|Year : 2015 | Volume
| Issue : 2 | Page : 57-62
Cancer pattern in a hospital-based registry
MO Samaila1, EI Ayeni2, SA Ahmed3
1 Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria; Department of Zaria Cancer Registry, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
2 Department of Zaria Cancer Registry, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
3 Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
|Date of Web Publication||16-Jun-2015|
Dr. M O Samaila
Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria
Source of Support: None, Conflict of Interest: None
Background: The Zaria Cancer Registry (ZCR) documents cancer cases within Zaria and environ with the objective of monitoring, planning, and screening of population at risk of developing cancer. The objective of this paper is to review the pattern and distribution of cancers as documented in the ZCR.
Materials and Methods: A 5-year analysis of cancer cases recorded from January 2009 to December 2013 was made. Data sourced were grouped into those primarily from the hospital (A) and referrals from hospitals within (B) and outside (C) Kaduna state. Data compilation was done using CANREG4 software and the International Classification of Diseases (ICD)-0 classification and coding system.
Results: A total of 2,536 new cancers were recorded with 1,014 males and 1,522 females. Cancer diagnosis from the histology of primary disease cases accounted for 86.3%, while cytology diagnosis cases comprised 10.6%. Over 90% of the diagnosis was based on symptomatic presentation by patients, while 81.6% were well-differentiated cancers. The peak age distribution was in 4 th -6 th decades of life in 58.9% cases, while 138 cancers were recorded in children aged 10 years and below. A total of 68 (2.7%) cases were also recorded in adolescents. Morphologically, squamous cell carcinoma (SCC), adenocarcinoma (not otherwise specified (NOS)), and infiltrating duct carcinoma were the commonest. About 60% of patients received two or more treatment modalities.
Conclusion: The cancer distribution pattern from this registry is reflective of the cancer distribution in the larger population. Breast cancer was most common in females and ranked first overall, while prostate cancer was the commonest in males. This information is useful in planning for effective cancer screening, prevention, and management.
Keywords: Breast, breast cancer, cancer, cancer registry, cancer screening, cervical cancer, cervix, prostate, prostate cancer, Zaria
|How to cite this article:|
Samaila M O, Ayeni E I, Ahmed S A. Cancer pattern in a hospital-based registry. Arch Int Surg 2015;5:57-62
| Introduction|| |
The Zaria Cancer Registry (ZCR) is located in the department of Pathology and Morbid Anatomy of the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. The hospital serves the northwest region of Nigeria and is also a center of excellence for oncology; thus, cancer patients come to Zaria from all over the country to access oncology and other specialized care. 
The registry was the first functional one in the northern part of the country in the early 1970s and was established by Prof GM Edington,  the then head of Pathology Department. It was designed from inception to be population-based with data sourcing from neighbouring states for proper monitoring, planning, and screening of population at risk of developing cancers, as well as a veritable source of research pool for understanding cancer evolution, mortality rates, and prevention modalities. However, the establishment of federal medical centers, specialized, and other tertiary hospitals in the northwestern zone of the country and to a large extent, the perennial problems of understaffing and transportation to these states negated this objective. The registry became computerized in 2006 and data computation using CANREG4  software commenced in 2009. The objective of this paper is to review the pattern and distribution of cancers as documented in the ZCR.
| Materials and Methods|| |
This is a 5-year analysis of cancer cases recorded in the ZCR from January 2009 to December 2013. The cases were either primarily diagnosed in the Department of Pathology, ABUTH or secondarily from cases referred to the hospital clinics and oncology unit. The secondary cases from outside the hospital come in with tissue blocks or histology slides so that pathologists in the department can make relevant diagnosis before commencement of surgery or treatment in the oncology unit of the hospital. The ABUTH (Hospital A) cases were sourced from relevant departments (Surgery, Obstetrics and Gynecology, Hematology, Pediatrics, Ophthalmology, Maxillofacial, and Oncology), wards, and clinics in the hospital. Cases referred from outside the hospital facility were grouped into those from within Kaduna state (Hospital B) and those from neighbouring states (Hospital C). Information on age, sex, site, and morphological diagnosis were put into departmental registers and colour (yellow)-coded with case identification cards. These data was also entered into computer using the CANREG4  software package by a trained cancer registrar using the International Classification of Diseases (ICD)-0 classification and coding system. Conflicting coding, standard tumor nomenclature and validity checks were done by the principal investigator, who is also a trained cancer registrar. The data is presented in frequency distribution tables and diagrams.
