A report from Population Based Cancer Registries19822010 Dr Meesha Chaturvedi Indian Council of Medical Research 6112019 1 NCDIRICMR Extreme High High Moderate Low 6112019 ID: 912739
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Slide1
Gall Bladder Cancers in India : A report from Population Based Cancer Registries(1982-2010)
Dr. Meesha
Chaturvedi Indian Council of Medical Research
6/11/2019
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Slide2Extreme 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.
Slide3Cancer Atlas in India-Gall Bladder cancers & Ganges River Course6/11/2019
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Slide4National Cancer Registry Programme Data – INDIA
A Synopsis
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Slide5Comparison of Age Adjusted Incidence Rates (AARs) of All PBCRs (2012-2014)GALLBLADDER (ICD-10: C23-C24)
Males
Females
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Slide6Fig: 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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Slide7Proportion (%) 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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Slide8Trends in Gall Bladder CancersPBCRs (1982-2010)
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Slide9Gall Bladder (ICD-10 : C23-C24)-Females Trends Over Time in AAR(1982-2011) Five Year Trend
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Slide10Gall Bladder (ICD-10 : C23-C24)-Females Trends Over Time (2003 -2011) in AAR(Range of Years) - Joinpoint regression-NEWER PBCRs
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Slide11Changes 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.
Slide14Table: 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.
Slide15Hospital Based Cancer Registry on Gall Bladder Cancers(1984-2010)
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Slide16Proportion (%) 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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Slide17Proportion (%) of Microscopically Diagnosed Gall Bladder Patients (ICD10: C23 - 24)
(1984 – 2010)
MalesFemales
*Data from HBCR Reports 1984 to 2010
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Slide18Clincial
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
Slide19Number (#) 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
Slide20Morphologies 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
Slide21Risk Factors6/11/2019
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Slide22Risk Factors for Gall Bladder Disease/Cancers
Geographic Pathology
Genetic Predisposition
Infections i.e. Salmonella, Helicobactor
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Slide23M
issed Opportunities- CLINICAL - Gall Bladder Cancers
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Slide24M
issed Opportunities- DIAGNOSTIC - Gall Bladder Cancers
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Slide25M
issed Opportunities- STAGING & SURVIVAL- Gall Bladder Cancers
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Slide26To 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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Slide27Roadmap 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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Slide28Roadmap 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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Slide29AcknowledgementsPopulation based Cancer RegistriesHospital Based Cancer RegistriesNCDIR-NCRPIndian Council of Medical Research (ICMR)
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Slide30International 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
Slide31Exposure 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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Slide33Number (#) 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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Slide34To 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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