Department Of Journalism & Mass Communication

Gandhi Memorial College Jammu.

Study of Cancer in Jammu Division

Research Proposal

By

Aakash Gulzar
 Abstract

Cancer pattern varies in different regions and depends on race, lifestyle and diet. There is a lack
of definitive information regarding hospital-based cancer profile in Jammu .To generate data on
the magnitude and pattern of cancer cases reporting in the medical college hospital and to plan
activities for prevention of cancer in the field practice area.A five year record-based
retrospective analysis of cancer cases who reported either for diagnosis or for treatment
(radiotherapy/chemotherapy/surgery) were included in the study. These confirmed cases of
cancer were classified according to the International classification of Disease (ICD-10) given by
WHO. Out of a total of 1328 cancer cases, females accounted for 809 (60.9%) and males for 519
(39.1%) cases. Male to female ratio was 1:1.55. The maximum number of patients were seen in
35-64 yr age group (63.5%). Top five leading sites of cancer in males were lung (9.6%),
myeloid leukemia (8.3%), prostate (6.8%), mouth (6.1%) and gall bladder (6.0%); and in
females were breast (35.7%), cervix (19.1%), esophagus (5.1%), myeloid leukemia (4.7%) and
gall bladder (3.9%). Population-based epidemiological studies are required to find out the
disease burden & its cause in this region
 Keywords: ​Cancer, ​Gynecologic Cancers , Jammu , risk factor.
Introduction

Cancer is one of the most dreadful diseases and leading cause of death in world . Cancer is a
condition in which a group of cells grow abnormally forming a tumor and invade to other parts
of the body. Cancerous cells have the ability to bypass the checkpoints in cell cycle .A number
of factors are responsible for the development of cancer which causes the mutation of
proto-oncogenes or tumor suppressor genes that allow a cancerous cell to row and divide
uncontrollably . Some major risk factors of cancers include tobacco consumption, obesity, viral
infections, radiation, stress, lack of physical activity, environmental pollutants and genetic
factors.
A lot of research is going on all over the world to develop the treatment strategies for cancer. A
number of chemotherapeutic agents are available in the market such as Tamoxifen, Angiostatin,
colchicine, etc., which specifically target one or the other pathogenetic pathway of cancer .
Radiotherapy is another treatment option in which specific cancer cells are killed . However,
there is a big problem with cancer that it remains undetected until its last stage of metastasis
which makes it quite difficult to target particular cancer cells that have spread to other body
parts J&K is the northern-most state of India. Over the last decade, an increasing trend has been
observed in the incidence of cancer in J&K . the major sites of cancer in males are lungs,
prostate, colorectal, stomach, esophageal and gastroesophageal tract, while in females major
sites include breast, stomach, lungs, esophageal, colorectal, cervical and ovarian cancers .There
are two main types of cancer screening; Hospital-based cancer registry and Population-based
cancer registry. Hospital based cancer registries are meant for recording the information of
cancer patients seen in a particular hospital. The main aim of such registries is to contribute to
patient care by providing readily available information, maintain case history, treatment
procedure and results thereof of the cancer patients. Clinical decision support system (CDSS) is
one of the newly developed aspects of hospital registry using information technology. A
database of cancer patients containing their overall information is stored in the computers in
addition to the handwritten registries, which makes it readily available and accessible for the
clinicians .Population-based cancer registry is another method of screening cancer patients in a
population of particular region. However, it has certain limitations such as the higher
expenditure in surveying and screening different communities for cancer and non-cooperation of
local population in such studies. In the present study, we have made an effort to evaluate the
total number of cancer patients in four prospective hospitals of J&K and categorized them on the
basis of sex, district, age and cancer groups.
 Literature Review