| Results|| |
A total of 2,536 new cancer cases were recorded over the 5-year period in the ZCR. Of these, 2,239 (88.3%) were from ABUTH (Hospital A), 258 (10.2%) from Hospital B, and 39 (1.5%) from Hospital C. There were 1,014 males and 1,522 females. The yearly cancer distribution is presented in [Table 1]. Cancer diagnosis from the histology of primary disease cases accounted for 2,189 (86.3%), while cytology diagnosis cases were 270 (10.6%). Histology of metastatic disease accounted for 74 (2.9%) [Table 2]. Over 90% of the diagnosis was based on symptomatic presentation by patients. Two females with cervical cancer and a male with prostate cancer were detected at screening. Tumor differentiation is presented in [Table 3].
Topographic distribution by age and sex for all the cancers using the ICD-0 coding system is presented in [Table 4] and [Figure 1]. The peak age distribution was in the 4 th -6 th decades of life and accounted for 1,494 cases (58.9%), while 138 cancers (5.4%) were recorded in children aged 10years and below. A total of 68 (2.7%) cases were also recorded in adolescents with 29 (1.1%) cases in age group 11-14years and 39 (1.5%) cases in 15-18years. The top cancers involved the breast (20.4%), cervix (16.8%), prostate (8.3%), skin (7.1%), gastrointestinal tract (GIT;6.5%), head and neck (6.0%), soft tissue (5.3%), and lymph nodes (4.4%) [Table 5].
|Figure 1: Topography and sex distribution of cancers. GIT = Gastrointestinal tract, CNS = Central nervous system, NOS = Not otherwise specified|
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Morphologically, squamous cell carcinoma (SCC) and its variants was the commonest with 639 (25.2 %) cases and involved the cervix uteri and skin predominantly. Large cell non keratinizing SCC of the cervix uteri was most frequent with 274 cases and was closely followed by SCC, not otherwise specified (NOS) with 269 cases involving the skin, cervix, GIT, and other sites. Adenocarcinoma involving the prostate, breast, ovary, endometrium, and gastrointestinal tract amongst other sites accounted for 491 (19.4%) cases and variants included mucinous, clear, papillary, intestinal, villous, follicular, and endometrial. Of these, adenocarcinoma, NOS accounted for 353 (71.9%) with 209 cases in the prostate gland. The predominant morphologic breast cancer was invasive duct carcinoma with 339 cases. Other variants included lobular carcinoma (nine), medullary carcinoma (four), malignant phylloides (three), stromal sarcoma (two), and lymphoma (three).
Other GIT cancers included gastrointestinal stromal tumor (GIST), carcinoid, leiomyosarcoma, and lymphoma. Overall, there were 98 (3.9%) lymphoma cases and Hodgkin disease alone accounted for 17 cases. Of the non-Hodgkin lymphoma, diffuse large B-cell (15), malignant lymphoma NOS (13), and Burkitt lymphoma (18) were the commonest. Others included follicular and lymphoblastic lymphoma. Other specific cancer types were Kaposi's sarcoma (64) and variants of rhabdomyosarcoma and liposarcoma [Table 6]. Of the 138 cancers recorded in children below10 years, retinoblastoma accounted for 46.4%. Other recorded childhood tumors include nephroblastoma (11), embryonal rhabdomyosarcoma (18), teratoma (five), Burkitt lymphoma (12), neuroblastoma (five), and medulloblastoma (two). Overall, 60% (1524) of cases received two or more treatment, while 23% (584) and 14.6% (371) had surgery and chemotherapy, respectively.
