related Cancer Cases ( ) 73 Chapter: 21 Cancer Cases according to Digestive organ ( ) 75 Chapter: 22 Districts wise distribution of Cancer ( ) 76 viii ix

6 Executive Summary A brief outline of the purpose and ways of interpreting each of the chapters and some other additional data gathered in order to get a more complete picture as indicated below. For the period of 10 years data from AD, a total of 56,013 new cancer patients (26,108 males and 29,905 females) were registered. The cancer incidence per 100,000 in males was 12.8 in 2003 and 25.3 in Similarly,The cancer incidence per 100,000 in females was 15.1 in 2003 and 28.1 in In 2011,incidence rate in male was 26.7 and was decreased 25.3 in 2012 but in female showed increasing trend in to 28.1 in yrs. data shows that Female cancer was found more than Male in 2003 to Total cancer cases shows that more than 48% cancer was diagnosed at BP Koirala Memorial Cancer Hospital, Bharatpur, Chitwan followed by 20% at Bhaktapur cancer hospital, Bir hospital 12.4%. Total 57,120 number of cancer cases was diagnosed during 10 yrs. period. Among them, 1,107 Indian cancer cases were excluded and only Nepali cancer cases 56,013 were included for the analysis. Average age at diagnosis of cancer cases was 60-64yrs. in males (14.6%) and50-54 yrs. in females (13.4%). Among males, Lung cancer (19.9%) was the leading site followed by Ca. Stomach (7.8%). Among females, Ca. Cervix uteri (20.9%) was the leading site followed by Ca. Breast (15.5.%). Ca. Lung(10.5%) is the third Ca. Ovary (10.5%) is forth and Ca. Gall bladder (4.2%) is fifth leading female cancer site which was not changed throughout the 10 yrs. In the broad age group more cancer diagnosed at yrs. in female 66.3% diagnosed more than male 51.4%. Number of cancer cases in marital status, in married cancer diagnosed in male was 84.7% but in female was 86.9%. more than male. By Religion in male cancer cases, 83.5% Hindu, 6.5% Buddhist, 1.3% Islam and 0.6% Christian but in female, 83.6% Hindu, 6.9% Buddhist,1.3% Islam and 0.8% Christian. Literate cancer cases in male was found 40.3%, illiterate was 43.9%,below age of 5yrs.included not applicable was 1.4% and not available was 14.4%. In Female literate was found 33.8%, illiterate was 51.6%,below age of 5yrs included not applicable was 2.8% and not available was 11.7%. Most of the people s occupation is agriculture in Nepal.So, more cancer cases in male diagnosed 56.9% were agriculture and in female 46.5% were found in housework. Below 15 yrs. cancer cases were included not applicable. 8.8% in male and 10.2% in female cancer cases were found not any mentioned occupation. x 1

7 Among the 75 districts in Nepal, more cancer was diagnosed from Kathmandu districts throughout the year from 2003 to In Pediatric (below 14 yrs) age, 5.8% of male cancers were found but in female found 3.1%. In Children (0-14 years) more common cancer was Haematopoetic Reticuloendothelial system/spleen diagnosed 18.1% in male and in females was 16.9%. 10.0% of all cancers were in the age group years. In this age group, the leadingcancers were leukemia in males (26.4%) and thyroid cancer in females (37.7%). 10.7% of all cancers were in the age group years. In the age of yrs the leading cancer was found Haematopoetic Reticuloendothelial system/spleen cancer (8.0% ) in male but in female breast cancer was 14.1%. 59.3% of all cancers were in the age group years. the leading cancer sites were Bronchus and lung in males (19.2%) and Cervix uteri in females (24.8%). 25.3% of all cancers were in the age group 65+ years. In this age group, the leadingcancer sites were Bronchus &lung in males (27.3%) and in females (19.9%). In Geriatric age group (+75yrs.) the leading cancer site in male was Bronchus & lung (25.3%) and in female was 19.9%. The proportion of tobacco related cancers (oral cavity, pharynx, oesophagus, larynx,lung and urinary bladder) relative to all cancers was 43.8% in males and 18.8% in female. Among the cancer cases of leading cancer was Bronchus & lung 43.5% in males and 55.7%in females. In the case of Digestive organ cancer relative to all cancers was 23.4% in males and 16.4%. Among the cancer cases leading cancer was stomach33.9% in males butin females Gall bladder cancer was 25.7%. About NEPAL Nepal is a land-locked country bordering with the Tibet Autonomous Region of the People s Republic of China in the north and surrounded by India in the east, south and west. Contains eight of world s 10 highest peaks, including Mount Everest and Kanchenjunga the world s tallest and third tallest on the borders with China and India respectively. Nepali is the national language of Nepal. Educated people understand and speak English as well. There are hundreds of local dialects spoken by people from various ethnic groups. Nepal has four major seasons, namely,(1) Winter: December-February, (2) Spring: March-May, (3) Summer: June-August and (4) Autumn: September-November. Nepal can be visited all the year round. Nepalese people are mainly divided into two distinct groups, the Indo-Aryans and the Mongoloids (the Kirats). Before 2007 AD, Nepal was regarded as the only Hindu Kingdom in the world. But after that, the Government of Nepal has already announced the country to be a secular country. The Hindu Temples and Buddhist Shrines are scattered all over the Kingdom. Nepal is the birthplace of Lord Buddha, Herald of Peace, the Light of Asia. Hindus, Buddhists, Muslims and Christians live together in harmony. And other nature worshippers, too, exist here. Geographical Location and Area: Latitude : ' North to ' North Longitude : ' East to ' East Area : 1,47,181 Sq. Km. Border : North Tibet, Autonomous Region of China, East, West and South-India Source: Demographic Health Survey *Central Bureau of Statistics,2011 Population & Households Characteristics Population ( ) Nepal 23,15,14,23 Male 11,56,3,921 Female 11,58,7,502 Total Households : 42,53,220 Population Growth rate : 2.25% Population Distribution by Geographical Region, 2011: Area Male Female Total Nepal 1,28,49,041 1,36, ,64,94,504 Mountain 8,62,592 9,19,200 1,78,1,792 Hill 5,44,0067 5,95,3,940 1,13,94,007 Tarai 6,54,6,382 6,77,2,323 1,33,18,705 Urban 2,30,6,049 2,21,7,771 4,52,3,820 Rural 1,05,42,992 1,14,27,692 1,97,0684 Population by Religion, 2011 Religion Population Religion Population Hindu % Kirat 3.05% Buddhist 9.04 % Christian 1.42% Islam 4.39% Others* 1.42% Source: Population & Housing Census, CBS * Including not stated cases Some Vital Indicators Crude Birth Rate 24.3 Crude Death Rate

8 Total Fertility Rate (per women) 2.6 Infant Mortality Rate 46 Mortality Rate under five 54 Average Life Expectancy at birth (Years)* Total 64.1 Male 63.6 Female 64.5 Source: Demographic Health Survey *Central Bureau of Statistics Health Manpower Doctors* 12,571 Nurses 19,098 ANM 19,222 Source: Nepal Nursing Council * Nepal Medical Council Health Facilities under MoHP Hospitals 95 Health Centers 209 Health Posts 676 Sub Health Posts 3,129 Hospital Beds (Available) 5,644 Source: Department of Health Services, MoHP : Ministry of Health and Population School Education School Teacher Student (2011/12) Primary 33,881 1,73,714 47,82,885 Lower Secondary 13,791 48,848 18,12,680 Secondary 7,938 35,675 8,48,569 Higher Secondary 3,382 17,445 3,53,338 Total 58,992 2,75,682 77,97,472 Source: Department of Education Students Enrolled in Higher Education Faculty 2011/12 Ayurved 87 Forestry 365 Agriculture & Animal Science 1,101 Sanskrit 1,871 Law 4,708 Medicine 12,999 Engineering 15,841 Science & Technology 16,004 Humanities & Social Sciences 72,844 Management 1,28,507 Education 1,58,213 Source: Ministry of Education Literacy Rate (%) National 65.9 Male 75.1 Female 57.4 Urban 82.2 Rural 62.5 Source: Population Census, CBS Macro Economic Indicators Annual Growth Rates GDP (%) 4.63 Per Capita GDP, current prices (NRs.) 57,726 Per Capita GDP, constant prices (NRs.) 24,908 Annual change in real per capita GDP (%) 3.19 Per Capita GDP (US$) 735 Gross domestic saving/gdp, (%) 9.98 Grass national saving/gdp (%) Gross Fixed Capital Formation/GDP (%) Export of goods and services/gdp (%) 9.78 Import of goods and services/gdp (%) Exchange rate (USD : NRs.) METHODOLOGY * Literacy rate of six years and above population, Source: National Accounts of Nepal The collected data was edited, checked and entered in computer using cancer registry proprietary software made by BPKMCH. In order to avoid double/multiple entry of the cases, the database was verified by name, age, sex, address, topography and morphology of cancer cases. All multiple entries were deleted and Non-Nepalese cases were excluded from database. Then the data was coded according to ICD-03 and published in ICD-10. Only Nepali cases of data were included for analysis using SPSS Software. The findings were presented in the tables and graphs. The inclusion criteria of cancer cases were set up by National Cancer Registry as follows: Diagnosed and treated cancer cases at one of the collaborating hospital. Diagnosed as cancer at one of the collaborating hospitals but the other treatment were taken elsewhere. Diagnosed and other treatments were taken elsewhere but patient admitted only for supportive/palliative care in one of the collaborating hospitals. 4 5

9 Introduction of collaborating 7 hospitals 1. B.P. Koirala Memorial Cancer Hospital (BPKMCH), Bharatpur, Chitwan: B.P. Koirala Memorial Cancer Hospital (BPKMCH) is the national cancer center to fight against cancer in Nepal. It was established in 1992 AD (2049BC) with the support of Chinese government and located in center part of Nepal Bharatpur, Chitwan. Patients from all 75 districts as well as some of the neighboring districts of India come to the hospital for cancer treatment. This hospital is only one comprehensive type of cancer hospital in Nepal with good infrastructure, modern equipment and trained manpower for diagnosis, treatment of cancer under one roof. Besides curative services. This also provides cancer prevention, early detection (screening) and research services throughout the country under National Cancer Prevention and Control program. Chinese medical doctors are providing different type of services as volunteer. Hospital has been 200 beds and is planned to expand into 400 beds in the near future. a teaching hospital, it provides practical field for the academic training programs (basic, graduate and postgraduate) of the Institute and, as a national hospital, renders medical care and services. Besides, it conducts medical research projects and provides a major impetus to Biomedical and Health Sciences Research in Nepal. The establishment of the Teaching Hospital was a landmark in the evolution of medical education in Nepal. This hospital also provides oncology services. 5. Kanti Children s Hospital (KCH), Kathmandu: Kanti Children s Hospital (KCH) was established in the year 1963 AD under Russia aid as a general hospital and was converted into Kanti Children's Hospital in the year 1970 AD. Today KCH has 300 beds children s hospital and it is planned to convert into 500-beds institute for child health in the future. During , KCH received grant from Government-Nepal Assistance Association. Hospital has already established Pediatric oncology unit to treat pediatric cancer. 2. Bhaktapur Cancer Hospital (BCH), Bhaktapur: 6. B.P. Koirala Institute of Health Sciences (BPKIHS) Dharan, Sunsari: Bhaktapur Cancer Hospital (BCH) was established by Nepal B.P. Koirala Institute of Health Sciences (BPKIHS) was established on Cancer Relief Society in 1992 as a 15-bedded cancer care Jan 18, 1993 and subsequently upgraded as an autonomous Health center. At present Bhaktapur Cancer Hospital has become a Sciences University on Oct 28, 1998 with a mandate to work towards model hospital of first public -private partnership. Nepal Cancer developing socially responsible and competent health workforce, Relief Society is running the hospital with the support of Nepal providing health care & involving in innovative health research. The Government, Rotary International and Local Community as well Institute, located in eastern part of Nepal, has extended its continued as the foreign residents and visitors also have contributed the health services through teaching. This Institute is one of the successful project through donation of land, money and services. Currently, examples of Nepal-India co-operation. BPKIHS has a vision of a selfgoverning, self-reliant international Health Sciences University attracting students and teachers from all over it has 150 beds & modern treatment facility. the world to its constantly innovative educational programs. BPKIHS has postgraduate, undergraduate, and 3. Bir Hospital, (BH) Mahaboudha, Kathmandu: university certificate programs. It has four colleges: Medical, Dental, Nursing, and Public Health with a 700 Bir Hospital is Nepal s oldest medical institute established in bedded Teaching Hospital. the year 1889 A.D. It is located at the center of Kathmandu city. The hospital is run by the National Academy of Medical Sciences 7. Manipal Teaching Hospital (MTH) Pokhara, Kaski: (NAMS), a government agency since 2003AD. Many patients from Manipal Teaching Hospital (MTH) was established in 1994 AD. Affiliated the rural areas come to this hospital to get treatment. Current to the Kathmandu University, MTH is recognized across the world, for its capacity of the hospital has 535 beds. Hospital provides services in high standards of excellence. Rated as Nepal s institute of choice, Manipal highly specialized areas like Neurology, Neuro-Surgery, Cardiology, Teaching Hospital has accorded recognition by the Medical Councils of Cardio-thoracic and Vascular Surgery, Burn and Plastic Surgery, Nephrology, Urology, G.I. surgery, Gastroenterology, Nepal, Sri Lanka, Bangladesh, and Mauritius, besides being accredited by Hepatology and Radiotherapy. Majority of outdoor examination service and indoor beds in Bir Hospital are free. the California Medical Boards & New York State Medical Board. It is located This is the only medical oncology referral center in the country which provides such services. in Pokhara, a scenic location 200 km west of Kathmandu,Manipal Teaching Hospital has students from India, SriLanka, Maldives, Bangladesh, Bhutan, Singapore, Middle East, Kenya, Australia, 4. Tribhuvan University Teaching Hospital (TUTH) Maharajgunj, Kathmandu: New Zealand, United States & Canada. Manipal Teaching Hospital functions two campuses. The Deep campus, T. U. Teaching Hospital was established in 1983AD with the generous support of Japanese Government. Hospital spread on 8 acres of wooded land, houses the basic sciences departments, hostels and other facilities for basic is an integral part of the Institute of Medicine of Tribhuvan University. It performs two distinct functions. As sciences students. In the 30 acrephulbari campus, is 700beds ofmanipal Teaching Hospital comprising clinical teaching departments and Radiation oncology units for treatment of cancer patients. 6 7

