Home | About us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Instructions | Online submissionContact Us   |  Subscribe   |  Advertise   |  Login  Page layout
Wide layoutNarrow layoutFull screen layout
Lung India Official publication of Indian Chest Society  
  Users Online: 655   Home Print this page  Email this page Small font size Default font size Increase font size


 
ORIGINAL ARTICLE
Year : 2009  |  Volume : 26  |  Issue : 3  |  Page : 74-76 Table of Contents   

Clinico-pathological profile of lung cancer in Uttarakhand


1 Department of Pulmonary Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
2 Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
3 Department of Oncology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India

Date of Web Publication6-Jul-2009

Correspondence Address:
Jagdish Rawat
Department of Pulmonary Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-2113.53229

Rights and Permissions
   Abstract 

Background: Lung cancer is one of the most aggressive and prevalent type of malignancy causing high morbidity and mortality. Tobacco smoking continues to be the leading cause of lung cancer worldwide. An increasing incidence of lung cancer has been observed in India. Objective: The aim of this study was to evaluate the clinico, a pathological profile of the lung cancer in hilly state of Uttrakhand. Materials and Methods: We performed a retrospective analysis of histopathologically proven cases of bronchogenic carcinoma admitted in our hospital from January 1998 to August 2005. Results: Our study included 203 patients with confirmed cases of lung cancer. Male to female ratio was 8.2:1. The common age group being 40-60 years, 9.86% of the patients were less than 40 years old age. Smoking was found to be the main risk factor in 81.77% patients. The most frequent symptom was cough (72.90%) followed by fever (58.12%). The most common radiological presentation was mess lesion (46.31%). The most common histopathological type was squamous cell carcinoma (SCC) (44.83%) followed by adenocarcinoma (19.78%) and small cell lung carcinoma (SCLC) (16.75%). The majority patients (73.29%) were diagnosed in the later stages of the disease (III B and IV). Conclusion: It was found out that SCC was the most frequent histopathological form. SCLC predominates below 40 year and SCC over 60 years of age. Smoking still remains the major risk factors in pathogenesis of lung cancer.

Keywords: Lung cancer, histopathology type, smoking, squamous cell carcinoma


How to cite this article:
Rawat J, Sindhwani G, Gaur D, Dua R, Saini S. Clinico-pathological profile of lung cancer in Uttarakhand. Lung India 2009;26:74-6

How to cite this URL:
Rawat J, Sindhwani G, Gaur D, Dua R, Saini S. Clinico-pathological profile of lung cancer in Uttarakhand. Lung India [serial online] 2009 [cited 2019 Dec 8];26:74-6. Available from: http://www.lungindia.com/text.asp?2009/26/3/74/53229


   Introduction Top


Lung cancer is believed to be the most common fatal neoplastic disease in the world today. It is responsible for 28% of all the cancer related deaths. [1] In the developed countries, incidence and mortality from lung cancer in females is rising, whereas it is declining in males. Lung cancer is responsible for approximately one million deaths per year at present, and it is estimated to rise to three million per year by the year 2010.

Progressive survival extension and increasing cigarette smoking has led to a numerical rise of patients with primary lung cancer in India. It is in accordance with the epidemiological data from western countries, which shows rising prevalence of the disease in Indian population. [2] Smoking is the cause for more than 85% of the bronchogenic carcinoma cases. [3],[4] According to the world health organization (WHO) classification formulated in 1999; there are six major types of malignant epithelial non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). [5] The proportions of histopathological cell types of lung cancer vary with changes in social and other environmental factor.

We undertook this retrospective review of patients diagnosed with lung cancer at Himalayan Institute of Medical Sciences (HIMS), the only postgraduate institute and a large tertiary acre center of the region, to understand the clinico in this hilly state.


   Materials and Methods Top


This retrospective study was performed using a database with 203 patients of lung cancer who had been diagnosed at our hospital, during January-August 2005.

The clinical records of the patients were received for demographic data, smoking history, duration of symptoms, symptoms and signs, radiographic findings, histopathology, and clinical staging of lung cancer. Only patients with a confirmed pathological cell type and adequate medical records were included for the analysis. For confirmation of diagnosis of lung cancer, majority of patients were subjected to fiber-optic bronchoscopy and/or percutaneous fine needle aspiration biopsy (FNAB) under imaging guidance.

The Ethical committee of the Institute has approved the study.


