Turkish Journal of Pathology

2015, Vol 31, Num, 2 (Pages: 119-125)

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Profile of Head and Neck Cancers in Dr. Lütfi Kırdar Kartal Educational and Research Hospital

Kayhan BAŞAK ¹, Yasin SAĞLAM ¹, Ayşe Gökçen YILDIZ ¹, Merve BAŞAR ¹, Hanım İstem KÖSE ¹, Şükran KAYIPMAZ ¹, Nimet KARADAYI ¹

¹ Department of Pathology, Dr. Lütfi Kırdar Kartal Education and Research Hospital, İSTANBUL, TURKEY

DOI: 10.5146/tjpath.2014.01294

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Summary

Objective: Head and neck cancers account for 17.6% of all malignant neoplasms. Data on the incidence of head and neck cancers and histological subtypes in Turkey are limited. This study aimed to provide an overview of statistics for head and neck cancers.

Material and Method: This retrospective and descriptive study included 1973 cases of in-situ carcinomas, malignant and borderline neoplasia from the head and neck region in a period of 5 years, diagnosed at Dr.Lütfi Kırdar Kartal Education and Research Hospital's Department of Pathology. Demographic data of patients and data from histopathological report were recorded. The topography of all tumours was coded according to the International Classification of Diseases for Oncology, 2nd and 3rd edition and histological and behavioral codes were given according to ICD-O-3. Data was entered and analyzed using Microsoft Excel™, version 2010.

Results: Male and female ratio was 1.03 for head and neck cancers. The most common sites for males were described as the ratio in head and neck cancers and all malignant tumours as follows: the skin (non-melanoma) (48.4%-8.2%), the larynx (12.6%-2.3%), the thyroid (11.1%-1.2%), the lips (7.8%-1.3%), and the nasopharynx (3.1%-0.5%). The most common sites for females were as follows: the thyroid (45.3%-8.3%), the skin (non-melanoma) (39.6%-7.3%), the lips (3.6%-0.6%), the nasopharynx (2.2%-0.4%) and the eye (1.7%-0.3%). The male: female ratio was 25.2 for larynx cancers. The most common histological types and rates for males and females were also given.

Conclusion: This descriptive epidemiological pathology-based cancer incidence study has relative value for describing head and neck cancer incidences in the İstanbul region and shown that pathology report-based descriptive epidemiological studies are still valuable for determination of the regional distribution of cancer incidence out of the active cancer registration regions.

Introduction

Data on the incidence of cancers and histological subtypes in Turkey are limited. The studies for determination of cancer incidences dominantly describe topographical distribution according to organs or tissues. For determination of priority in cancer control studies, estimated rate of new cancers and estimated deaths caused by cancer must be predicted. In Turkey, the Cancer Registration System and death declaration system (Republic of Turkey Ministry of Health, Directorate of Public Health) are primary systems to collect cancer data. The death declaration system also provides survival information for each special type of cancer[1].

Histopathological verification of new case records in registration center is crucial. In addition, advances in molecular pathology and targeted therapies in many organs requires identifying and determining the rates of histological types.

The Republic of Turkey Ministry of Health started a passive cancer registration system at 1983[2]. The active cancer registration system first was to be built in the İzmir province in 1992. There are 15 active cancer registration centers in Turkey that are located in the provinces of Antalya (1998), Bursa (2000), Eskişehir (2000), Samsun (2001), Trabzon (2003), Edirne (2004), Erzurum (2005), Ankara (2006), Kocaeli (2007), Gaziantep (2010), Malatya (2010), Mersin (2012), İstanbul (2012), and Adana (2012). These fifteen cancer registration centers comprise more than 50% of the population in Turkey (1). Active registration results were first reported in 2002 and data included in “Cancer Incidence in Five Continents”[3].

Methods

This retrospective and descriptive study included 1973 biopsy-proven cases of all in-situ carcinomas, malignant and borderline neoplasia from the head and neck region diagnosed at Dr.Lütfi Kırdar Kartal Education and Research Hospital (KEAH), Department of Pathology, İstanbul, Turkey. Permission was granted from the ethics committee of KEAH to review the pathology archive records of the Department of Pathology. 150.035 histopathological and cytopathological report records were reviewed in archives of the Pathology Department, within a period of 5 years from January 2008 to December 2012. During five year period, 7.846.143 patients admitted to KEAH, 202.424 hospitalized, 150.035 pathological material examined and 11.189 cancer included 1.973 head and neck region cancers (HNCs) were diagnosed.

Data about the Turkish personal identification number, date of diagnosis, pathology laboratory record number, age, gender, the exact site of the tumour and histological diagnosis from pathology laboratory were recorded. The topography of all tumours was coded according to the International Classification of Diseases for Oncology, 2nd and 3rd edition (4) (ICD-O-2 and ICD-O-3) in 3 and 4 digits. Histological and behavioral codes were given according to ICD-O-3. Data was entered and analyzed using Microsoft Excel™, version 2010. All records were sorted by Turkish personal identification number, pathology report number, date of pathological diagnosis, topography and histological diagnosis. Repeated records that belong to the same patient's same tumours were sorted out and different tumours at a different site were recorded separately. Local recurrence and distant metastasis were considered.