10 Introduction of Cancer Registry Cancer Registration is continuous process that collect cancer information from hospital.hospital Based Cancer Registries are concerned with recording of information on the cancer patients seen in a particular hospital (Isabel dos Santos Silva et al.,1999).cancer data collection is done by standardized common core form for all the registries which mainly consists of patient identifying and demographic information, details of diagnosis, the clinical stage of disease and the broad type of treatment. Objectives of Hospital Based Cancer Registries (HBCR) have been defined as follows (Maclennan et al., 1978;YoungJ.L.,1991): 1. General objectives: a. Assess patient cancer care. b. Participate in Clinical Research to evaluate therapy. c. To know the patterns of cancer. d. Helps to plan hospital facilities. 2. Specific objectives: a. Contribute to active follow-up of the cancer patient. b. Describe length and quality of survival in relation to anatomical site, clinical stage and treatment. c. Contribute to the Population Based Cancer Registries (PBCRs) in the given area. d. Undertake epidemiological research through short-term case control studies. e.show time trends in proportion of early to late stages at time of diagnosis. f. Help to assess quality of hospital care and cancer services in covered area. To publish 10 years HBCR report ( AD), B.P.Koirala Memorial Cancer Hospital had been working under National Cancer registry program. Hospital based national cancer registry program was started with the support of WHO -Nepal since 2003 in coordination with seven major hospitals where cancer patients were diagnosed and treated. These hospitals were B. P. Koirala Memorial Cancer Hospital (BPKMCH) Bharatpur, Chitwan, Bhaktapur Cancer Hospital (BCH) Bhaktapur. Bir Hospital (BH) Kathmandu, TU Teaching Hospital (TUTH) Kathmandu and Kanti Children s Hospital (KCH) in Kathmandu, B. P. Koirala Institute of Health Sciences (BPKIHS) Dharan and Manipal Teaching Hospital (MTH) in Pokhara. Quality of Data All diagnosed and treated cancer patients' data were abstracted in National cancer registry form from medical records and related department. All forms were collected by BPKMCH from 6 hospitals. The collected data were entered in excel sheet in computer. The quality of data from each registry will undergo vigorous checks during data entry subsequently. Efforts are made by both the individuals of HBCR committee and the coordinators of BPKMCH to ensure that the data reported are correct and complete as possible. Data was checked as per international norms. In Hospital Based Cancer Registry setup, the core form is mainly divided into three portions, Patient demographic Information, Diagnostic details and details of stage & treatment which require recalling the patients record more than one time to complete the form. In order to facilitate the above, partial saving of a record has been provided. Double/multiple entry cancer cases were excluded and malignant cases coded as per ICD-O 3 rd and published report by ICD -10, IARC/WHO format. Cancer Problem in world: Cancer is currently the cause of one-tenth of all deaths, and the second most frequent cause of death in the world in economic countries. The high prevalence of communicable diseases, diseases related to poverty pose a serious threat in one side and in the other, there is raising trend of non-communicable diseases like cancer, cardiovascular diseases and diabetes. According to GLOBOCAN 2012, an estimated 14.1 million new cancer cases and 8.2 million cancer-related deaths occurred in Prevalence estimates for 2012 show that there were 32.6 million people (over the age of 15 years) alive who had had a cancer diagnosed in the previous five years. The most commonly diagnosed cancers worldwide were those of the lung (1.8 million, 13.0%), breast (1.7 million, 11.9%), and colorectum (1.4 million, 9.7%). The most common causes of cancer death were lung cancer (1.6 million, 19.4%), liver cancer (0.8 million, 9.1%), and stomach cancer (0.7 million, 8.8%). Projections based on the GLOBOCAN 2012 estimates predict a substantive increase to 19.3 million new cancer cases per year by 2025, due to growth and ageing of the global population. More than half of all cancers (56.8%) and cancer deaths (64.9%) in 2012 occurred in less developed regions of the world, and these proportions will increase further by Facts about Cancer The number of new cases is expected to rise by about 70% over the next 2 decades. Among men, the 5 most common sites of cancer diagnosed in 2012 were lung, prostate, colorectum, stomach, and liver cancer. Among women the 5 most common sites diagnosed were breast, colorectum, lung, cervix, and stomach cancer. Around one third of cancer deaths are due to the 5 leading behavioural and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, alcohol use. Tobacco use is the most important risk factor for cancer causing around 20% of global cancer deaths and around 70% of global lung cancer deaths. Cancer causing viral infections such as HBV/HCV and HPV are responsible for up to 20% of cancer deaths in low- and middle-income countries. More than 60% of world s total new annual cases occur in Africa, Asia and Central and South America. These regions account for 70% of the world s cancer deaths. It is expected that annual cancer cases will rise from 14 million in 2012 to 22 million within the next 2 decades. Deaths from cancer in the world are projected to continue rising, with an estimated 9 million people deaths from cancer in 2015 and 11.4 million deaths in Cancer burden in the World Year Developed Countries Less Developed Countries All Countries million 5.4 million 10.1 million million 9.3 million 15.3 million Cancer incidence in Developing & Developed Countries: Male Female Rank Developing Developed Developing Developed 1 Lung Prostate Breast Breast 2 Stomach Lung Cervix Colorectum 3 Liver Colorectum Stomach Lung 4 Esophagus Lymph Node Lung Uterus 5 Colrectum Larynx Colorectum Stomach 8 9

11 Cancer Problem in Nepal At present, Nepal s common health problems are communicable diseases, malnutrition, population growth, poor hygiene and sanitation, which are mostly associated to poverty and low level of literacy. However, with change in food habits, life style and high consumption of tobacco and alcohol the non communicable diseases like heart diseases, diabetes mellitus, hypertension and cancer are becoming more common in recent years. Now cancer has been recognized as an important public health issue as elsewhere in the world. In Nepal, before 1999 there was no centre that provided comprehensive care to cancer patients. Central level hospitals in Kathmandu, Medical College hospitals and some private hospitals provided services to cancer patients in scattered form. Since June 1999, B.P. Koirala Memorial Cancer Hospital has been providing comprehensive cancer services in the form of national cancer center of Nepal. Other cancer service providing centers are: Bhaktapur Cancer Hospital, Bir Hospital, Teaching Hospitals of various medical colleges and larger private hospitals. Availability of comprehensive cancer care within the country has made possible for more cancer cases to be diagnosed and treated every day. Cancer has been recognized as an important disease of public health importance. However, due to lack of organized national cancer registry program we do not have proper data to explain the exact burden of cancer in Nepalese population. History of Cancer Registry in Nepal First time in Nepal, to assess the burden of cancer problem in central hospitals of Kathmandu, an initiation was made by B.P. Koirala Memorial Cancer Hospital Management Committee in January The five-year records of six central level hospitals of Kathmandu which included T.U. Teaching Hospital, Kanti Children's Hospital, Bir Hospital, Birendra Military Hospital, Patan Hospital and Maternity Hospital were reviewed. From the records it was found that a total of 5,090 cancer cases were recorded out of 1,71,172 admitted patients in five years period ( BS). In sex distribution, it was found that 54%of the patients were male and 46% were female. The top ranking cancers were cancer of GI-system, cancer of female genital organs, respiratory system, cancer of the breast, skin, lymphomas, leukemia, cancer of the urinary system, male genital organs and skeletal system. It was also noticed that there was an obvious increase in number of cancer patients in these hospitals from 899 in 2045 BS to 1,206 in 2049 BS. In age distribution, it was found that 46.7% of cancer was found in age group 45-64years, 28% in age group years, 17.4% in age group 65 and more. Similarly there was 2.8 and 1.6 % of cancer inpatient of age groups 5-14 and 0-4 years respectively (Reference: Survey 1994 conducted by B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan, Nepal. In 1995 Hospital based cancer registry was started in 3 major hospitals ie Bir Hospital,TU Teaching hospital and Kanti children hospital in Kathmandu. Findings was found as follows: Hospital Based Cancer Registry data in 1995/96: 1. Number of Cancer patient by Hospitals of Kathmandu in 1995/96 SN Name of the hospital Number Percentage 1 Bir Hospital, Kathmandu TU,Teaching Hospital, Kathmandu Kanti children's Hospital, Kathmandu Total 1, Cancer patients by Gender in 1995/96 Gender Number Percentage Male Female Total 1, Cancer cases by age groups in 1995/96 Age Group Number Percentage 0 14 years years years years and above Total 1, The top ranking cancers by site in 1995/96 SN Cancer # Percentage 1 Lungs and Bronchus Cancer Cervix Cancer Breast Cancer Lymphoma Stomach Cancer Leukemia ( Blood cancer) Larynx Cancer Brain Tumours Rectum Cancer Skin Cancer Others Total 1, First time in Nepal B. P. Koirala Memorial Cancer Hospital Management Committee in 1995 initiated a hospital based cancer registry (HBCR) as a pilot program, with objectives to assess the cancer load and the types of cancer. Bir Hospital, Kanti Children's Hospital and T. U. Teaching Hospital were the hospitals included in the program. The cancer patients data abstracted from the medical record for a period of one year of the three hospitals which was coordinated by Dr.Murari Man Shrestha and Mr.Kishore Kumar Pradhananga. A total of 1,041 histopathologically diagnosed cancer patients were recorded in one year. The most common ten cancers identified by HBCR were: cancer of the lungs, cervix, lymphoma, breast, stomach, larynx, blood, brain tumors, bone, and others. Among these, the commonest cancer was the lung cancer in both sex. The record also showed that the patients were diagnosed incidentally while attending the hospital for treatment of other acute or chronic diseases. Most of the patients presented in advanced stage of disease which resulted into poor treatment outcome. As mentioned earlier, due to lack of proper diagnostic facilities in the district and periphery, most of the patients suffering from cancer die without being diagnosed. So, it is not possible to have population based figures without proper and adequate health centers and improved cancer registry program. Thus, in countries like Nepal, estimation is made based on scientific as well as on WHO- guidelines. According to which, it has been assumed that the background incidence of cancer in developing countries will be in the range per 100,000 population. The lower level is likely to represent the situation in a country with more than half its population is under 20 years of age, and the upper level a country in which a maximum of one-third of the population is under 20 years. Based on these guidelines and demographic structure, pattern of prevalent health conditions, resident tribes, culture of the country, it is estimated that the incidence of cancer should be around 120 per 100,000 population in Nepal. The hospital based cancer registry ( ) data shows that lung cancer is the most common cancer and cancer of uterine cervix has ranked number one in female followed after breast cancer. Overall cancer associated morbidity and mortality are in rise. Illiteracy, lack of knowledge, poverty, lack of adequate health care facilities and limited access to health care services are found to be directly or indirectly associated with increase cancer burden