   Results Top


The series included 181 male (89.16%) and 22 female (10.84%) patients. Age distribution of these patients is shown in [Table 1]. In less than 40 years of age, SCLC was the commonest type, while SCC was common (71.69%) after 60 years of age. The break up of both sexes according to their smoking history is shown in [Table 1]. Cough was the most common symptom found in (72.90%) patients, followed by fever (58.12%), chest pain (55.64%), and dyspnea (50.74%) [Table 2].

Mass lesion (46.13%) was the commonest radiological feature followed by collapse-consolidation (40.89) [Table 2]. The various diagnosis modalities, either single or in combination, used for confirmation of lung cancer are shown in [Table 3]. Central endobronchial tumors were seen in 99 (48.77%) patients, whereas peripheral tumors in 104 (51.23%). The adenocarcinoma most commonly manifested as peripheral mass (75%).

The most common histopathological type was SCC (44.83%), followed by adenocarcinoma (19.70%), and SLCC (16.75%) [Table 3]. The majority of patients (73.29%) were diagnosed in the later stages of the disease. The patients presented to their physician, on an average, 112 days (range 30-270), after the onset of symptoms.


   Discussion Top


Most of our study belonged to the patients of age group between 40-60 years, with a male predominance (M:F ratio 8.2:1). Smoking was the most common predisposing factor, which included cigarettes, beedis, hookah, etc. Similar observation has been reported by other Indian studies also. [6],[7],[8],[9],[10] In contrast to our study, Belcher JR [11] found that in USA and UK, the male: female ratio was approximately 5:1 in 1970 but fell to around 2.5:1 in 1982. This is because of the striking increase in cigarette smoking in western women.

The prevalence of respiratory system malignancies is quite variable in different parts of India. In most studies, including reports of National Cancer Registry Program (NCRP) [12],[13] from Bhopal, Delhi, and Mumbai; and other studies; [12],[14] laryngeal cancer was the most common site. The present study was in agreement with those where lung was the topmost site for malignancy in males.

One important observation made in our study is the delay in presentation of patients to their attending physician. Majority of the cases were misdiagnosed as tuberculosis and treated at various other centers, there by causing a delay in diagnosis.

In our study, the delay in seeking treatment was observed to vary from 4-6 months, which is similar to another study. [15] The diagnosis of cancer in an individual not only affects the person physically but produces significant psychological disturbance too. A study from Tata Memorial Hospital, Mumbai, [16] analyzing the psychological state of patients suffering from cancer, concluded that 89% of the patients used denial as a mental defense mechanism, leading to delay in seeking medical help for the confirmation and treatment of cancer. Psychological reasons such as, denial of illness, fear of cancer, fear of its treatment, and domestic difficulties were the most common causes of delay in seeking treatment. This emphasizes the need for patient counseling as well as more effective methods for early detection of lung cancer cases by general practitioner.

Our data shows that unexplained cough of several weeks is the commonest symptoms along with fever, weight loss, chest pain, and shortness of breath. This is similar to reports published in the literature from different part of India. [10],[17],[18]

The pattern of lung cancer has been changing in the West. Lung cancer is being increasingly diagnosed in women and adenocarcinoma has over taken SCC as the most common histological cell type. [19] However, the pattern seen at our hospital was different. SCC was still the commonest cell type seen, followed by adenocarcinoma and SLCC. This is similar to reports from other part of India. [6],[7],[8],[9],[17],[18] This difference in histopathology may be due to the fact that smoking is less prevalent among women in India as opposed to the West, where it is rising; and urbanization, that exposes the patient to other carcinogens, risk factors or a complex interaction among gender, race, smoking status in West.

Bronchoscopy is the most useful investigation in the evaluation of the patient suspected of endobronchial lung cancer. Tumors that were beyond bronchoscopic vision, are difficult to reach and require the other technique. [20] FNAB done under CT is the investigation of choice for peripherally situated lesions, which has very high complication rates as seen in various international, [21],[22],[23] and Indian studies. [24],[25] In our study, the overall yield with bronchoscopy was 48.77% and with FNAB was 43.84%.

The commonest radiological finding seen in present study was mass followed by collapse consolidation with slight predominance of right lung; similar to reports published in the literature. [10],[26] The adenocarcinoma commonly manifested as peripheral mass or a malignant pleural effusion. Similar finding were also reported in other studies. [27],[28] The SCLC presented commonly as central lesion, which was in agreement with other studies. [19],[27],[29]


   Conclusion Top


This study has shown smoking as the principle risk factor in the causation of lung cancer among men. Primary lung cancer should always be suspected in a person presenting with unexplained cough of several weeks with other symptoms such as weight loss and fever with nonresolving collapse-consolidation on chest radiograph; and further investigations should be carried out to rule lung cancer. Majority of the cases were misdiagnosed as tuberculosis and treated by antitubercular treatment, thereby causing delay in diagnosis, this emphasized the need for more effective methods for early detection of lung cancer cases among general population.