Cancer​ is a group of diseases involving abnormal ​cell growth​ with the potential to invade or
spread to other parts of the body. These contrast with ​benign tumors​, which do not spread to
other parts of the body. Possible ​signs and symptoms​ include a lump, abnormal bleeding,
prolonged cough, unexplained ​weight loss​ and a change in ​bowel movements​. While these
symptoms may indicate cancer, they may have other causes. Over 100 types of cancers affect
humans. ​Cancers are a large family of diseases that involve abnormal​ ​cell growth​ with the
potential to invade or spread to other parts of the body. They form a subset of ​neoplasms​.​ A
neoplasm or tumor is a group of cells that have undergone unregulated growth and will often
form a mass or lump, but may be distributed diffusely.
All tumor cells show the ​six hallmarks of cancer​. These characteristics are required to produce a
malignant tumor. They include:
● Cell growth and division​ absent the proper signals
● Continuous growth and division even given contrary signals

● Avoidance of ​programmed cell death

● Limitless number of cell divisions

● Promoting ​blood vessel construction

● Invasion​ of tissue and formation of ​metastases

The progression from normal cells to cells that can form a detectable mass to outright cancer
involves multiple steps known as malignant progression​.
When cancer begins, it produces no symptoms. Signs and symptoms appear as the mass grows
or ulcerates. The findings that result depend on the cancer's type and location. Few symptoms
are specific. Many frequently occur in individuals who have other conditions. Cancer is a "great
imitator". Thus, it is common for people diagnosed with cancer to have been treated for other
diseases, which were hypothesized to be causing their symptoms.
People may become anxious or depressed post-diagnosis. The risk of suicide in people with
cancer is approximately double.
​Causes
The majority of cancers, some 90–95% of cases, are due to genetic mutations
from ​environmental factors​. The remaining 5–10% are due to ​inherited genetics​. ​Environmental,​
as used by cancer researchers, means any cause that is not ​inherited genetically​, such as lifestyle,
economic and behavioral factors and not merely pollution. Common environmental factors that
contribute to cancer death include tobacco (25–30%), diet and ​obesity​ (30–35%), infections
(15–20%), ​radiation​ (both ionizing and non-ionizing, up to 10%), stress, lack of ​physical
activity​ and pollution.
It is not generally possible to prove what caused a particular cancer because the various causes
do not have specific fingerprints. For example, if a person who uses tobacco heavily develops
lung cancer, then it was probably caused by the tobacco use, but since everyone has a small
chance of developing lung cancer as a result of air pollution or radiation, the cancer may have
developed for one of those reasons. Excepting the rare transmissions that occur with pregnancies
and occasional ​organ donors​, cancer is generally not a ​ ​transmissible disease.
Gynecologic Cancers