12 HBCR Flow Chart Hospital based Cancer Registry 1. BPKM cancer Hospital 2. Bir Hospital 3. TU Teaching Hospital 4. Kanti Children Hospital 5. Bhaktapur Cancer Hospital 6. Civil Hospital 7. Patan Hospital 8. Army Hospital 9. Maternity and Women Hospital 10. BPKIHS, Dharan 11. Manipal Teaching Hospital 12. Nepalgunj Medical College Orientation training on quality cancer data abstraction to the medical records and concerned staffs Detail findings of Hospital Based National Send Cancer Registry Form to all Hospitals Collect Cancer Registry Form from all hospitals All Cancer Data entry in Computer at BPKMCH Cancer Registry (7 Hospital) 10 years Consolidated Report ( ) Exclusion of Duplication Data Analysis Publish Cancer Registry Report and distribution to all stake holders

13 Chapter: 1 Cancer Cases according to Institute from 2003 to 2012 AD Table-1. Distribution of Cancer Cases according to Institute from 2003 to 2012 AD SN Institutes / Hospitals Total % 1 B.P.K.M.Cancer Hospital, Chitwan 1,869 1,815 2,154 2,564 3,261 2,936 2,732 3,216 3,320 3,307 27, Bhaktapur Cancer Hospital, Bhaktapur ,008 1,086 1,138 1,253 1,289 1,253 1,361 1,513 11, Chapter: 2 Cancer Cases according to Gender from 2003 to 2012 AD Table- 2. Distribution of Cancer Cases according to Gender from 2003 to 2012 AD Gender Total % Male 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 26, Female 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 29, Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 56, Bir Hospital, Kathmandu ,228 1,173 1, , Figure- 2.Distribution of Cancer Cases according to Gender from 2003 to 2012 AD 4 B.P.K.I.HealthScience,Dharan , T.U.Teaching Hospital, Kathmandu , Male Female Total 6 Manipal Teaching Hospital, Pokhara , Kanti Children Hospital, Kathmandu Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 56, Number Figure 1. Distribution of Cancer Cases according to Institute from 2003 to 2012 AD Year Percentage BPKMCH BCH BH BPKIHS TUTH MTH KCH Reporting Institute Among the total 56,013 cancer cases, female cancer 53.4% wasdiagnosed more than male 46.6 %. The Male tofeamlesex ratio is 87.3.Total cancer cases were diagnosed 3,251 in 2003 to 7,212 in female increased 45.0% in the period of 10 yrs. Male Cancer cases in 2003 were 1,488 to 3,291 in 2012increased 45.2% in 10 yrs. Similarly in female cancer cases in 2003 were 1,763 to 3,921 in 2012 increased 44.9%. Crude incidence rate of cancer Gender Male Female Total A total of 56,013 cancer cases were registered in above mentioned seven hospitals during Cancer cases were increased in 2003, 3,251 to 7,212 in Among them about half of the total cancer patients (49%) were diagnosed and received treatment from BPKMCH. Source: Population projection , Central Bureau of Statistics, Nepal 14 15

14 Chapter: 3 Cancer Cases according to Nationality from 2003 to 2012 Table - 3. Number of Cancer Cases by Nationality ( ) S.N Nationality Total % 1. Nepali 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 56, Indian , Others country Not Available Total 3,303 4,296 4,519 5,041 6,167 5,998 6,298 6,931 7,234 7,333 57, Total 57,120 numbers of cancer cases were diagnosed during 10 yrs. period. Among them, 1,107 (1.9%) Indian cancer cases were excluded. Only Nepali cancer cases 56,013 were included for the analysis. Chapter: 4 Cancer Cases according to Age group 2003 to 2012 Table -4. Total Cancer Cases according to Age Group ( AD) Age Groups Total % 0-4 yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs , yrs , Not Available Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 56, Table -5. Cancer Cases according to Age Group in Male ( AD) Age Groups Total % 0-4 yrs yrs yrs yrs yrs yrs yrs yrs yrs , yrs , yrs , yrs , yrs , yrs , yrs , yrs , NA Total 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 26, For male cases, majority of cases (14.6%) were from years age groups

15 Table - 6. Cancer Cases according to Age Group in Female ( AD) Age Groups Total % 0-4 yrs yrs yrs yrs yrs yrs yrs , yrs , yrs , yrs , yrs , yrs , yrs , yrs , yrs , yrs , NA Total 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 29, Similarly, majority of cases (13.4%) were from years age group in female Figure-3.Total Cancer Cases according to Age Group ( AD) 0-4 yrs 5-9 yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs 75 + Male Female Above table and figure showed that in both gender and in male (14.6%), majority of cancer cases were from years age group, but in female (13.4%) were from years age group. Total Chapter: 5 Top ten common Cancer Cases in both sex (2003 to 2012) Table7 - Top ten common cancer in both sex ( AD) S.N. ICD -10 Topography Total % 1 C 34 Bronchus & lung , C 53 Cervix uteri , C 50 Breast , C 16 Stomach , C 42 Hematopoitic & Reticuloendothelial system/spleen , C 23 Gall bladder , C 56 Ovary , C 32 Larynx , C 67 Bladder , C 15 Esophagus , Others 1,258 1,662 1,744 1,924 2,305 2,273 2,478 2,883 3,026 3,192 22, Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 56, Above table showed that Bronchus & Lung (C34) site was the most common site which was found 14.5% in total cases. Followed by Cervix Uteri (C53) were 11.2%, Breast(C50) 8.4%, Stomach (C16) 5.8%, and others in 10 yrs. Table 8: Top ten common cancer in Male ( AD) S.N. ICD -10 Topography Total % 1 C 34 Bronchus & lung , C 16 Stomach , C 42 Hematopoitic & Reticulo-endothelial system/spleen , C 32 Larynx , C 67 Urinary Bladder , C 15 Esophagus C 06 8 C 02 parts of mouth parts of tongue C 20 Rectum C 23 Gall bladder Other cancers ,072 1,100 1,124 1,342 1,433 1,458 1,543 11,600 Total 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 26, Above table showed that Bronchus & Lung (C34) site was also the most common site which was found 19.1% in male cases. Other common sites were Stomach(C16) 7.9%, Haematopoetic (C42) 6.7%, Larynx (C32) 4.9%, U.Bladder(C67) 4.2%, Oesophagus(C15) 3.2% and others

16 Table - 9. Top ten common cancerin Female ( AD) S.N. ICD -10 Topography Total % 1 C 53 Cervix uteri , C 50 Breast , C 34 Bronchus & lung , C 56 Ovary , C 23 Gall bladder , C 16 Stomach , C 42 Hematopoitic & Reticuloendothelial system/spleen , C 73 Thyroid C 20 Rectum C 76 Other &ill defined sites Other Total 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 29, Among females, Ca. Cervix uteri (20.9%) was the leading site followed by Ca.Breast (15.5.%). Ca. Lung (10.5%) is the third Ca. Ovary (10.5%) is forth and Ca.Gall bladder (4.2%) is fifth leading female cancer site which was not changed throughout the 10 yrs. Chapter: 6 Cancer Cases according to Broad age group 2003 to 2012 Table 10. Total Cancer Cases by broad age group in both sex ( ) S.N Broad age group Total % years , years , years 1,958 2,476 2,671 2,974 3,702 3,633 3,697 3,856 4,162 4,109 33, years 728 1,067 1,062 1,168 1,455 1,453 1,561 1,857 1,850 1,992 14, Not Available Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 56, In total cancer cases 59.3% were from years age group followed by 65+ years (25.3%) and in years (10.7%) in both sex. Table 11. Distribution of Cancer Cases by broad age group in Male ( ) S.N Broad age group Total % years , years , years 789 1,019 1,091 1,209 1,467 1,433 1,529 1,581 1,705 1,596 13, years ,100 1,053 1,130 8, Not Available Total 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 26, More than half (51.4%)of the male cancer cases were diagnosed in years followed by 65+ years (32.1%) and in years (10.4%) age group. Table 12. Distribution of Cancer Cases by broad age group in Female ( ) S.N Broad age group Total % years years , years 1,169 1,458 1,580 1,765 2,235 2,200 2,168 2,275 2,457 2,513 19, years , Not Available Total 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 29, About two-third (66.3%) of the female cases were diagnosed in years age group followed by 65+ years (19.4%) and years (11.0%) of age group. Male 26,108 - Total cancer - Female 29,

17 35,000 30,000 25,000 20,000 15,000 10,000 5, ,517 Figure- 4. Total Cancer Cases by broad age group ( ) 2, ,002 3,286 2,715 13,419 19,820 33,238 8,381 14,193 5, yrs yrs 35-64yrs above 65yrs Not available 146 Male Female Above graph showed that more cancer cases were diagnosed in the age group of yrs from AD. In the broad age group more cancer was diagnosed yrs. in female and 66.3% female cases were diagnosed more than male 51.4%. Total Chapter: 7 Cancer Cases according to Marital Status 2003 to 2012 Table Total Number of Cancer Cases by Marital Status in both sex( ) S.N Marital Status Total %* 1. Married 2,248 NA NA 4,075 5,332 5,050 5,143 5,762 6,016 6,415 40, Unmarried 53 NA NA , Widow NA NA NA , Divorced NA NA NA Separated 37 NA NA Not Applicable (<15 yrs.) 325 NA NA , Not Available 588 NA NA , Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 47, *Percent is calculated based on available data. 0.10% 2.50% 3.50% Figure- 5. Total Cancer Cases by Marital Status in both sex( ) 0.10% 4.40% 4.90% Married Unmarried Widow Divorced Separeted Not applicable Not available 84.40% Above graph showed that majority of cancer cases were diagnosed in married life (84.4%) rather than unmarried and others.the disaggregated data for 2004 and 2005 was not available. Table Number of Cancer Cases by Marital Status in Male ( ) S.N Marital Status Total %* 1. Married NA NA NA NA 2,416 2,271 2,400 2,678 2,773 2,891 15, Unmarried NA NA NA NA Widow NA NA NA NA Divorced NA NA NA NA

18 5. Separated NA NA NA NA Not Applicable (< 15 yrs.) NA NA NA NA Not Available NA NA NA NA Total 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 18, *Percent is calculated based on available data. Majority of male cancer cases (84.7%) were married and disaggregated data for was not available. Table Number of Cancer Cases by Marital Status in Female ( ) S.N Marital Status Total %* 1. Married NA NA NA NA 2,916 2,779 2,743 3,084 3,243 3,524 18, Unmarried NA NA NA NA Widow NA NA NA NA Divorced NA NA NA NA Separated NA NA NA NA Not Applicable NA (< 15 yrs.) NA NA NA Not Available NA NA NA NA Total 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 21, *Percent is calculated based on available data. Chapter: 8 Cancer Cases according to Religions 2003 to 2012 Table Total number of Cancer Cases by Religions in both sex ( ) S.N. Religions Total %* 1. Hindu 1,714 3,029 3,751 4,289 5,398 NA 4,705 5,792 5,776 6,169 40, Buddhist NA , Islam NA Christian NA Others NA Not Available 1, NA 1, , Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 50, *Percent is calculated based on available data. Figure- 6. Total Cancer Cases by Religions in both sex ( ) Number of Cancer Cases by Religions Similarly, majority of female cancer cases (86.9%) were married and disaggregated data for was also not available Hindu Buddhist Islam Christian Others Not Available 81.1% of total cancer cases were diagnosed in Hindu religion and followed by Buddhist (5.6%) and Islam (1.3%). The disaggregated data for 2008 was not available. Table -17. Number of Cancer Cases by Religions in Male ( ) S.N Religions Total %* 1. Hindu NA NA NA NA 2,460 NA 2,245 2,735 2,683 2,831 12, Buddhist NA NA NA NA 93 NA , Islam NA NA NA NA 28 NA Christian NA NA NA NA 43 NA Others NA NA NA NA 15 NA Not Available NA NA NA NA 119 NA Total 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 15, *Percent is calculated based on available data. 83.5% of male cancer cases were diagnosed in Hindu religion and followed by Buddhist and Islam. The disaggregated data for 2003, 2004, 2005, 2006 and 2008 was not available

