Cancer Statistics

The computerized cancer registry of the Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC), Lahore, Pakistan, is a data system designed for the collection, management, and analysis of detailed data on patients registered at the facility. The hospital-based cancer registry has been functioning since the inauguration of the hospital in Lahore in December 1994. Every year, the Registry generates cancer statistics according to sex, age, demographic area, topography, morphology, stage, grade, etc. From December 1994 until December 2003, the International Classification of Diseases, Ninth Revision, Clinical Modification, was used to code the diseases. In January 2004, the Registry implemented the International Classification of Disease for Oncology, Third Edition (ICD-O-3) to code cancer cases. The Registry also implemented the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) in 2013, to do an in-depth coding of cancer and non-cancer cases.

Patients included in this report include those registered at the centers affiliated with the Shaukat Khanum Memorial Trust and accessioned into the computerized cancer registry within the hospital information system in Lahore. The affiliated centers include two hospitals called the ‘Shaukat Khanum Memorial Cancer Hospital and Research Center’ in Lahore and Peshawar and the Karachi Diagnostic Center (KDC). SKMCH&RC Lahore is the oldest center and has been functioning since December 29, 1994, SKMCH&RC Peshawar since December 29, 2015, and the KDC since 2010.

Results

During the last twenty-seven years, a total of 119,456 neoplasms were registered at SKMCH&RC and KDC, of which 7,515 were benign and 111,941 malignant. The distributions seen among males and females were 47.3% and 52.7%, respectively. About 90.4% of tumors were found in adults, whereas 9.6% were diagnosed in children. The top three malignancies in all age groups, both sexes combined were breast cancer, colon/rectum/anal canal/anus cancers, and leukemia. The top three malignancies among adult females were cancers of the breast, ovary & uterine adnexa, and lip & oral cavity, while, in adult males, colon, rectum, anal canal/anus, prostate, and lip & oral cavity cancers.

In adults, regardless of gender, malignant neoplasm of the breast, colon/rectum/anal canal/anus, and lip & oral cavity were the leading malignancies. In children, the most commonly diagnosed cancers were Hodgkin lymphoma, acute lymphoblastic leukemia, and non-Hodgkin Lymphoma

In the year 2021, a total of 7,539 neoplasms were added to the Registry database, of which 645 were benign and 6,894 malignant. Of a total of 6,894 malignant cases, 6,731 (97.6%) were analytical cases, whereas 163 (2.4%) were non-analytical cases. Class of Case 00, 10, 11, 12, and 20 are considered analytical and 30, 31, 32, and 33 non-analytical cases, taken from the Facility Oncology Revised Data Standards (FORDS) Revised for 2016. In the area of cancer registration, analytical cases are included in treatment and survival analysis, while non-analytical cases are usually not included in routine treatment or survival statistics.

The top three malignancies in all age groups, both sexes combined were breast, colon, rectum, anal canal and anus, and Hodgkin lymphoma. In adult males, colon, rectum, anal canal/anus, prostate, and lip & oral cavity were the top malignancies, whereas, in adult females, breast, cervix uteri, and ovary were the leading malignancies. In children, Hodgkin lymphoma, acute lymphoblastic leukemia, and non-Hodgkin lymphoma were the commonest malignancies.

The Registry uses the American Joint Committee on Cancer (AJCC 8^th edition) staging manual for staging all available cancer sites. TNM categorizes cancers in stages 0, 1, 2, 3, 4, unstageable, and not applicable. Among 6,731 analytical cases, 0.7% of cases were staged into Stage 0, 14.5% in Stage I, 26.4% in Stage II, 24.5% in Stage III, and 17.9% in Stage IV. In 10.7% of the patients, no AJCC stage was defined and 5.3% of the cases were unstageable.

According to the SEER Summary Staging Manual-2000 Codes and Coding instructions, 0.6% of cases were in-situ, 22.9% localized, 42.4% regional, and 19.6% distant. In 14.4% of the cases, the summary stage was unknown.

By histological grading/differentiation/immunophenotype, 6.4% presented in Grade I, 30.3% in Grade II, 25.1% in Grade III, 1.8% in Grade IV, 0.2% T-cell, 4.1% B-cell, 0.01% NK-cell and grade/differentiation/immunophenotype not determined, not stated, or not applicable in 32.1%.

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