Cervical, Endometrial, and Ovarian

NCI estimates that endometrial, or uterine, cancer will be diagnosed in an estimated 39,080
American women this year, more than twice the number of women who will be diagnosed with
cervical (lower part of the uterus) and ovarian (female reproductive glands) cancers combined.
However, in terms of 2007 deaths, ovarian cancer is forecast to kill 15,280 women, while deaths
caused by uterine (7,400) and cervical (3,670) cancers are fewer than half that number. That is a
combined 26,350 deaths in this country this year from cancers of the female reproductive
system. To avoid these cancers, it's important to understand them.
Cervical cancer:​ The cancer is caused by several types of a virus called human
papillomaviruses (HPV). HPV spreads through sexual contact. Most women's bodies are able to
fight this infection. But sometimes the virus leads to cancer. You're at higher risk of cervical
cancer if you smoke, have many children, have many sex partners, use birth control pills for a
long time, or have HIV infection.
Endometrial cancer:​ Although the exact cause of endometrial cancer is unknown, increased
levels of estrogen appear to have a role. Estrogen helps stimulate the buildup of the lining of the
uterus.
Ovarian cancer:​ This cancer usually occurs in women over age 50 but can affect younger
women. It causes more deaths than any other cancer of the female reproductive system and is the
leading cause of death from gynecologic cancer in the developed world. Its cause is unknown.
Screening and Diagnosis
Among all three of these reproductive-system cancers, early detection is crucial. But detection
can be very difficult, especially in the early stages.
Cervical cancer:​ The cancer may not cause any symptoms at first, but later, you may have
pelvic pain or bleeding from the vagina. It usually takes several years for normal cells in the
cervix to turn into cancer cells. A test called a Pap smear is very effective in screening for
cervical cancer.
Endometrial cancer:​ A pelvic examination is frequently normal in the early stages of
endometrial cancer. Changes in the size, shape, or consistency of the uterus or its surrounding,
supporting structures may be seen when the disease is more advanced.
Ovarian cancer:​ The sooner ovarian cancer is found and treated, the better the chance for
recovery. But ovarian cancer is hard to detect early. Many times, women with ovarian cancer
have no symptoms or just mild symptoms until the disease is in an advanced stage and hard to
treat. To date, there is no effective screening regimen for ovarian cancer. More than half of
women with ovarian cancer have advanced-stage disease at the time of diagnosis.
Treatment
Current treatments for all three cancers, especially in advanced stages, include surgery followed
by chemotherapy or a combination of chemo and radiation therapies. The exact mix of the
cancer-fighting drugs, sometimes called a "cocktail," depends on the particular form and stage of
the cancer.
Society and culture
Although many diseases (such as heart failure) may have a worse prognosis than most cases of
cancer, cancer is the subject of widespread ​fear​ and ​taboos​. The ​euphemism​ of "a long illness"
to describe cancers leading to death is still commonly used in ​obituaries​, rather than naming the
disease explicitly, reflecting an apparent ​stigma​. In Nigeria, one local name for cancer translates
into English as "the disease that cannot be cured". This deep belief that cancer is necessarily a
difficult and usually deadly disease is reflected in the systems chosen by society to compile
cancer statistics: the most common form of cancer—non-melanoma ​skin cancers​, accounting for
about one-third of cancer cases worldwide, but very few deathsare excluded from cancer
statistics specifically because they are easily treated and almost always cured, often in a single,
short, outpatient procedure.
Western conceptions of ​patients' rights​ for people with cancer include a duty to fully disclose the
medical situation to the person, and the right to engage in ​shared decision-making​ in a way that
respects the person's own values. In other cultures, other rights and values are preferred. For
example, most African cultures value whole families rather than ​individualism​. In parts of
Africa, a diagnosis is commonly made so late that cure is not possible, and treatment, if
available at all, would quickly bankrupt the family. As a result of these factors, African
healthcare providers tend to let family members decide whether, when and how to disclose the
diagnosis, and they tend to do so slowly and circuitously, as the person shows interest and an
ability to cope with the grim news. People from Asian and South American countries also tend
to prefer a slower, less candid approach to disclosure than is idealized in the United States and
Western Europe, and they believe that sometimes it would be preferable not to be told about a
cancer diagnosis. In general, disclosure of the diagnosis is more common than it was in the 20th
century, but full disclosure of the prognosis is not offered to many patients around the world.
In the United States and some other cultures, cancer is regarded as a disease that must be
"fought" to end the "civil insurrection"; a ​War on Cancer​ was declared in the US. Military
metaphors are particularly common in descriptions of cancer's human effects, and they
emphasize both the state of the patient's health and the need to take immediate, decisive actions
himself rather than to delay, to ignore or to rely entirely on others. The military metaphors also
help rationalize radical, destructive treatments.
In the 1970s, a relatively popular ​alternative cancer treatment​ in the US was a specialized form
of ​talk therapy​, based on the idea that cancer was caused by a bad attitude. People with a "cancer
personality"—depressed, repressed, self-loathing and afraid to express their emotions—were
believed to have manifested cancer through subconscious desire. Some psychotherapists said
that treatment to change the patient's outlook on life would cure the cancer. Among other
effects, this belief allowed society to ​blame the victim​ for having caused the cancer (by
"wanting" it) or having prevented its cure (by not becoming a sufficiently happy, fearless and
loving person). It also increased patients' anxiety, as they incorrectly believed that natural
emotions of sadness, anger or fear shorten their lives. The idea was ridiculed by ​Susan Sontag​,
who published ​Illness as Metaphor​ while recovering from treatment for breast cancer in
1978. Although the original idea is now generally regarded as nonsense, the idea partly persists
in a reduced form with a widespread, but incorrect, belief that deliberately cultivating a habit
of ​positive thinking​ will increase survival. This notion is particularly strong in ​breast cancer
culture​.
One idea about why people with cancer are blamed or stigmatized, called the ​just-world
hypothesis​, is that blaming cancer on the patient's actions or attitudes allows the blamers to
regain a sense of control. This is based upon the blamers' belief that the world is fundamentally
just and so any dangerous illness, like cancer, must be a type of punishment for bad choices,
because in a just world, bad things would not happen to good people.
Economic effect
The total health care expenditure on cancer in the US was estimated to be $80.2 billion in
2015.​]​ Even though cancer-related health care expenditure have increased in absolute terms
during recent decades, the share of health expenditure devoted to cancer treatment has remained
close to 5% between the 1960s and 2004. A similar pattern has been observed in Europe where
about 6% of all health care expenditure are spent on cancer treatment. In addition to health care
expenditure, cancer causes indirect costs in terms of productivity losses due to lost work days
and premature death, as well as informal care. Indirect costs are typically estimated to exceed
the health care costs of cancer.
Workplace
In the United States, cancer is included as a protected condition by the ​Equal Employment
Opportunity Commission​ (EEOC), mainly due to the potential for cancer having discriminating
effects on workers. Discrimination in the workplace could occur if an employer holds a false
belief that a person with cancer is not capable of doing a job properly, and may ask for
more ​sick leave​than other employees. Employers may also make hiring or firing decisions based
on misconceptions about cancer disabilities, if present. The EEOC provides interview guidelines
for employers, as well as lists of possible solutions for assessing and accommodating employees
with cancer.