19 Table Number of Cancer Cases by Religions in Female ( ) S.N Religions Total %* 1. Hindu NA NA NA NA 2,938 NA 2,460 3,057 3,093 3,338 14, Buddhist NA NA NA NA 103 NA , Islam NA NA NA NA 34 NA Christian NA NA NA NA 54 NA Others NA NA NA NA 24 NA Not Available NA NA NA NA 124 NA Total 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 17, *Percent is calculated based on available data. Similarly, 83.6 % female cancer cases were diagnosed in Hindu religion and followed by Buddhist and Islam. The disaggregated data for 2003, 2004, 2005, 2006 and 2008 was not available. The trend was same for both male and female. In Nepal,Bureau of statisstic department s published data shows that must of the people are hidusreligion,so the cancer cases in male shows 83.5% hindu, 6.5% Buddhist, 1.3% Islam and 0.6% Christian but in female, 83.6% hindu, 6.9% Buddhist,1.3% Islam and 0.8% Christian. Chapter: 9 Cancer Cases according to Education from 2003 to 2012 Table -19. Cancer Cases by Education in both sex( ) S.N Education Total %* 1. Literate NA NA NA 1,278 2,387 2,681 2,050 2,464 2,410 2,460 15, Illiterate NA NA NA 1,831 2,795 2,788 2,459 3,227 3,728 3,862 20, Not Applicable (<5yrs) NA NA NA Not Available NA NA NA , Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 44, *Percent is calculated based on available data. Figure- 7. Cancer Cases by Education in both sex ( ) Percentage Number of Cancer Cases by Education ( ) Literate Illiterate Not Applicable Not Available Education Status Above table and graph showed that 46.8 % of total cancer patients were illitrate and 35.6 % were literate. The disaggregated data for was not available. Table Number of Cancer Cases by Education in Male ( ) S.N Education Total %* 1. Literate NA NA NA NA 1,178 1,205 1,031 1,346 1,342 1,227 7, Illiterate NA NA NA NA 1,170 1,276 1,107 1,291 1,495 1,649 7, Not Applicable (<5yrs) NA NA NA NA Not Available NA NA NA NA , Total 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 18, *Percent is calculated based on available data. About equal number of literate (40.3%) and illitrate (43.9%) male cases were registered in cancer registry system. The disaggregated data for was not available. Table Number of Cancer Cases by Education in Female ( ) S.N Education Total %* 1. Literate NA NA NA NA 1,209 1,476 1,019 1,118 1,068 1,233 7, Illiterate NA NA NA NA 1,625 1,512 1,352 1,936 2,233 2,213 10, Not Applicable (<5yrs) NA NA NA NA Not Available NA NA NA NA Total 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 21, *Percent is calculated based on available data. Regarding the female patients, 51.6% were illitrate whereas onle 33.8 % were literate. The disaggregated data for was not available. In above data below the age of 5 yrs. was included as not applicable

20 Chapter: 10 Cancer Cases according to Occupation from 2003 to 2012 Table Total number of Cancer Cases by Occupation in both sex ( ) S.N Occupation Total % 1. Agriculture ,272 1,916 3,434 2,894 2,151 2,923 2,839 2,699 20, Business , Housework 626 1,132 1,534 1,226 1,137 1,950 1,457 1,996 2,160 2,819 16, Office work , Others 2, , Not Applicable (<15yrs) , Not Available , , Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 56, Percentage Figure- 8. Total Cancer Cases by Occupation ( ) 37.4 Number of Cancer Cases by Occupation ( ) Agriculture Business Housework Office Work Others Not Applicable Occupation 13.4 Not Available *Percent is calculated based on available data. Agriculture (56.9%) was the major occupation of cancer patients in male cases followed by housework (9.5%). The disaggregated data for was not available. Table Number of Cancer Cases by Occupation in Female ( ) S.N Occupation Total %* 1. Agriculture NA NA NA NA 1,501 1, ,154 1, , Business NA NA NA NA Housework NA NA NA NA 898 1,518 1,180 1,790 1,895 2,507 9, Office work NA NA NA NA Others NA NA NA NA Not Applicable (<15yrs) NA NA NA NA Not Available NA NA NA NA , Total 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 21, *Percent is calculated based on available data. Housework (46.5%) was the major occupation of cancer patients in female cases followed by Agriculture (31.3%). The disaggregated data for was not available. Above graph shows that Agriculture (37.4%) and housework (28.6%) were the major occupation of cancer patients in total cases. Table Number of Cancer Cases by Occupation in Male ( ) S.N Occupation Total %* 1. Agriculture NA NA NA NA 1,933 1,721 1,263 1,769 1,757 1,917 10, Business NA NA NA NA Housework NA NA NA NA , Office work NA NA NA NA , Others NA NA NA NA , Not Applicable (<15yrs) NA NA NA NA , Not Available NA NA NA NA , Total 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 18,

21 S.N Chapter: 11 Top Ten Cancer Cases according to Districts ( ) Table 25. Top Ten District wise distribution of Cancer in both Gender District # District # District # District # District # 1. Kathmandu 219 Kathmandu 461 Kathmandu 418 Kathmandu 481 Kathmandu Kaski 193 Kaski 237 Sunsari 266 Sunsari 287 Sunsari Morang 178 Morang 208 Morang, 224 Morang 252 Kaski Chitwan 174 Sunsari 176 Jhapa 210 Kaski 226 Chitwan, Sunsari 161 Jhapa 167 Kaski 183 Jhapa 219 Morang Jhapa 121 Chitwan 155 Chitwan 138 Chitwan 177 Jhapa Nawalparasi 105 Rupandehi 143 Rupandehi 134 Rupandehi 165 Bhaktapur Rupandehi 103 Lalitpur 134 Lalitpur 112 Nawalparasi 143 Lalitpur Saptari 94 Kavre 117 Nawalparasi 111 Lalitpur 136 Nawalparasi Dhanusha 80 Syangja 111 Syangja 102 Kavre 121 Kavre 140 S.N District # District # District # District # District # 1. Kathmandu 739 Kthmandu 947 Kathmandu 876 Kathmandu 875 Kathmandu Sunsari,284 Sunsari 348 Sunsari 326 Morang 343 Sunsari Morang 272 Jhapa 291 Morang 297 Sunsari 343 Morgang Chitwan 266 Morang 283 Chitawan 282 Jhapa 255 Jhapa Nawalparasi 249 Latitpur 211 Lalitpur 261 Chitawan 249 Chitwan Rupandehi 227 Kaski 200 Jhapa 247 Lalitpur 232 Lalitpur Jhapa 214 Bhaktapur 195 Kaski 236 Rupandehi 221 Kaski Kaski 188 Chitawan 195 Nawalparasi 210 Kaski 219 Rupandehi Sarlahi 136 Nawalparasi 165 Rupandehi 209 Saptari 154 Nawalparasi Dhanusha 123 Kavre 158 Kavre 169 Bhaktapur 149 Kavre 162 Among 75 districts of Nepal, most of the total cancer cases were diagnosed in Kathmandu, Sunsari,Kaski, Morang, Chitwan, Jhapa, Lalitpur, Bhaktapur, Rupandehi, Saptari, Sarlahi, Dhanusha, Nawalparasi, Kavre, and Dhanusha. The detail is presented in above table from 2003 to Table 26. Top Ten District wise distribution of Cancerin Male S.N District # District # District # District # 1. Not Available Kathmandu 220 Kathmandu 208 Kathmandu 228 Kathmandu Not Available Kaski 106 Sunsari 124 Morang 134 Sunsari Not Available Morang 91 Morang 107 Sunsari 121 Kaski Not Available Sunsari 88 Jhapa 95 Kaski 112 Chitwan Not Available Jhapa 86 Kaski 74 Jhapa 109 Jhapa Not Available Lalitpur 82 Chitwan 67 Chitwan 91 Morang Not Available Chitwan 74 Lalitpur 56 Nawalparasi 73 Lalitpur Not Available Kavre 66 Rupandehi 47 Lalitpur 73 Bhaktapur Not Available Syangja 58 Syangja 45 Rupandehi 70 Kavre Not Available Rupandehi 55 Nawalparasi 40 Kavre 66 Nawalparasi 69 S.N District # District # District # District # District # 1. Kathmandu 326 Kathmandu 458 Kathmandu 405 Kathmandu 411 Kathmandu Morang 128 Jhapa 154 Sunsari 160 Morang 162 Sunsari Chitwan 124 Sunsari 148 Morang 153 Sunsari 155 Morang Nawalparasi 106 Morang 124 Chitwan 120 Chitawan 119 Kaski Rupandehi 102 Lalitpur 98 Jhapa 120 Lalitpur 114 Jhapa Jhapa 98 Chitwan 89 Kaski 107 Jhapa 107 Chitawan Kaski 73 Bhaktapur 87 Lalitpur 107 Rupandehi 91 Lalitpur Syangja 67 Kavre 83 Rupandehi 96 Kaski 83 Nawalparasi Tanahau 63 Nawalpur 73 Nawalparasi 95 Makawanpur 73 Rupandehi Sarlahi 53 Rupandehi 73 Kavre 86 Bara 72 Kavre 84 Among the male sex, most of the cases were diagnosed inkathmandu,sunsari,morang,jhapa, Chitwan, Kaski, Bhaktapur, Rupandehi and Nawalparasi. The detail is presented in above table. Table 27. Top Ten Districtwise distribution of Cancer in Female S.N District # District # District # District # 1. Not Available Kathmandu 241 Kathmandu 210 Kathmandu 253 Kathmandu Not Available Kaski 131 Sunsari 142 Sunsari 166 Sunsari Not Available Morang, 117 Jhapa 121 Morang 118 Kaski Not Available Sunsari 88 Morang 117 Kaski 114 Chitwan Not Available Rupandehi 88 Kaski 109 Jhapa 110 Morang Not Available Jhapa 81 Rupandehi 87 Rupandehi 95 Nawalparasi Not Available Chitwan 81 Chitwan 71 Chitwan 86 Bhaktapur Not Available Nawalparasi 64 Nawalparasi 71 Nawalparasi 70 Lalitpur Not Available Syangja 53 Syangja 57 Lalitpur 63 Bara Not Available Lalitpur 52 Lalitpur 56 Kavre 61 Rupandehi 75 S.N District # District # District # District # District # 1. Kathmandu 413 Kathmandu 489 Kathmandu 471 Kathmandu 464 Kathmandu Sunsari 155 Sunsari 200 Sunsari 166 Sunsari 188 Sunsari Morang 144 Morang 159 Chitwan 162 Morang 181 Morang Nawalparasi 143 Lalitpur 113 Lalitpurt 154 Jhapa 148 Chitwan Chitwan 142 Bhaktapur 108 Morang 144 Kaski 136 Jhapa Rupandehi 125 Chitwan 106 Kaski 129 Chitwan 130 Lalitpurt Jhapa 116 Kaski 103 Jhapa 127 Rupandehi 130 Rupandehi Kaski 115 Nawalparasi 92 Nawalparasi 115 Lalitpurt 118 Bhaktapur Sarlahi 83 Kavre 75 Rupandehi 113 Saptari 86 Nawalparasi Bhaktapur 64 Rupandehi 75 Kavre 183 Nawalparasi 81 Makwanpur 72 Among the female cases, most of the cancer diagnosedfrom Kathmandu, Sunsari,Morang, Chitwan, Kaski, Rupandehi, Nawalparasi, Jhapa etc. The detail is presented in above table. Above table shows that Kathmandu district is a 1st leading cancer diagnosed in all years

