Gall Bladder Cancers in India : - PowerPoint Presentation

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Gall Bladder Cancers in India : A report from Population Based Cancer Registries(1982-2010)

Dr. Meesha

Chaturvedi Indian Council of Medical Research

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Extreme High

High

Moderate

Low

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GBC incidence rates in the World. Worldwide incidence of GBC in both genders has been mentioned in age standardized rate per 100,000 (www.globocan.iarc.fr). Chile –

9.7; Bolivia – 8.1;

Peru

– 4.0; Ecuador – 4.0; Colombia – 2.8;

Brazil – 1.9; China – 2.8; Japan – 4.7; India – 1.8; Republic of Korea – 6.5; Bangladesh – 4.2; Germany – 2.3; Hungary – 2.9; Poland – 2.9; USA- 1.6; UK – 0.5; France – 1.6; Norway – 1.6.

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Cancer Atlas in India-Gall Bladder cancers & Ganges River Course6/11/2019

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National Cancer Registry Programme Data – INDIA

A Synopsis

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Comparison of Age Adjusted Incidence Rates (AARs) of All PBCRs (2012-2014)GALLBLADDER (ICD-10: C23-C24)

Males

Females

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Fig: Relative Proportion (%) of GALL BLADDER (ICD-10: C23- C24) cancers to ALL TYPE of Cancers - (Pooled Data 1982-2010)Males

Females

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Proportion (%) and Rank of Gall Bladder Cancersin PBCRs – featured in top 10 leading sites

Registry

Proportion (%)

Rank

Tripura- Females

9.0

4

Cachar- Females

10.6

4

Dibrugarh- Females

9.1

4

Delhi - Females

6.2

5

Kamrup- Females

8.4

5

Manipur State-Females

6.0

5

Kolkata- Males

6.0

5

Sikkim State- Females

5.1

7

Bhopal - Females

3.8

7

Meghalaya- Females

3.8

7

East Khasi hills- Females

3.6

7

Cachar- Males

3.3

9

Dibrugarh-

Males

2.7

10

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Trends in Gall Bladder CancersPBCRs (1982-2010)

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Gall Bladder (ICD-10 : C23-C24)-Females Trends Over Time in AAR(1982-2011) Five Year Trend

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Gall Bladder (ICD-10 : C23-C24)-Females Trends Over Time (2003 -2011) in AAR(Range of Years) - Joinpoint regression-NEWER PBCRs

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Changes in Broad Age Groups – Females (Bangalore) 

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↑ in AARs for 65 and above age group of Bangalore PBCR.

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Changes in Broad Age Groups – Females (Bhopal)

 

↑ in AARs for

25-34

35-44 and 45-54 age group of Bhopal PBCR.

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Changes in Broad Age Groups – Females (Chennai)

 

↑ in AARs for

25-34

35-44 and 65 and above age group

Chennai

PBCR.

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Table: Projected Cases at India level (2015 and 2020)*Gall Bladder and Extra Hepatic Ducts (ICD-10: C23-24)

2020

Males

36046

Females

55141

Both Sexes

91187

All Cancers

1734886

% to All cancers

5.2

*Three-year Report of the PBCRs: 2012-2014, Bengaluru, 20166/11/201914NCDIR-ICMREstablishment of Population Based Cancer Registries in the Gangetic Belt in Allahabad (the land of Kumbh Mela),Aligarh and Patna India.

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Hospital Based Cancer Registry on Gall Bladder Cancers(1984-2010)

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Proportion (%) of Gall Bladder Cancers

(ICD10: C23 - 24)

according to Method of Diagnosis (1984 – 2010)

Males

Females

*Data from HBCR Reports 1984 to 2010

Microscopic

Imaging techniques

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Proportion (%) of Microscopically Diagnosed Gall Bladder Patients (ICD10: C23 - 24)

(1984 – 2010)

MalesFemales

*Data from HBCR Reports 1984 to 2010

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Clincial

Extent of Disease

Males

Females

#

%

#

%

Localised (L)

526

16.7

481

12.7

Regional (R)

769

24.4

772

20.5

L + R

1295

41.2

1253

33.2

Distant

1489

47.3

2059

54.6

Others

62

2.0

92

2.4

Unknown

300

9.5

370

9.8

Total

3146

100.0

3774

100.0

Number (#) and

Proporation

(%) of Gall Bladder Cancer patients (ICD10: C23 - 24) according to Clinical Extent of Disease

(Excludes Patients Previously Treated)*Data from HBCR Reports 1984 to 20106/11/201918NCDIR-ICMR

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Number (#) and Proportion (%) of Gall Bladder Cancer patients (ICD10: C23 - 24) according to Type of Treatment Given at Reporting Institution (1984 – 2010)

Type of Treatment

Males

Females

#

%

#

%

Surgery (S)

495

55.3

392

43.4

Radiotherapy (R)

455.0

56

6.2

Chemotherapy (C)

223

24.9

273

30.2

S + R

27

3.0

32

3.5

S + C

69

7.7

114

12.6

R + C

12

1.3

19

2.1

S + R + C

11

1.2

5

0.6

Others

13

1.5

13

1.4Total895100.0904100.0*Data from HBCR Reports 1984 to 20106/11/201919NCDIR-ICMR