Results

A total of 1973 biopsy proven cases of head and neck cancer (HNC) were seen during the study period. The mean age of the patients was 57.9 years. The mean age of male patients was 59.9 (range 3-99) years and the mean age of female patients was 56.2 (range 2-98) years. The male to female ratio was 1.026 (number of males: 999 and females: 974).

The most common sites for males were the skin (nonmelanoma skin cancers) (48.4%), larynx (12.6%), thyroid (11.1%), lips (7.8%) and nasopharynx (3.1%). The most common sites for the females were the thyroid (45.3%), skin (non-melanoma skin cancers) (39.6%), lip (3.6%), nasopharynx (2.2%) and the eye (1.7%) (Table I).

Table I: Most frequent topographical sites for gender

Age distribution for both sexes is shown in Figure 1 and the most common histological types in both genders are shown in Table II.

Table II: Most common histological types and rates in the head and neck region

Sixty cases had multiple tumours; 41 cases had 2 tumours, 16 cases had 3 tumours, 2 cases had 4 tumours and 1 case had five tumours. The mean age of cases at the time of initial tumour diagnosis was 62.9 years and the ages ranged between 26 and 93 years. Thirty-one cases were male and 29 cases were female. Time intervals were 1.8 years, 1.9 years, 1.5 years and 1 year for the second, third, fourth and fifth primary tumours, respectively.

Discussion

Dr.Lütfi Kırdar Kartal Education and Research Hospital's (KEAH) receives 87.8% of its patient population from İstanbul and 4.4% from Kocaeli province, so our data predominantly represent the cancer distribution of İstanbul. During the study period, a total of 7.846.143 patients applied to KEAH and 11.189 new cancer cases were diagnosed.

There was a female predominance between the age 15 and 49 years, and male predominance after age 50 as shown in Figure 1. 89.7% of cases were between 35 and 84 years. According to the 2012 population of Turkey[5], the group older than 80 years made up 1.5% of all the population, and HNC in this age group was 9.1%. The group aged 35- 79 years made up 39.9% and HNC in this age group was 83.3%. Those under 34 years made up 58.5% and the rate of HNC in this age group was 7.6%.

Figure 1: Distribution of all head and neck malignancies in 20 age group by gender.

Many histopathological report-based studies have been performed in Turkey before the Active Cancer Registration Centers were established[1,7-27]. Thirteen studies included 149.647 cancer records reviewed for an incidence rate of special topographic sites of the head and neck region[8,9,12-15,19,22-27] (Table III). Many of these studies describe the cancer profile in Turkey before active cancer recording. Table IV provides a summary of valuable data from these studies. It is obviously seen that these reports have no standardization. Most of these studies did not use coding topography or histology according to ICD-O[12-15,20-22,27] and did not document the rate of incidence of special topographic sites cancers separately, They therefore do not include or have only limited data regarding the rate of cancer incidence of special topographic sites of the head and neck region[8,14,20,22-26]. A limited number of studies used ICD-O coding for topography and histology and described rates for all sites including specific topographic sites of the head and neck[9,19,25]. Burgut et al. reported one of the first results coded with ICD-O and described frequencies according to organ and system groups[8].

Table III: Pathology report based descriptive studies.

Table IV: Head and neck cancers percentage and frequency in all cancers in pathology report based descriptive studies.

Data for the most frequent head and neck region cancers from the Republic of Turkey Ministry of Health, Directorate of Public Health 2009[1] and KEAH 2008- 2012 are presented in Table V. The first six most frequent cancer topography in males and first five most frequent cancer topography in females are similar. The six studies with valuable information on HNC rates also show a high rate of similarity with data from the Turkey cancer statistics in 2009[1].

Table V: Comparison of most frequent head and neck region cancer rates in data from the Republic of Turkey Ministry of Health, Directorate of Public Health 2009 (1) and KEAH 2008-2012.

The expected rate of people older than 50 years in Turkey is 10.2% for the year 2023 and 20.8% for the year 2050[1]. Data on the incidence of HNCs and histological subtypes in Turkey are limited. It is important to document cancer distribution findings about time trends and variations in incidence, mortality and survival. In 1998, cancer was the second leading cause of death in Turkey (15.4%) while the leading cause of death was cardiovascular diseases[2]. In 2012, cancer was still the second leading cause of death (21.1%) (5,28). According to the Turkey's 2013 Health Statistics Yearbook from the Ministry of Health, the incidence of cancer is 281.6 cases per 100.000 people[29].

In conclusion, this cancer incidence study based on descriptive epidemiological pathology reports has relative value for describing HNC incidences and represents the İstanbul region. The cancer incidence of topographical sites was similar in incidence to the Turkish literature and data from the Directorate of Public Health. Pathology reportbased descriptive epidemiological studies are still valuable for determination of the regional distribution of cancer incidence out of the active cancer registration regions.