22 Chapter: 12 Cancer Cases according to Basis of diagnosis in both sex ( ) Table Total number of Cancer Cases by Basis of Diagnosis ( ) S.N Basis of Diagnosis Total % 1. Clinical Exam Endoscopy Biopsy/Histology 2,704 2,611 3,861 3,786 4,607 3,925 3,675 3,850 3,944 4,307 37, Cytology/Hematology ,086 1,829 1,668 1,646 1,676 1,695 11, Radiology , Exploratory Surgery Death Certificate Others Not Available , Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 56, % 60% 50% Figure - 9. Total number of Cancer Cases by Basis of Diagnosis ( ) 66.50% Total number of Cancer Cases by Basis of Diagnosis 8. Others NA 2 NA NA NA Not Available NA 230 NA NA NA 1, Total NA 2,030 NA NA 2,758 2,702 2,970 3,192 3,295 NA 16, *Percent is calculated based on available data. Biopsy/histology (58.2%) and cytology/hematology (27.0%) were main basis of diagnosis of cancer cases in male. The disaggregated data for 2003, 2005, 2006 and 2012 was not available. Table Number of Cancer Cases by Basis of Diagnosis in Female ( ) S.N Basis of Diagnosis Total %* 1. Clinical Exam NA 76 NA NA NA Endoscopy NA 7 NA NA NA Biopsy/Histology NA 1,403 NA NA 2,579 2,315 2,003 2,151 2,296 NA 12, Cytology/Hematology NA 396 NA NA NA 4, Radiology NA 52 NA NA NA Exploratory Surgery NA 10 NA NA NA Death Certificate NA 7 NA NA NA Others NA 6 NA NA NA Not Available NA 214 NA NA NA 1, Total NA 2,171 NA NA 3,277 3,247 3,229 3,581 3,793 NA 19, *Percent is calculated based on available data. Above table shows that Biopsy/histology (66.1%) and cytology/hematology (21.7%) were main basis of diagnosis of cances cases in female. The disaggregated data for 2003, 2005, 2006 and 2012 was not available. 40% 30% 20.20% 20% 10% 0% Biopsy/Histology Cytology/Haematology 7.60% 4.30% 0.70% 0.40% 0.10% 0.10% Radiology Clinical exam Endoscopy Exploratory surgery Death certificate Not available Above table and graph data showed that 66.5% of cancer cases were confirmed by biopsy/histology, followed by cytology/hematology(20.2%) and others. Table Number of Cancer Cases by Basis of Diagnosis in Male ( ) S.N Basis of Diagnosis Total %* 1. Clinical Exam NA 50 NA NA NA Endoscopy NA 11 NA NA NA Biopsy/Histology NA 1,208 NA NA 2,028 1,610 1,672 1,699 1,648 NA 9, Cytology/Hematology NA 462 NA NA NA 4, Radiology NA 49 NA NA NA Exploratory Surgery NA 4 NA NA NA Death Certificate NA 14 NA NA NA

23 Chapter: 13 Cancer Cases according to Treatment modalities Table - 31.Total Number of Cancer Cases by Treatment Modalities in both sex ( ) S.N Treatment Modalities Total %* 1. Chemotherapy 697 NA NA 806 2,297 2,277 1,363 1,296 1,407 1,528 11, Radiotherapy 403 NA NA , Surgery 536 NA NA ,054 1,009 1,002 5, Supportive 287 NA NA , Symptomatic 0 NA NA Hormone 13 NA NA Immunotherapy 3 NA NA NA NA NA Surgery + Radiotherapy 77 NA NA , Surgery + Chemotherapy 127 NA NA , Radiotherapy+ Chemotherapy 152 NA NA , Surgery + Chemotherapy + Radiotherapy 60 NA NA , Not Available/unknown 896 NA NA ,769 1,852 1,584 10, Total 3,251 NA NA 4,908 6,035 5,949 6,199 6,773 7,088 7,212 47, *Percent is calculated based on available data. Above data shows that Chemotherapy (24.6%), Surgery (11.7%), Radiotherapy+ Chemotherapy (11.3%), Surgery + Chemotherapy (7.8%), Supportive (7.0%) and Radiotherapy (6.6%) were the main treatment modalities among the total cases. The disaggregated data for 2004 & 2005 was not available. Table Number of Cancer Cases by Treatment Modalities in Female ( ) S.N Treatment Modalities Total %* 1. Chemotherapy NA NA NA NA NA 1,203 NA , Radiotherapy NA NA NA NA NA 196 NA , Surgery NA NA NA NA NA 290 NA , Supportive NA NA NA NA NA 179 NA , Symptomatic NA NA NA NA NA 78 NA Hormone NA NA NA NA NA 1 NA 3 1 NA Immunotherapy NA NA NA NA NA NA NA NA NA NA Surgery + Radiotherapy NA NA NA NA NA 111 NA Surgery + Chemotherapy NA NA NA NA NA 268 NA , Radiotherapy+ Chemotherapy NA NA NA NA NA 603 NA , Surgery + Chemotherapy +Radiotherapy NA NA NA NA NA 220 NA Not Available/unknown NA NA NA NA NA 98 NA , Total NA NA NA NA NA 3,247 NA 3,581 3,793 3,921 14, *Percent is calculated based on available data. Chemotherapy (22.9%), Surgery (13.6%) followed by Radiotherapy+ Chemotherapy (11.9%), Surgery + Chemotherapy (7.9%), Radiotherapy (7.5%) and Supportive (7.0%), were the main treatment modalities among the total female cases. The disaggregated data for & 2009 was not available. Table 32. Number of Cancer Cases by Treatment Modalities in Male ( ) S.N Treatment Modalities Total %* 1. Chemotherapy NA NA NA NA NA 1,074 NA , Radiotherapy NA NA NA NA NA 188 NA Surgery NA NA NA NA NA 235 NA , Supportive NA NA NA NA NA 170 NA , Symptomatic NA NA NA NA NA 61 NA Hormone NA NA NA NA NA 3 NA Immunotherapy NA NA NA NA NA 1 NA NA NA NA Surgery + Radiotherapy NA NA NA NA NA 75 NA Surgery + Chemotherapy NA NA NA NA NA 290 NA Radiotherapy+ Chemotherapy NA NA NA NA NA 377 NA , Surgery + Chemotherapy NA +Radiotherapy NA NA NA NA 116 NA Not Available/unknown NA NA NA NA NA 112 NA , Total NA NA NA NA NA 2,702 NA 3,192 3,295 3,291 12, *Percent is calculated based on available data. Chemotherapy (25.5%), Surgery (12.9%), Radiotherapy+ Chemotherapy (9.6%), Supportive (8.5%), Surgery + Chemotherapy (6.4%) and Radiotherapy (6.6%) were the main treatment modalities among the total male cases. The disaggregated data for & 2009 was not available

24 Chapter: 14 Total Number of Cancer Cases in both sexfrom Table Total Number of Cancer Cases( ) in both sex. S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate C 06 parts of mouth C 07 Parotid gland C 08 major salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined sites in C 14 lip oral cavity & Pharynx C 15 Esophagus , C 16 Stomach , C 17 Small intestine C 18 Colon , C 19 Rectosegmoidjucnction C 20 Rectum , C 21 Anus &Anal canal C 22 Liver C 23 Gall bladder , C 24 billary tract C 25 Pancreas C 26 Ill defined digestive organs C 30 Nasal cavity & middle ear C 31 Accessory sinus C 32 Larynx , C 33 Trachea C 34 Bronchus & lung , C 37 Thymus C 38 Heart, Mediastinum & pleura Bones joints & C 40 articular cartilage C 41 bones joints & articular cartilage Hematopoitic & 37 C 42 Reticulo-endothelial system/spleen , C43 Skin melanoma C 44 Skin other Perepheral nerves & C 47 autonomic nervous system 41 C 48 Peritonium & retroperitonium Connective subcutaneous C 49 & other soft tissue C 50 Breast , C 51 Vulva C 52 Vagina C 53 Cervix uteri , C 54 Endometrium C 55 Uterus C 56 Ovary , C 57 female genital organs C 60 Penis C 61 Prostate gland C 62 Testis C 63 male genital organs C 64 Kidney C 65 Renal pelvis C 67 Bladder , C 68 urinary organs C 69 Eye &adnexa C 70 Meninges C 71 Brain , C 72 Spinal cord & parts of CNS C 73 Thyroid , C 74 Adrenal gland Other endocrine & C 75 related C 76 Other &ill defined sites , C77 Lymphnode , C 80 Unknown primary site ,

25 69 C 81 Hodgkin's disease C 85 NHL Not available Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 56, Leukemia cases - 71 C 90 Multiple myeloma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified Above table shows that Bronchus & Lung (C34) site was 1 st leading of common cancer which was found 14.5% in both sex. Other common sites were Cervix Uteri (C53) 11.2%, Breast(C50)8.4%,andStomach (C16) 5.8% etc.types of leukemia and other cases showsin detail in above table Bronchus & lung Figure - 10: Top ten common cancer in both sex ( AD) 11.2 Cervix uteri Top Ten Common Cancer ( AD) 8.4 Breast Stomach Haematopoetic Gall bladder Ovary Larynx U. bladder 2.3 Oesophagus Table -35. Total Number of Cancer Cases in Male ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate C 06 parts of mouth C 07 Parotid gland C 08 major salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined C 14 sites in lip oral cavity & Pharynx 16 C 15 Esophagus C 16 Stomach C 17 Small intestine C 18 Colon C 19 Rectosegmoidjucnction C 20 Rectum C 21 Anus &Anal canal C 22 Liver C 23 Gall bladder C 24 billary tract C 25 Pancreas C 26 Ill defined digestive organs Nasal cavity & C 30 middle ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung , C 37 Thymus C 38 Heart, Mediastinum & pleura Bones joints & C 40 articular cartilage C 41 bones joints & articular cartilage Hematopoitic & Reticulo C 42 -endothelial system/spleen , C43 Skin melanoma C 44 Skin other Perepheral nerves C 47 & autonomic nervous system C 48 Peritonium & retroperitonium Connective 42 C 49 subcutaneous & other soft tissue

26 43 C 50 Breast C 51 Vulva C 52 Vagina C 53 Cervix uteri C 54 Endometrium C 55 Uterus C 56 Ovary C 57 female genital organs C 60 Penis C 61 Prostate gland C 62 Testis C 63 male genital organs C 64 Kidney C 65 Renal pelvis C 67 Urinary Bladder , C 68 urinary organs C 69 Eye &adnexa C 70 Meninges C 71 Brain Spinal cord & other C 72 parts of CNS C 73 Thyroid C 74 Adrenal gland C 75 Other endocrine & related C77 Lymphnode Other &ill defined C 76 sites C 80 Unknown primary site C 81 Hodgkin's disease C 85 NHL Not available Total 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 26, Leukemia types- C 90 Multiple myeloma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified Above table shows that Cancer of the Bronchus & Lung (C34) was the most common site found 19.1% in male cases. Other common sites were Stomach(C16) 7.9%, Larynx(C32)4.9% and U.Bladder(C67) 4.2% etc. The detail all is presented in above table Figure - 11: Total Number of Cancer Cases in Male ( ) 19.1 Bronchus & lung 7.9 Stomach Top Ten Cancer Cases in Male ( AD) 6.7 Haematopoetic Larynx U. bladder Oesphagus other part of mouth other part of tongue Rectum Gall bladder Table -36. Number of Total Cancer Cases in Female ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate C 06 parts of mouth C 07 Parotid gland C 08 major salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined sites in C 14 lip oral cavity & Pharynx C 15 Esophagus C 16 Stomach , C 17 Small intestine C 18 Colon C 19 Rectosegmoidjucnction C 20 Rectum C 21 Anus & anal canal

27 23 C 22 Liver C 23 Gall bladder , C 24 billary tract C 25 Pancreas Ill defined digestive C 26 organs Nasal cavity & C 30 middle ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung , C 37 Thymus Heart, Mediastinum C 38 & pleura Bones joints & C 40 articular cartilage C 41 bones joints & articular cartilage 37 Hematopoitic & Reticulo C 42 -endothelial system/spleen , C43 Skin melanoma C 44 Skin other Perepheral nerves & C 47 autonomic nervous system C 48 Peritonium & retroperitonium Connective C 49 subcutaneous & other soft tissue C 50 Breast , C 51 Vulva C 52 Vagina C 53 Cervix uteri , C 54 Endometrium C 55 Uterus C 56 Ovary , C 57 female genital organs C 60 Penis C 61 Prostate gland C 62 Testis C 63 male genital organs C 64 Kidney C 65 Renal pelvis C 67 Urinary Bladder C 68 urinary organs C 69 Eye &adnexa C 70 Meninges C 71 Brain Spinal cord & other C 72 parts of CNS C 73 Thyroid C 74 Adrenal gland Other endocrine & C 75 related Other &ill defined C 76 sites C77 Lymphnode C 80 Unknown primary site C 81 Hodgkin's disease C 85 NHL Not available Total 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 29, Leukemia- C 90 Multiple myeoma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified Cervix uteri Figure 12: Top ten cancer cases in Female ( ) Top Ten Cancer Cases in Female ( AD) 15.5 Breast 10.5 Bronchus & Lung Ovary Gall bladder Stomach Haematopoetic Thyroid Rectum ill defined site In female, Cervix Uteri(C53) site was the most common site which was found 20.9%. Other common sites were Breast(C50) 15.5%, Bronchus & Lung (C34) 10.5%, Ovary (C56) 6.1%, Gall bladder (C23) 4.2%, and Stomach (C16) 4.0%. The detail all data are presented in above table