Treatment

Many treatment options for cancer exist. The primary ones include
surgery, ​chemotherapy​, ​radiation therapy​, ​hormonal therapy​, ​targeted
therapy​ and ​palliative care​. Which treatments are used depends on the type, location
and grade of the cancer as well as the patient's health and preferences. The ​treatment
intent​ may or may not be curative.
Chemotherapy
Chemotherapy​ is the treatment of cancer with one or
more ​cytotoxic​ anti-​neoplastic​ drugs (​chemotherapeutic agents​) as part of
a ​standardized regimen​. The term encompasses a variety of drugs, which are divided
into broad categories such as ​alkylating agents​and ​antimetabolites​. Traditional
chemotherapeutic agents act by killing cells that divide rapidly, a critical property of
most cancer cells.
Targeted therapy​ is a form of chemotherapy that targets specific molecular differences
between cancer and normal cells. The first targeted therapies blocked the ​estrogen
receptor​ molecule, inhibiting the growth of breast cancer. Another common example is
the class of ​Bcr-Abl inhibitors​, which are used to treat ​chronic myelogenous
leukemia​ (CML). Currently, targeted therapies exist for many of the most common
cancer types, including ​bladder cancer​, ​breast cancer​, ​colorectal cancer​, ​kidney
cancer​, ​leukemia​, ​liver cancer​, ​lung cancer​, ​lymphoma​, ​pancreatic cancer​, ​prostate
cancer​, ​skin cancer​, and ​thyroid cancer​ as well as other cancer types.
The efficacy of chemotherapy depends on the type of cancer and the stage. In
combination with surgery, chemotherapy has proven useful in cancer types including
breast cancer, colorectal cancer, ​pancreatic cancer​, ​osteogenic sarcoma​, ​testicular
cancer​, ovarian cancer and certain lung cancers. Chemotherapy is curative for some
cancers, such as some ​leukemias​, ineffective in some ​brain tumors​, and needless in
others, such as most ​non-melanoma skin cancers​. The effectiveness of chemotherapy
is often limited by its toxicity to other tissues in the body. Even when chemotherapy
does not provide a permanent cure, it may be useful to reduce symptoms such as pain
or to reduce the size of an inoperable tumor in the hope that surgery will become
possible in the future.
Radiation
Radiation therapy​ involves the use of ​ionizing radiation​ in an attempt to either cure or
improve symptoms. It works by damaging the DNA of cancerous tissue, killing it. To
spare normal tissues (such as skin or organs, which radiation must pass through to
treat the tumor), shaped radiation beams are aimed from multiple exposure angles to
intersect at the tumor, providing a much larger dose there than in the surrounding,
healthy tissue. As with chemotherapy, cancers vary in their response to radiation
therapy.
Radiation therapy is used in about half of cases. The radiation can be either from
internal sources (​brachytherapy​) or external sources. The radiation is most commonly
low energy x-rays for treating skin cancers, while higher energy x-rays are used for
cancers within the body. Radiation is typically used in addition to surgery and or
chemotherapy. For certain types of cancer, such as early ​head and neck cancer​, it may
be used alone. For painful ​bone metastasis​, it has been found to be effective in about
70% of patients.
Surgery
Surgery is the primary method of treatment for most isolated, solid cancers and may
play a role in palliation and prolongation of survival. It is typically an important part of
definitive diagnosis and staging of tumors, as biopsies are usually required. In localized
cancer, surgery typically attempts to remove the entire mass along with, in certain
cases, the ​lymph nodes​ in the area. For some types of cancer this is sufficient to
eliminate the cancer.