| Discussion|| |
Cancer is a global public health problem and an estimated 15 million people live with cancer, while 12% of these die annually from cancer-related causes. Developing countries in Africa contribute a substantial percentage to this global burden. Thus, it is imperative to document the distribution pattern of cancer in our environment and identify population at risk. This will aid the development of screening, treatment, and prevention strategies. The International Agency for Research on Cancer (IARC) reported an estimated burden of 14.1 million new cases in 2012 compared to the 12.7 million new cases in 2008, while 8.1 million cancer-related death was recorded in 2012, an increase from the 7.6 million deaths recorded in 2008.  Over 75% of these fatalities were in developing nations due to the poor health indices in these settings. , The decreasing annual frequency distribution recorded over the 5years in the present study may be attributable to reduced patient hospital attendant with migration of people following the 2011 post national election and sectarian crises as well as the escalating security challenges in Zaria and the northern part of Nigeria in general in the last 3 years.
Sixty percent of the cancers recorded were in females, similar to the current global female cancer preponderance and to reports from the Ibadan Cancer Registry, a population-based registry and an analysis of hospital-based cancer registries in Nigeria. ,, This female preponderance is attributable to the high percentage for breast cancer in the overall cancer distribution in this study. The histology of primary disease cases accounted for 86.3%, thus validating the reliability of the cancer data. Primary disease incidence is calculated based on the population at risk and is applicable in population-based registries; however, the frequency rates of the cases in this hospital-based registry are useful indices for projections on the incidence of these cancers in our environment. Globally, breast cancer is a public health problem and is the second most common cancer in both sexes in developed countries.  It remained the top female cancer in Zaria and was also the commonest cancer overall with 20.4% cases. This conforms to findings from other cancer reports. , The peak age of occurrence was in the 4 th and 5 th decades though, increasingly younger aged females presented with breast cancer as seen in 11.2% of women in their 20s and 1% of teenagers in this report. Reported peak incidence in other studies was the 4 th decade of life. ,,
Cervical cancer was the second commonest overall with 16.8% cases. It also accounted for 28% of female cancers. Its incidence remains a challenge in developing countries, though there is increased public awareness and acceptance of cervical screening of population at risk. , The incidence of this preventable cancer has reduced drastically in developed nations of the world, though it was the most common female cancer reported in Kano, northwest Nigeria with a rate of 22.9%.  In the present analysis, the peak age distribution was in the 5 th decade of life and high rates were also recorded in the 4 th and 6 th decades. A small percentage (3%) was seen in females in their 20s, similar to findings in Enugu, southeastern Nigeria.  The large cell nonkeratinizing SCC was the most frequent morphologic variant, though this confers no added prognostic advantage compared to other variants.
Prostatic adenocarcinoma was the third most common cancer overall and leading male cancer in this series. It accounted for 20.7% of male cancers and peak age was in the 7 th and 8 th decades of life, though about 6% was seen in men in the late 40s. Ogunbiyi and Shittu also described younger age affectation, while Mohammed et al., Okolo et al., and Oluwole et al., reported prostate cancer prevalence in Nigerian males. ,,, Skin cancer comprising of melanoma and nonmelanoma cancers constituted 7.1% overall. SCC constituted the bulk of nonmelanoma cancers, with only 12 cases of basal cell carcinoma. Acral melanoma remains the prototype in our setting and the small percentage of malignant appendage tumors comprising eccrine sweat gland and sebaceous differentiation only was not surprising as these are uncommon cancers. ,
Lymphoma cases are uncommon in our setting. The commonest non-Hodgkin lymphoma in our series was Burkitt lymphoma, which affected children below 10years predominantly. While diffuse large B-cell lymphoma and malignant lymphoma NOS were the predominant adult diseases.
| Conclusion|| |
The cancer distribution pattern from this hospital-based cancer registry is useful and reflective of the cancer distribution in the larger population. Breast cancer was the most common in females and ranked first overall, while prostate cancer was the commonest in males. The information gathered can be used in planning for effective cancer screening, treatment, prevention, and management.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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