28 Chapter: 15 Cancer Cases for 0-14 yrs (Paediatric) in Male Table 37. Total Cancer Cases for age group 0-14 yrs.(paediatric) in Male ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate C 06 parts of mouth C 07 Parotid gland C 08 major salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined 15 C 14 sites in lip oral cavity & Pharynx C 15 Esophagus C 16 Stomach C 17 Small intestine C 18 Colon C 19 Rectosegmoidjucnction C 20 Rectum C 21 Anus & anal canal C 22 Liver C 23 Gall bladder C 24 billary tract C 25 Pancreas Ill defined digestive C 26 organs Nasal cavity & C 30 middle ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung C 37 Thymus Heart, Mediastinum C 38 & pleura Bones joints & C 40 articular cartilage C 41 bones joints & articular cartilage Hematopoitic & Reticulo C 42 -endothelial system/spleen C43 Skin melanoma C 44 Skin other Perepheral nerves & 40 C 47 autonomic nervous system C 48 Peritonium & retroperitonium Connective subcutaneous C 49 & other soft tissue C 50 Breast C 51 Vulva C 52 Vagina C 53 Cervix uteri C 54 Endometrium C 55 Uterus C 56 Ovary C 57 female genital organs C 60 Penis C 61 Prostate gland C 62 Testis C 63 male genital organs C 64 Kidney C 65 Renal pelvis C 67 Bladder C 68 urinary organs C 69 Eye &adnexa C 70 Meninges C 71 Brain Spinal cord & other C 72 parts of CNS C 73 Thyroid C 74 Adrenal gland Other endocrine & C 75 related

29 66 Other &ill defined C 76 sites C77 Lymphnode Unknown primary C 80 site C 81 Hodgkin's disease C 85 NHL Not available Total Leukemia types- 71 C 90 Multiple myeloma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified % 35% 30% 25% 20% 15% 10% 5% 0% 37.50% Haematopoetic Eye & adnexa Figure- 13. Top ten Cancer for age group 0-14 yrs. in Male Top Ten Cancer for age group 0-14 yrs. in Male 8.80% 8.40% Brain Lymphnode 6.90% 3.80% 3.80% 3.60% 3.30% 3.00% 2.20% Non H.lymphoma Kidney other ill defind site Bone joints Hodgkins disease Connective subcutaneus.. Above table and graph shows that for male cancer cases age group of 0-14 yrs, common cancers were diagnosed in C 42 Hematopoitic&Reticuloendothelial system/spleen (18.1%), C 91 Leukemia/ lymphoid (12.8%), C 69 Eye &adexa (8.8%), C 71 Brain (8.4%), C77 Lymphnodes (6.9%). Cancer Cases for 0-14 yrs (Paediatric) in Female Table Number of Cancer Cases for age group of 0-14 yrs.in Female ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate parts C 06 of mouth C 07 Parotid gland major C 08 salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined sites in C 14 lip oral cavity & Pharynx C 15 Esophagus C 16 Stomach C 17 Small intestine C 18 Colon C 19 Rectosegmoidjucnction C 20 Rectum C 21 Anus & anal canal C 22 Liver C 23 Gall bladder C 24 billary tract C 25 Pancreas C 26 Ill defined digestive organs C 30 Nasal cavity & middle ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung C 37 Thymus C 38 Heart, Mediastinum & pleura Bones joints & articular C 40 cartilage C 41 bones joints & articular cartilage C 42 Hematopoitic&Reticuloen dothelial system/spleen C43 Skin melanoma C 44 Skin other Perepheral nerves & C 47 autonomic nervous system

30 41 C 48 Peritonium & retroperitonium Connective subcutaneous C 49 & other soft tissue C 50 Breast C 51 Vulva C 52 Vagina C 53 Cervix uteri C 54 Endometrium C 55 Uterus C 56 Ovary C 57 female genital organs C 60 Penis C 61 Prostate gland C 62 Testis male C 63 genital organs C 64 Kidney C 65 Renal pelvis C 67 Bladder C 68 urinary organs C 69 Eye &adnexa C 70 Meninges C 71 Brain Spinal cord & other parts C 72 of CNS C 73 Thyroid C 74 Adrenal gland C 75 Other endocrine & related C 76 Other &ill defined sites C77 Lymphnode C 80 Unknown primary site C 81 Hodgkin's disease C 85 NHL Not available Total % 35% 30% 25% 20% 15% 10% 5% 0% Figure- 14. Top ten Cancer for age group of 0-14 yrs. (Paediatric) in Female Haematopoetic 9.30% Eye & adnexa Top Ten Cancer for age group 0-14 yrs. in Female Lymphnode 6.00% 6.00% 4.70% 4.60% 3.60% 3.70% 3.50% 3.20% Brain Bone joints Non H.lymphoma Kidney other unspecified... other ill defined site Above table and graph shows that for female cancer cases in age group of 0-14 yrs, common cancer were C 42 Hematopoitic&Reticuloendothelial system/spleen (16.9%), C 91 Leukemia/ lymphoid (11.6%), C 69 Eye &adexa (9.3%), C 71 Brain (6.0%), C77 Lymphnodes (6.0%). ovary Leukemia types C 90 Multiple myeoma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified

31 Chapter: 16 Number of Cancer Cases for yrs in Male Table Number of Cancer Cases for yrs.in Male ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue parts C 02 of tongue C 03 Gum C 04 Floor of mouth C 05 Palate parts C 06 of mouth C 07 Parotid gland major C 08 salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined sites in C 14 lip oral cavity & Pharynx C 15 Esophagus C 16 Stomach C 17 Small intestine C 18 Colon C 19 Rectosegmoidjucnction C 20 Rectum C 21 Anus & anal canal C 22 Liver C 23 Gall bladder C 24 billary tract C 25 Pancreas C 26 Ill defined digestive organs C 30 Nasal cavity & middle ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung C 37 Thymus Heart, Mediastinum & C 38 pleura C 40 Bones joints & articular cartilage bones C 41 joints & articular cartilage Hematopoitic & 37 C 42 Reticuloendothelial system/spleen C43 Skin melanoma C 44 Skin other Perepheral nerves & C 47 autonomic nervous system C 48 Peritonium & retroperitonium Connective subcutaneous C 49 & other soft tissue C 50 Breast C 51 Vulva C 52 Vagina C 53 Cervix uteri C 54 Endometrium C 55 Uterus C 56 Ovary C 57 female genital organs C 60 Penis C 61 Prostate gland C 62 Testis male C 63 genital organs C 64 Kidney C 65 Renal pelvis C 67 U.Bladder C 68 urinary organs C 69 Eye &adnexa C 70 Meninges C 71 Brain C 72 Spinal cord & other parts of CNS C 73 Thyroid C 74 Adrenal gland C 75 Other endocrine & related C 76 Other &ill defined sites C77 Lymphnode C 80 Unknown primary site C 81 Hodgkin's disease C 85 NHL Not available Total ,

32 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% Leukemia types- C 90 Multiple myeloma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified % Haematopoetic Figure Top ten Cancer for age group yrs in Male 5.40% Brain Top Ten Cancer for Age Group yrs in Male Lymphnode 4.80% 4.70% 4.40% 4.30% Rectum other ill defined site Non H.lymphoma 4.20% 3.20% 3.20% 3.20% Bone joined other unspecified bones Bronchus & lung Stomach Age group of yrs in male above table and graph shows that most common cancer were diagnosed as C 42 Hematopoitic&Reticuloendothelial system/spleen (8.0%), C 92 Leukemia/myeloid (6.2%), C 71 Brain (5.4%), C77 Lymphnode (4.8%), C 20 Rectum (4.7%) were the most common cancer site. Number of Cancer Cases for yrs in Female Table Number of Cancer Cases for age group yrs.in Female ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate C 06 parts of mouth C 07 Parotid gland C 08 major salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined sites in C 14 lip oral cavity & Pharynx C 15 Esophagus C 16 Stomach C 17 Small intestine C 18 Colon C 19 Recto segmoidjucnction C 20 Rectum C 21 Anus & anal canal C 22 Liver C 23 Gall bladder C 24 billary tract C 25 Pancreas C 26 Ill defined digestive organs C 30 Nasal cavity & middle ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung C 37 Thymus C 38 Heart, Mediastinum & pleura C 40 Bones joints & articular cartilage bones C 41 joints & articular cartilage C 42 Hematopoitic&Reticuloen dothelial system/spleen C43 Skin melanoma C 44 Skin other Perepheral nerves & C 47 autonomic nervous system C 48 Peritonium & retroperitonium Connective subcutaneous 42 C 49 & other soft tissue C 50 Breast C 51 Vulva C 52 Vagina C 53 Cervix uteri C 54 Endometrium C 55 Uterus C 56 Ovary C 57 female genital organs C 58 placenta C 60 Penis C 61 Prostate gland C 62 Testis male 55 C 63 genital organs

33 56 C 64 Kidney C 65 Renal pelvis C 67 U.Bladder C 68 urinary organs C 69 Eye &adexa C 70 Meninges C 71 Brain C 72 Spinal cord & other parts of CNS C 73 Thyroid C 74 Adrenal gland C 75 Other endocrine & related C 76 Other &ill defined sites C77 Lymphnode C 80 Unknown primary site C 81 Hodgkin's disease C 85 NHL Not available Total , Leukemia type C 90 Multiple myeloma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified % 14% 12% 10% 8% 6% 4% 2% 0% 14.10% Breast Figure-16. Top ten Cancer for yrs in Female ( ) Top Ten Cancer for Age Group yrs in Female 10% 9.50% 8.90% Ovary Hematopoetic Cervix uteri 6.80% Thyroid 3.60% 2.90% 2.80% Rectum unspecified genital organ Stomach 2.70% 2.60% ill defined site Bronchus & lung Above table data and graph shows that in female cancer cases of age group yrs, most common cancers were C 50 Breast (14.1%), C 56 Ovary (10.0%), C 53 Cervix uteri (8.9%), C 73 Thyroid (6.8%), C 42 Hematop oitic&reticuloendothelial system/spleen (4.8%). Chapter: 17 Cancer Cases for yrs in Male Table Number of Cancer Cases for age group of yrs.in Male ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate C 06 parts of mouth C 07 Parotid gland C 08 major salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined sites in C 14 lip oral cavity & Pharynx C 15 Esophagus C 16 Stomach , C 17 Small intestine C 18 Colon C 19 Rectosegmoidjucnction C 20 Rectum C 21 Anus & anal canal C 22 Liver C 23 Gall bladder C 24 billary tract C 25 Pancreas Ill defined digestive C 26 organs Nasal cavity & middle C 30 ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung , C 37 Thymus

34 34 C 38 Heart, Mediastinum & pleura C 40 Bones joints & articular cartilage bones C 41 joints & articular cartilage Hematopoitic&Reticu 37 C 42 loendothelial system/ Spleen C43 Skin melanoma C 44 Skin other Perepheral nerves & C 47 autonomic nervous system C 48 Peritonium & retroperitonium Connective 42 C 49 subcutaneous & other soft tissue C 50 Breast C 51 Vulva C 52 Vagina C 53 Cervix uteri C 54 Endometrium C 55 Uterus C 56 Ovary C 57 female genital organs C 60 Penis C 61 Prostate gland C 62 Testis C 63 male genital organs C 64 Kidney C 65 Renal pelvis C 67 Urinary Bladder C 68 urinary organs C 69 Eye & adnexa C 70 Meninges C 71 Brain Spinal cord & other C 72 parts of CNS C 73 Thyroid C 74 Adrenal gland C 75 Other endocrine & related C 76 Other &ill defined sites C77 Lymphnode C 80 Unknown primary site C 81 Hodgkin's disease C 85 NHL Not available Total 786 1,020 1,128 1,198 1,467 1,413 1,529 1,581 1,705 1,599 13, Leukemia type- C 90 Multiple myeloma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified Figure- 17. Top ten Cancer for age group yrs in Male ( ) 19.2 Bronchus & lung 9 Stomach Top Ten Cancer for Age Group yrs in Male Larynx Hematopoetic.. Urniary bladder Oesophagus Other part of mouth Other part of tongue Colon Gall bladder For male cancer cases shows that age group of yrs, C 34 Bronchus& lung (19.2%), C 16 Stomach (9.0%), C 32 Larynx (5.6%), C 67 Urinary Bladder (3.9%), C 15 Esophagus (3.3%) were the most common cancer site. Table Number of Cancer Cases for age group yrs.in Female ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate C 06 parts of mouth C 07 Parotid gland C 08 major salivary gland C 09 Tonsil C 10 Oropharynx