​ aser​ therapy​ uses high-intensity light to treat cancer by shrinking or destroying tumors or
L
precancerous growths. Lasers are most commonly used to treat superficial cancers that are on
the surface of the body or the lining of internal organs. It is used to treat basal cell skin cancer
and the very early stages of others like cervical, penile, vaginal, vulvar, and non-small cell lung
cancer. It is often combined with other treatments, such as ​surgery​, chemotherapy, or radiation
therapy. ​Laser-induced interstitial thermotherapy​ (LITT), or interstitial laser ​photocoagulation​,
uses lasers to treat some cancers using hyperthermia, which uses heat to shrink tumors by
damaging or killing cancer cells. Laser are more precise than surgery and cause less damage,
pain, bleeding, swelling, and scarring. A disadvantage is surgeons must have specialized
training. It may be more expensive than other treatments.
Alternative medicine
Complementary and alternative cancer treatments​ are a diverse group of therapies, practices and
products that are not part of conventional medicine. "Complementary medicine" refers to
methods and substances used along with conventional medicine, while "alternative medicine"
refers to compounds used instead of conventional medicine. Most complementary and
alternative medicines for cancer have not been studied or tested using conventional techniques
such as clinical trials.
Materials and Methods

. The records of cancer patients generated for 5 years were analyzed from the Central record
section. All the cancer cases who reported either for diagnosis or treatment
(radiotherapy/chemotherapy/surgery) were included. All these cases were confirmed on the basis
of histopathology, fine needle aspiration cytology, and biopsy or hematology reports. The
different sites of cancer were classified according to the International classification of Disease
given by World Health Organization . A single medical registration number is given to each
patient at the OPD counter. The information is updated on every re-visit through computerized
hospital record maintenance software. The demographic details of the patient, that is, name, age,
sex, address, telephone number are recorded at the reception counter. It is therefore possible to
recognize and avoid duplication of cases.All the cases lacking the relevant information like
demographic details or adequate confirmation of diagnosis were excluded Descriptive statistical
analysis was done. The cases were grouped according to age, sex & top five leading sites of
cancer.
Selection of Hospitals:​ Two major hospitals of the Jammu state were selected for the present
study viz., Government Medical College (GMC) Hospital Jammu, Acharya Shri Chander
College of Medical Sciences and Hospital (ASCOMS) Jammu. The hospitals were selected on
the basis of cancer care facilities available and patient rush.