 
   References Top

1.Beckett WS. Epidemiology and etiology of lung cancer. Clin Chest Med 1993;14:1-15.  Back to cited text no. 1  [PUBMED]  
2.Ginsberg RJ, Vokes EE, Raben A. Cancer of the lung. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer: Principles and practices of oncology. Philadelphia, PA: Lippincott-Raven; 1999. p. 849-950.  Back to cited text no. 2    
3.Carr DT, Holoye PY, Hong WK. Bronchogenic carcinoma. In: Murray JF, Nadal JA, editors. Textbook of respiratory medicine.2 nd ed. Philadelphia: WB Saunders Company; 1994. p. 1528-96.  Back to cited text no. 3    
4.Rosenow EC. Symposium on intrathoracic neoplasm, Introduction. Mayo Clin Proc 1993;68:168-9.  Back to cited text no. 4    
5.Franklin WA. Diagnosis of lung cancer. Chest 2000;117:80-9 (Travis WD, Colby TV, Corrin B. Histological typing of tumors of lung and pleura. In: Sobin LH, editor. World Health Organization. Classification of tumors.3 rd ed. Berlin: Springer-Verlag 1999.  Back to cited text no. 5    
6.Jindal SK, Malik SK, Malik AK, Singh K, Gujral JS, Sodhi JS. Bronchogenic carcinoma: A review of 150 cases. Indian J Chest Dis Allied Sci 1979;21:59-64.  Back to cited text no. 6  [PUBMED]  
7.Notani P, Sanghvi LD. A retrospective study of lung cancer in Bombay. Br J Cancer 1974;29:477-82.  Back to cited text no. 7  [PUBMED]  
8.Jindal SK, Malik SK, Datta BN. Lung cancer in Northern India in relation to age, sex and smoking habits. Eur J Respir Dis 1987;70:23-8.  Back to cited text no. 8  [PUBMED]  
9.Jindal SK, Malik SK, Dhand R, Gujral JS, Malik AK, Datta BN. Bronchogenic carcinoma in Northern India. Thorax 1982;37:343-47.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Behera D, Balamugesh T. Lung cancer in India. Indian J Chest Dis Allied Sci 2004;46:269-81.  Back to cited text no. 10    
11.Belcher JR. The changing pattern of bronchial carcinoma. Br J Dis Chest 1987;81:87-90.  Back to cited text no. 11  [PUBMED]  
12.Annual report on National Cancer Registry. ICMR document, New Delhi: 1982.  Back to cited text no. 12    
13.National Cancer registry Program 1981-2001: An overview ICMR doc 2002. Available from: http://www.icmr.nic.in/ncrp/cancer_regoverview.htm. [cited on 2004 Feb 24].  Back to cited text no. 13    
14.Malhotra V, Shah BS, Sabharwal S. Pattern of cancer in Dayanand Medical College and Hospital, Ludhiana. Indian J Pathol Microbiol 2001;44:27-30.  Back to cited text no. 14    
15.Guleria JS, Gopinath N, Talwar JR, Bhargave S, Pande JN, Gupta RG. Bronchial carcinoma: An analysis of 120 cases. J Assoc Physicians India 1971;19:251-5.  Back to cited text no. 15  [PUBMED]  
16.Chakravorty SG, Chakravorty SS, Patel RR, DeSouza CJ, Doongarji DR. Delay in specialist consultation in cancer patients. Indian J Cancer 1993;30:61-6.  Back to cited text no. 16  [PUBMED]  
17.Jindal SK, Behera D. Clinical spectrum of primary lung cancer: Review of Chandigarh experience of 10 years. Lung India 1990;8:94-8.  Back to cited text no. 17    
18.Wig KL, Lazaro EJ, Gadekar NG, Guleria JS. Bronchogenic carcinoma: Clinical features and diagnosis. Indian J Chest Dis 1961;3:209-18.  Back to cited text no. 18    
19.Quinn Daniel, Gianlupi A, Broste S. The changing radiographic presentation of bronchogenic carcinoma with reference to cell type. Chest 1996;110:1474-9.  Back to cited text no. 19    
20.Arroliga AG, Matthay RA. The role of bronchoscopy in lung cancer. Clin Chest Med 1993;13:235-52.  Back to cited text no. 20    
21.Kaneko M, Eughci K, Ohmatsu H, Kakinuma R, Naruke T, Suemasu K, et al . Peripheral lung cancer: Screening and detection with low dose spiral CT versus radiograph. Radiology 1996;201:789-802.  Back to cited text no. 21    
22.Larscheid RC, Thrope PE, Scott WJ. Percutaneous transthoracic needle aspiration biopsy: A comprehensive review of its current role in diagnosis and treatment of lung tumors. Chest 1998;114:704-9.  Back to cited text no. 22    
23.Sandrucci F, Vismara L, Molinari S, Regimentri P, Rebeck L. Percutaneous needle biopsy guided with CT of chest: Personal experience of 1605 cases. Radiol Med 1998;96:675-83.  Back to cited text no. 23    
24.Dash BK, Tripathy SK. Comparison of accuracy and safety of CT guided and unguided transthoracic FNAB in diagnosis of lung lesions. JAPI 2001;49:629-9.  Back to cited text no. 24    
25.Sharma SK, Verma K, Pande JN, Guleria JS. FNAB for diagnosis of intrathoracic lesions. Indian J Chest Dis Allied Sci 1982;24:41.  Back to cited text no. 25    
26.Fraser RG, Pare JP, Pare PD, et al . Neoplastic disease of the lung. In: Fraser RG, editor. Diagnosis of diseases of the chest. 3 rd ed. Philadelphia: WB Saunders; 1989. p. 1327-475.  Back to cited text no. 26    
27.Brud RB, Carr DT, Miller WE, Payne WS, Woolner LB. Radiographic abnormalities in carcinoma of the lungs as related to histological cell type. Thorax 1969;24:573-5.  Back to cited text no. 27    
28.Swett HA, Nagel JS, Sostman HS. Imaging methods in primary lung carcinoma. Clin Chest Med 1982;3:337-41.  Back to cited text no. 28    
29.Kapoor R, Goswamy KC, Kapoor B, Dubey VK. Pattern of cancer in Jammu region (Hospital based study 1978-87). Indian J Cancer 1993;30:67-71.  Back to cited text no. 29  [PUBMED]  