35 12 C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined C 14 sites in lip oral cavity & Pharynx 16 C 15 Esophagus C 16 Stomach C 17 Small intestine C 18 Colon C 19 Rectosegmoidjucnction C 20 Rectum C 21 Anus & anal canal C 22 Liver C 23 Gall bladder C 24 billary tract C 25 Pancreas Ill defined digestive C 26 organs Nasal cavity & C 30 middle ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung , C 37 Thymus Heart, Mediastinum C 38 & pleura Bones joints & C 40 articular cartilage C 41 bones joints & articular cartilage 37 Hematopoitic&Re C 42 ticuloendothelial system/spleen 38 C43 Skin melanoma C 44 Skin other Perepheral nerves & C 47 autonomic nervous system C 48 Peritonium & retroperitonium Connective subcutaneous C 49 & other soft tissue C 50 Breast , C 51 Vulva C 52 Vagina C 53 Cervix uteri , C 54 Endometrium C 55 Uterus C 56 Ovary , C 57 female genital organs C 58 placenta C 60 Penis C 61 Prostate gland C 62 Testis C 63 male genital organs C 64 Kidney C 65 Renal pelvis C 67 Urinary Bladder C 68 urinary organs C 69 Eye &adnexa C 70 Meninges C 71 Brain Spinal cord & other C 72 parts of CNS C 73 Thyroid C 74 Adrenal gland Other endocrine & C 75 related Other &ill defined C 76 sites C77 Lymphnode Unknown primary C 80 site C 81 Hodgkin's disease C 85 NHL Not available Total , Leukemia type- C 90 Multiple myeloma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified

36 Cervix uteri Figure Top ten Cancer for yrs in Female ( ) Top Ten Cancer cases for Age Group yrs in Female 18.2 Breast 9.4 Bronchus & lung Ovary Gall bladder Stomach Hematopoetic Thyroid Colon Rectum For female cancer cases age group of yrs, C 53 Cervix uteri (24.8%), C 50 Breast (18.2%), C 34 Bronchus & lung (9.4%), C 56 Ovary (6.1%), C 23 Gall bladder (4.6%), C 16 Stomach (4.2%) were the most common cancer site. Chapter: 18 Cancer Cases for age group +65 yrs in Male Table Number of Cancer Cases for age group +65 yrs. in Male ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate C 06 parts of mouth C 07 Parotid gland C 08 major salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined sites in C 14 lip oral cavity & Pharynx C 15 Esophagus C 16 Stomach C 17 Small intestine C 18 Colon C 19 Rectosegmoidjucnction C 20 Rectum C 21 Anus & anal canal C 22 Liver C 23 Gall bladder C 24 billary tract C 25 Pancreas C 26 Ill defined digestive organs C 30 Nasal cavity & middle ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung , C 37 Thymus C 38 Heart, Mediastinum & pleura

37 35 Bones joints & C 40 articular cartilage C 41 bones joints & articular cartilage 37 Hematopoitic&Reticu C 42 loendothelial system/ Spleen 38 C43 Skin melanoma C 44 Skin other Perepheral nerves & C 47 autonomic nervous system 41 C 48 Peritonium & retroperitonium Connective subcutaneous C 49 & other soft tissue C 50 Breast C 51 Vulva C 52 Vagina C 53 Cervix uteri C 54 Endometrium C 55 Uterus C 56 Ovary C 57 female genital organs C 60 Penis C 61 Prostate gland C 62 Testis C 63 male genital organs C 64 Kidney C 65 Renal pelvis C 67 U. Bladder C 68 urinary organs C 69 Eye &adnexa C 70 Meninges C 71 Brain Spinal cord & other C 72 parts of CNS C 73 Thyroid C 74 Adrenal gland Other endocrine & C 75 related C 76 Other &ill defined sites C77 Lymphnode C 80 Unknown primary site C 81 Hodgkin's disease C 85 NHL Not available Total , C 90 Multiple myeloma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified Bronchu & lung Figure-19. Top ten Cancer for age group 65 +yrs in Male ( ) 8.9 Stomach Top Ten Cancer for 65+ yrs in Male ( ) Urinary bladder Larynx Oesophagus Prostate Pyriform sinus Gall bladder other part of mouth other part of tongue For male cancer cases age group of +65 yrs, C 34 Bronchus & lung (27.3%), C 16 Stomach (8.9%), C 67 U. Bladder (6.2%), C 32 Larynx (5.9%), C 15 Esophagus (4.2%), C 61 Prostate gland (3.5%) were the most common cancer site. Table Number of Cancer Cases for age group +65 yrs.in Female ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate C 06 parts of mouth C 07 Parotid gland

38 9 C 08 major salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx C 14 Other &ill defined sites in lip oral cavity & Pharynx C 15 Esophagus C 16 Stomach C 17 Small intestine C 18 Colon C 19 Rectosegmoidjucnction C 20 Rectum C 21 Anus & anal canal C 22 Liver C 23 Gall bladder C 24 billary tract C 25 Pancreas C 26 Ill defined digestive organs C 30 Nasal cavity & middle ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung C 37 Thymus C C C C 42 Heart, Mediastinum & pleura Bones joints & articular cartilage bones joints & articular cartilage Hematopoitic&Reticu loendothelial system/ Spleen C43 Skin melanoma C 44 Skin other C 47 Perepheral nerves & autonomic nervous system C 48 Peritonium&retroperitonium C 49 Connective subcutaneous & other soft tissue C 50 Breast C 51 Vulva C 52 Vagina C 53 Cervix uteri , C 54 Endometrium C 55 Uterus C 56 Ovary C 57 female genital organs C 60 Penis C 61 Prostate gland C 62 Testis C 63 male genital organs C 64 Kidney C 65 Renal pelvis C 67 Bladder C 68 urinary organs C 69 Eye &adnexa C 70 Meninges C 71 Brain C 72 Spinal cord & other parts of CNS C 73 Thyroid C 74 Adrenal gland C 75 Other endocrine & related C 76 Other &ill defined sites C77 Lymphnode

39 68 C 80 Unknown primary site C 81 Hodgkin's disease C 85 NHL Not available Total , Leukemia types- C 90 Multiple myeloma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified Figure-20. Top ten Cancer for age group 65 +yrs in Female ( ) 19.9 Bronchus & lung 17.9 Cervix uteri Top Ten Cancer for 65+ yrs in Female ( ) 9.2 Breast 5 Stomach Gall bladder Ovary Oesophagus Urinary bladder Thyroid Ill defined site In female cancer cases for age group of +65 yrs, C 34 Bronchus & lung (19.9%), C 53 Cervix uteri (17.9%), C 50 Breast (9.2%), C 16 Stomach (5.0%), C 23 Gall bladder (4.6%), C 56 Ovary (4.0%) were the most common cancer site. Chapter : 19 Cancer Cases for age +75yrs (Geriatric) in Male Table Number of Cancer Cases for age group + 75 yrs.( Geriatric)in Male ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate C 06 parts of mouth C 07 Parotid gland C 08 major salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined sites in C 14 lip oral cavity & Pharynx C 15 Esophagus C 16 Stomach C 17 Small intestine C 18 Colon C 19 Rectosegmoidjucnction C 20 Rectum C 21 Anus & anal canal C 22 Liver C 23 Gall bladder C 24 billary tract C 25 Pancreas C 26 Ill defined digestive organs C 30 Nasal cavity & middle ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung C 37 Thymus

40 34 C 38 Heart, Mediastinum & pleura C 40 Bones joints & articular cartilage C 41 bones joints & articular cartilage 37 C 42 Hematopoitic&Reticu loendothelial system/ Spleen 38 C43 Skin melanoma C 44 Skin other C 47 Perepheral nerves & autonomic nervous system C 48 Peritonium & retroperitonium C 49 Connective subcutaneous & other soft tissue C 50 Breast C 51 Vulva C 52 Vagina C 53 Cervix uteri C 54 Endometrium C 55 Uterus C 56 Ovary C 57 female genital organs C 60 Penis C 61 Prostate gland C 62 Testis C 63 male genital organs C 64 Kidney C 65 Renal pelvis C 67 Bladder C 68 urinary organs C 69 Eye &adnexa C 70 Meninges C 71 Brain C 72 Spinal cord & other parts of CNS C 73 Thyroid C 74 Adrenal gland C 75 Other endocrine & related C 76 Other &ill defined sites C77 Lymphnode C 80 Unknown primary site C 81 Hodgkin's disease C 85 NHL Not available Total Leukemia type- 71 C 90 Multiple myeloma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified Bronchus & lung Figure 21: Top ten Cancer for 75 +yrs (Geriatric) in Male ( ) 8.7 Stomach Top Ten Cancer for 75+ yrs (Geriatric) in Male 7.4 Urinary bladder Prostate Larynx Oesophagus Pyriform Sinus ill defined site Skin other other part of tongue For male cancer cases for age group of+75 yrs, C 34 Bronchus & lung (25.3%), C 16 Stomach (8.7%), C 67 Bladder (7.4%), C 61 Prostate gland (5.2%), C 32 Larynx (4.5%), C 15 Esophagus (4.2%) were the most common cancer site. Table Number of Cancer Cases for + 75 yrs.in Female ( ) S.N. ICD -10 Topography Total % 1 C 00 Lip C 01 Base of tongue C 02 parts of tongue C 03 Gum C 04 Floor of mouth C 05 Palate C 06 parts of mouth

41 8 C 07 Parotid gland C 08 major salivary gland C 09 Tonsil C 10 Oropharynx C 11 Nasopharynx C 12 Pyriform sinus C 13 Hypopharynx Other &ill defined sites in C 14 lip oral cavity & Pharynx C 15 Esophagus C 16 Stomach C 17 Small intestine C 18 Colon C 19 Rectosegmoidjucnction C 20 Rectum C 21 Anus & anal canal C 22 Liver C 23 Gall bladder C 24 billary tract C 25 Pancreas Ill defined digestive C 26 organs C 30 Nasal cavity & middle ear C 31 Accessory sinus C 32 Larynx C 33 Trachea C 34 Bronchus & lung C 37 Thymus C 38 Heart, Mediastinum & pleura Bones joints & articular C 40 cartilage C 41 bones joints & articular cartilage Hematopoitic & 37 C 42 Reticuloendothelial system/spleen 38 C43 Skin melanoma C 44 Skin other Perepheral nerves & C 47 autonomic nervous system C 48 Peritonium & retroperitonium Connective subcutaneous & C 49 other soft tissue C 50 Breast C 51 Vulva C 52 Vagina C 53 Cervix uteri C 54 Endometrium C 55 Uterus C 56 Ovary C 57 female genital organs C 60 Penis C 61 Prostate gland C 62 Testis male C 63 genital organs C 64 Kidney C 65 Renal pelvis C 67 Bladder C 68 urinary organs C 69 Eye &adnexa C 70 Meninges C 71 Brain Spinal cord & other parts C 72 of CNS C 73 Thyroid C 74 Adrenal gland C 75 Other endocrine & related C 76 Other &ill defined sites C77 Lymphnode C 80 Unknown primary site C 81 Hodgkin's disease C 85 NHL Not available Total Leukeemia types 71 C 90 Multiple myeloma C 91 Leukemia/ lymphoid C 92 Leukemia/myeloid C 95 Leukemia unspecified