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Morphologies for Cancer Gall Bladder (23-C24)

Rank

PHM

%

1

ADENOCARCINOMA (8140 )

60.8

2

MALIGNANCY (8000 )

24.4

3

CARCINOMA (8010 )

6.1

4

CHOLANGIOCARCINOMA(C22.1,C24.0) (8160 )

1.7

5

PAPILLARY ADENOCARCINOMA (8260 )

1.1

6

SQUAMOUS CELL CARCINOMA (8070 )

0.9

7

ADENOSQUAMOUS CARCINOMA (8560 )

0.5

8

MUCIN-PRODUCING ADENOCARCINOMA (8481 )

0.5

9

NEUROENDOCRINE CARCINOMA (8246 )

0.4

10

MUCINOUS ADENOCARCINOMA (8480 )

0.4

11

SIGNET RING CELL CARCINOMA (8490 )

0.3

12

TUMOR CELLS, MALIGNANT (8001 )

0.2

13

CARCINOMA, UNDIFFERENTIATED (8020 )

0.1

14

SMALL CELL CARCINOMA (8041 )

0.1

 

Total

Cases

100.0

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Risk Factors6/11/2019

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Risk Factors for Gall Bladder Disease/Cancers

Geographic Pathology

Genetic Predisposition

Infections i.e. Salmonella, Helicobactor

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M

issed Opportunities- CLINICAL - Gall Bladder Cancers

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M

issed Opportunities- DIAGNOSTIC - Gall Bladder Cancers

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M

issed Opportunities- STAGING & SURVIVAL- Gall Bladder Cancers

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To identify environmental high risk regions for

gall bladder cancer and correlation with ground water arsenic in the state of Assam, India.

Incidental Gall Bladder Cancer and Other Pre malignant Gall Bladder Condition in India towards early Detection of Gall Bladder Cancer

Patterns of Care and Survival Studies –

Gall Bladder Cancers.

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Roadmap Forward (1/2)Synchronization between Registry and clinical practice.Consensus on aspects of staging and treatment for Gall Bladder cancers.Specific studies on preventable risk factors, early diagnostic and prognostic markers .

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Roadmap Forward (2/2)Disease Free survival for cases with Ca Gall BladderSpecial registries on Gall Bladder Cancer : customized to scientific requirement (Geographic pathology needs to be revisited).Long term benefit in planning screening programmes in future.

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AcknowledgementsPopulation based Cancer RegistriesHospital Based Cancer RegistriesNCDIR-NCRPIndian Council of Medical Research (ICMR)

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International Classification of Diseases for Oncology (ICD-O)

C23 Gallbladder

C23.9 Gallbladder

C24 Other and Unspecified Parts of Biliary Tract

C24.0 Extrahepatic Bile Duct

Bile Duct, NOS

Biliary Duct, NOS

Choledochal Duct

Common Bile Duct

Common Duct

Cystic Bile Duct

Cystic Duct Hepatic Bile Duct Hepatic Duct Sphincter of Oddi

C24.1 Ampulla of Vater PeriampullaryC24.8 Overlapping lesion of biliary tract(Note: Neoplasms involving both intrahepatic and extrahepatic bile ducts)C24.9 Biliary Tract, NOS6/11/201930NCDIR-ICMR

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Exposure to certain chemicals and heavy metals, age, female gender, family history, obesity, cholelithiasis, chronic cholecystitis, porcelain gallbladder, polyps, and chronic infection by Salmonella species

Environmental Factors

Gallbladder Cancer Pathogenesis

Genetic Factors

Genes of Drug Metabolism pathway, Hormonal pathway, Inflammatory pathway, DNA Repair pathway, Hedgehog pathway, Apoptotic pathway, Wnt signaling pathway, miRNA and some other

Schematic representation of factors contributing to GBC pathogenesis

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Number (#) and Proportion (%) of Gall Bladder Cancers(ICD10: C23 - 24) by Five Year Age Groups (1984 – 2010)

Age Group

Males

Females

#

%

#

%

00-04

-

- 

-

-

05-09

-- 

-

-

10-14

-

- 

1

0.0

15-19

3

0.1

5

0.1

20-24

21

0.5

25

0.5

25-29

57

1.4

68

1.3

30-34

133

3.3

186

3.5

35-39

281

7.0

412

7.840-4443610.867312.745-4954413.587716.650-5462915.691117.255-5964115.972113.660-6450812.6689

13.0

65-69

422

10.5

404

7.6

70-74

221

5.5

204

3.9

75+

122

3.0

115

2.2

Unknown

3

0.1

1

0.0

All Ages

4021

100.0

5292

100.0

*Data from HBCR Reports 1984 to 2010

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To identify environmental high risk regions for

gall bladder cancer and correlation with ground water arsenic in the state of Assam, India.

Life Style Behavior, Dietary Habits, Reproductive factors and risk of

Gall Bladder Cancer in Upper Assam

A multidisciplinary case control study on

Gall bladder cancer -

Identification of modifiable risk factors and risk reduction.

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