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


This article has been cited by
1 Clinico-pathological profile of bronchogenic carcinoma cases presented to Chest Department, Cairo University in the last 10 years
Yosri M. Akl,Raef H. Emam,Irene M. Sabry,Abdullah A. Ali
Egyptian Journal of Chest Diseases and Tuberculosis. 2013;
[Pubmed] | [DOI]
2 Lung cancer in malabar cancer center in kerala - A descriptive analysis
Bhaskarapillai, B. and Kumar, S.S. and Balasubramanian, S.
Asian Pacific Journal of Cancer Prevention. 2012; 13(9): 4639-4643
[Pubmed]
3 Cancer patterns in Nainital and adjoining districts of Uttarakhand: A one year survey
Bag, A. and Rawat, S. and Pant, N.K. and Jyala, N.S. and Singh, A. and Pandey, K.C.
Journal of Natural Science, Biology and Medicine. 2012; 3(2): 186-188
[Pubmed]
4 Comments: Other considerations about surgery in lung cancer
Ghanei, M. and Saburi, A. and Akhavan-Moghadam, J.
Lung India. 2012; 29(3): 303
[Pubmed]
5 Comparison study of clinicoradiological profile of primary lung cancer cases: An Eastern India experience
Dey, A. and Biswas, D. and Saha, S.K. and Kundu, S. and Kundu, S. and Sengupta, A.
Indian Journal of Cancer. 2012; 49(1): 89-95
[Pubmed]
6 Analysis of a routine database to identify risk factors of the host and the environment associated with respiratory diseases [Análisis de una base de datos rutinaria para identificar factores de riesgo del huésped y el medio ambiente asociados con las enfermedades respiratorias]
Figueroa, C.G.S. and Plata, R.F. and Briseño, D.M. and de la Garza, S.R. and Pizano, A.M. and Marina, F.F. and Pérez-Padilla, J.R.
Revista del Instituto Nacional de Enfermedades Respiratorias. 2012; 71(1): 11-20
[Pubmed]
7 Lung Cancer in Malabar Cancer Center in Kerala - A Descriptive Analysis
Binukumar Bhaskarapillai,Saina Sunil Kumar,Satheesan Balasubramanian
Asian Pacific Journal of Cancer Prevention. 2012; 13(9): 4639
[Pubmed] | [DOI]



 

Top
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed3771    
    Printed124    
    Emailed1    
    PDF Downloaded632    
    Comments [Add]    
    Cited by others 7    

Recommend this journal