42 Figure: 22. Top ten Cancerfor 75 +yrs (Geriatric) in Female ( ) 19.9 Bronchus & lung 13.9 Cervix uteri Top Ten Cancer for 75+ yrs (Geriatric) in Female 8.4 Breast 5.8 Stomach 3.9 Ovary Urinary bladder Skin other Oesophagus Thyroid ill defined site In female, cancer cases for age group of +75 yrs, C 34 Bronchus & lung (19.9%), C 53 Cervix uteri (13.9%), C 50 Breast (8.4%), C 16 Stomach (5.8%), C 56 Ovary (3.9%) were the most common cancer site. Chapter: 20 Tobacco Related Cancer Cases ( ) Table 47. Number of Tobacco Related Cancer in Male ( ) ICD 10 Cancer Site Total % C 00 Lip C 01 Base of Tongue C02 Unspecified of Tongue C03 Gum C04 Floor of Mouth C05 Palate C06 Unspecified of mouth C09 Tonsil C10 Oropharynx C11 Nasopharynx C12 Pyriform Sinus C13. Hypopharynx C14 Ill defined site in oral cavity C15 Esophagus C32 Larynx , C33. Trachea C34 Bronchus & Lung C 67 Urinary Bladder Total ,001 1,276 1,259 1,261 1,356 1,444 1,384 11, Among the male, tobaco related cancer sites C34 Bronchus & Lung was the most common site and Larynx, Esophagus, Pyriform Sinus, Unspecified of mouth, Unspecified of Tongue are other common sites. Table Number of Tobacco Related Cancer in Female ( ) ICD 10 Cancer Site Total % C 00 Lip C 01 Base of Tongue C02 Unspecified of Tongue C03 Gum C04 Floor of Mouth C05 Palate C06 Unspecified of mouth

43 C09 Tonsil C10 Oropharynx C11 Nasopharynx C12 Pyriform Sinus C13. Hypopharynx C14 Ill defined site in oral cavity C15 Esophagus C32 Larynx C33. Trachea C34 Bronchus & Lung , C 67 Urinary Bladder Total , Among the female,tobaco related cancer sites, C34 Bronchus & Lung was the most common site and Esophagus, Larynx, Urinary Bladder, Pyriform Sinus, Unspecified of mouth, Unspecified of Tongue are other common sites. Chapter: 21 Cancer Cases according to Digestive organ ( ) Table -49. Number of Digestive organ Cancer Cases in Male ( ) ICD 10 Cancer Site Total % C08 Other unspecified Salivary gland C 10 Oropharynx C15 Oesophagus C16 Stomach , C17 Small Intestine C18 Colon C19 Rectosegmoid junction C20 Rectum C21 Anus & Anal canal C22 Liver C23 Gallbladder C24 Other unspecified biliary tract C25 Pancreas C26 Ill defined digestive organ Total , Among the digestive organ related cancer sites, C36 Stomach was also the most common site in male cases and Esophagus, Rectum, Gall bladder, Colon, Liver, Pancreas are other common sites. Table Number of Digestive organ Cancer Cases in Female ( ) ICD 10 Cancer Site Total % C08 Other unspecified Salivary gland C 10 Oropharynx C15 Oesophagus C16 Stomach , C17 Small Intestine C18 Colon C19 Rectosegmoid junction C20 Rectum C21 Anus & Anal canal C22 Liver C23 Gallbladder , C24 Other unspecified biliary tract C25 Pancreas C26 Ill defined digestive organ Total , Among the digestive organ related cancer sites, C 23 Gallbladder was also the most common site in male cases and Stomach, Colon, Esophagus, Rectum, Gall bladder, Liver, Pancreas are other common sites

44 Chapter: 22 Districts wise distribution of Cancer ( ) Table Number of Cancer Cases by Districts in Male ( ) SN Districts Name Total %* 1 Achham NA 3 NA Arghakhachi NA 16 NA Baglung NA 22 NA Baitadi NA 2 NA Bajhang NA 2 NA Bajura NA 0 NA Banke NA 9 NA Bara NA 29 NA Bardia NA 12 NA Bhaktapur NA 52 NA Bhojpur NA 15 NA Chitwan NA 74 NA Dadeldura NA 2 NA Dailekha NA 6 NA Dang NA 29 NA Darchula NA 2 NA Dhading NA 29 NA Dhankuta NA 23 NA Dhanusha NA 46 NA Dolkha NA 19 NA Dolpa NA 0 NA Doti NA 1 NA Gorkha NA 40 NA Gulmi NA 25 NA Humla NA 1 NA Ilam NA 15 NA Jajarkot NA 2 NA Jhapa NA 86 NA Jumla NA 7 NA Kailali NA 23 NA Kalikot NA 5 NA Kanchanpur NA 9 NA Kapilbastu NA 18 NA Kaski NA 106 NA Kathmandu NA 220 NA , Kavre NA 66 NA Khotang NA 24 NA Lalitpur NA 82 NA Lamjung NA 22 NA Mahotari NA 21 NA Makwanpur NA 31 NA Manang NA 2 NA Morang NA 91 NA , Mugu NA 1 NA Mustang NA 3 NA Myagdi NA 13 NA Nawalparasi NA 35 NA Nuwakot NA 27 NA Okhaldhunga NA 19 NA Palpa NA 17 NA Panchthar NA 7 NA Parbat NA 29 NA Parsa NA 27 NA Pyuthan NA 10 NA Ramechap NA 12 NA Rasuwa NA 1 NA Rautahant NA 23 NA Rolpa NA 7 NA Rukum NA 0 NA Rupandehi NA 55 NA Salyan NA 3 NA Sankhuwasava NA 12 NA Saptari NA 39 NA Sarlahi NA 44NA Sindhuli NA 9 NA Sindupalchowk NA 28 NA Siraha NA 30 NA Solukhumbu NA 11 NA Sunsari NA 88 NA , Surkhet NA 7 NA Syangja NA 58 NA Tanahun NA 42 NA Taplejung NA 15 NA Tehrathum NA 6 NA Udayapur NA 17 NA Not Available NA 46 NA Total 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 22, *Percent is calculated based on available data

45 Kathmandu Figure : 23. Top ten Cancer by districts in Male ( ) Sunsari Morang Jhapa Chitwan Kaski Lalitpur Rupandehi Nawalparasi Among the male cases, most of the cases were from Kathmandu, Lalitpur, Kaski, Bhaktapur, Morang, Chitwan, Sunsari, Rupandehi, Nawalparasi, Kavre, Siraha, Jhapa, Syangja, Bara and Tanahu. The detail is presented in above table and 2005 yrs data was not available. Table Number of Cancer Cases by Districts in Female ( ) SN Districts Name Total %* 1 Achham NA 1 NA Arghakhachi NA 17 NA Baglung NA 35 NA Baitadi NA 1 NA Bajhang NA 0 NA Bajura NA 1 NA Banke NA 20 NA Bara NA 24 NA Bardia NA 18 NA Bhaktapur NA 36 NA Bhojpur NA 12 NA Chitwan NA 81 NA Dadeldhura NA 6 NA Dailekha NA 4 NA Dang NA 35 NA Darchula NA 1 NA Dhading NA 31 NA Dhankuta NA 25 NA Dhanusha NA 47 NA Dolkha NA 22 NA Dolpa NA 0 NA Doti NA 1 NA Gorkha NA 42 NA Gulmi NA 26 NA Kavre 25 Humla NA 2 NA Ilam NA 17 NA Jajarkot NA 1 NA Jhapa NA 81 NA Jumla NA 2 NA Kailali NA 21 NA Kalikot NA 2 NA Kanchanpur NA 17 NA Kapilbastu NA 25 NA Kaski NA 131 NA , Kathmandu NA 241 NA , Kavre NA 51 NA Khotang NA 16 NA Lalitpur NA 52 NA Lamjung NA 21 NA Mahotari NA 33 NA Makwanpur NA 29 NA Manang NA 3 NA Morang NA 117 NA , Mugu NA 0 NA Mustang NA 1 NA Myagdi NA 15 NA Nawalparasi NA 64NA Nuwakot NA 25 NA Okhaldhunga NA 10 NA Palpa NA 25 NA Panchthar NA 9 NA Parbat NA 24 NA Parsa NA 33 NA Pyuthan NA 15 NA Ramechap NA 18 NA Rasuwa NA 2 NA Rautahant NA 34 NA Rolpa NA 11 NA Rukum NA 7 NA Rupandehi NA 88 NA Salyan NA 7 NA Sankhuwasava NA 10 NA Saptari NA 36 NA Sarlahi NA 47 NA Sindhuli NA 24 NA Sindupalchowk NA 26 NA Siraha NA 32 NA Solukhumbu NA 9 NA

46 69 Sunsari NA 88 NA , Surkhet NA 8 NA Syangja NA 53 NA Tanahun NA 30 NA Taplejung NA 6 NA Tehrathum NA 11 NA Udayapur NA 14 NA Not Available NA 41 NA Total 1, ,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 29, *Percent is calculated based on available data Kathmandu Figure 24 : Top ten Cancer by districts in Female ( ). Top Ten Cancer by districts in Female ( ) 5.4 Sunsari 4.5 Morang Kaski Jhapa Chitwan Rupandehi Nawalparasi Bhaktapur Among the female cases, most of the cancers were from Kathmandu, Lalitpur, Kaski, Bhaktapur, Morang, Chitwan, Sunsari, Rupandehi, Nawalparasi, Kavre, Jhapa, Saptari, Syangja, Siraha and Sarlahi. The detail is presented in above table. In 2003 and 2005 data was not available. Trend of most common cancer ( ) I. Bronchus & Lung Cancer (ICD- 34) : A total no. of Bronchus & Lung Cancer was registered during the past 10 yrs. = 8,102(14.5%) out of 56,013 from Total Male cases = 4,975 (19.1%), Female cases = 3,127 (10.5%) Leading site of cancer 1 st in both sex and in Male but in Female 3 rd Male to female ratio 1.59 Gender Male 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 Female 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 Sex Ca.Lung (Male) % Ca.Lung (Female) % Kavre Both Sex % Bronchus & Lung Cancer cases in percentage Total cases of Bronchus & Lung Cancer Male Female Total Male Female II. Cancer of Cervix uteri (ICD- 53) : A total number of Cervix uteri cancer was registered during the past 10 yrs. = 6,250 (20.9%) out of 56,013 from Leading site of cancer 1 st in Female Ca.Cervix Total Female 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 % Gender Male 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 Female 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 Total 80 81

47 Cervix Cancer cases in percentage Breast Cancer cases in percentage Breast cancer Total cases of Cervix Cancer Total Cases of Breast Cancer Cervix Cancer III. Breast Cancer (ICD- 50) : A total number of Breastcancer were registered in female during the past 10 yrs. = 4,625 (15.5%) out of 56,013 from Leading site of cancer 2 nd in Female Ca.Breast Total Female 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 % Gender Male 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 Female 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7, Breast Cancer iv. Stomach Cancer (ICD- 34) : A total no of StomachCancer were registered during the past 10 yrs. = 3,241 Total Male = 2,042 (7.8%), Female = 1,199 (4.0%) Leading site of cancer 3 rd in both sex, 2 nd Male but in Female 6 th. Male to female ratio 1.70 Gender Male 1,488 2,030 2,057 2,325 2,758 2,702 2,970 3,192 3,295 3,291 Female 1,763 2,171 2,340 2,583 3,277 3,247 3,229 3,581 3,793 3,921 Total 3,251 4,201 4,397 4,908 6,035 5,949 6,199 6,773 7,088 7,212 Sex Ca.Stomach (Male) %

48 Ca. Stomach (Female) % Both Sex % vi. Ovary Cancer (ICD- 56) : A total number of ovarian cancers were registered in female during the past 10 yrs. = 1,815 (6.1% in total 56,013 cases in 10 yrs ) Leading site of cancer 4 th in Female Stomach Cancer cases in percentage Male Female Both v. Gall bladder Cancer (ICD- 23) : A total no of Gall bladder Cancer were registered during the past 10 yrs. = 1,848 (3.3%) out of 56,013 cases from Total Male = 589(2.3%), Female = 1,259 (4.20%). Leading site of cancer 5 th in both sex and 10 th in Male but in Female 5 th. Male to female ratio Male Female 84 85

49 Cancer Registry Program Activities Review workshop on Hopital Based Cancer Registry and Planning on Population Based Cancer Registry at Kathmandu Meeting with Dean of Manipal Teaching Hospital Cancer Registry Interaction Program at Pokhara National Cancer Registry Workshop at Kathmandu Data Collection in Manipal Teaching Hospital Data collection in Gandaki Medical College, Pokhara 86

50 B.P. KOIRALA MEMORIAL CANCER HOSPITAL al=kl=sf]o/fnf d]df]l/on SofG;/ c:ktfn 2049BS/1992AD BPKMCH,NEPAL B. P. Koirala Memorial Cancer Hospital Cancer Prevention, Control & Research Department Bharatpur, Chitwan, Nepal Quality Press, Bharaptur, Chitwan,