Government Medical College Hospital Jammu (GMC Jammu)

A total of 1716 cancer patients were observed in GMC Jammu from which the number of male
patients was 1125 (65.6%), while as the number of female patients was 591 (34.4%) (Table 1).
In this hospital, stomach-403 (23.5%), lung-398 (23.2%), esophagus and gastroesophageal (GE)
junction-216 (12.6%), colorectal-102 (5.9%), lymphomas-98 (5.7%), skin-56 (3.3%),
laryngopharynx-43 (2.5%), acute leukemias-79 (4.6%), prostate-21 (1.2%), brain-71 (4.1%),
ovary-94 (5.5%), breast-83 (4.8%) and gall bladder-52 (3.0%) were the leading sites of cancer .
Acharya Shri Chander College of Medical Sciences and Hospital Jammu (ASCOMS
Jammu)
Our results showed that a total number of 1040 patients were diagnosed with cancer between
Jan 2016 and Jan 2017 in ASCOMS Jammu, out of which male patients included 598 (57.5%)
and female patients included 442 (42.5%) (Table 1). The leading sites of incidence in cancer
patients diagnosed in this hospital were stomach-322 (31.0%), lung-243 (23.4%), esophagus and
gastroesophageal (GE) junction-176 (16.9%), colorectal-67 (6.4%), lymphomas-45 (4.3%),
skin-31 (3.0%), laryngopharynx-22 (2.1%), acute leukemias-23 (2.2%), prostate-09 (0.9%),
brain-13 (1.3%), ovary-43 (4.1%), breast-27 (2.6%) and gall bladder-19 %.
 Results

A total of 1328 cancer cases reported in this tertiary care hospital during the years 2007 to
2011, out of which females accounted for 809 (60.9%) and males for 519 (39.1%) cases
(Table-1). More females reported with that is 844 cases (63.5%). There were 1.2% cases in 0- 14
y age-group, 8.3% in 15-34 y, & 26.9% in >65 y agegroup . On further analysis, the peak age of
cancer was found to be 50-54 y in both males & females. The frequency of malignancies
decreased towards both younger and older age-groups. This is similar to the observations in
studies carried out at Ludhiana, Dehradun, Jabalpur & Eastern Rajasthan .The proportion of
cases in the Hospital-based Cancer Registries under the National Cancer Registry Program of
India varied between 1.8 - 8.9 in 0-14 y age-group; between 6.8 - 12.5 in 15-34 y age-group;
between 60.3 - 67.6 in 35-64 y age group and between 16.9 - 24.5 in >65 y age-group .The total
malignant cases for males (n= 519) ​re cancer in our study; with a male to female ratio of 1:1.55.
There were 16 (1.2%) cases in childhood age-group (0- 14 y), 110 cases (8.3%) in 15-34 y
age-group, 844 (63.5%) in 35-64 y & 358 (26.9%) in geriatric (>65 y) age-group). Pattern of
cancer was different in the two sexes. In males, maximum cases were of lung cancer (9.6%),
followed by myeloid leukemia (8.3%), prostate (6.8%), mouth (6.1%) and gall bladder (6.0%). In
females (n=809), the top five leading sites were breast (35.7%), followed by cervix (19.1%),
esophagus (5.1%), myeloid leukemia (4.7%), and gall bladder (3.9%).
Sex wise distribution of cancer cases year 2017-2018

Sex Number of Cases Proposition%

Male 519 39.1

Female 809 60.9
Total 1328 100.0

Age wise distribution of Cancer cases year 2017-2018

Age Group No. Cancer cases Relative proposition

0-14 16 1.2
15-34 110 8.3
35-64 844 63.5
>65 358 26.9
Total 1328 100.0
Conclusion

This hospital-based study indicates the cancer profile in Jammu. However, no large site-specific,
population based epidemiological study has been done so far. These studies need to be done to
find out the differences in the epidemiological profile of cancers, to find out the incidence of
cancer, and to study the risk factors associated with them. This may also suggest the preventive
measures to deal with the increased incidence of cancer in this part of Jammu. A number of
'Cancer Awareness & Health Education' camps have been organized in the Rural Field Practice
Area under the Department of Community Medicine since this study was done.

Citation or Bibliography

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