|Year : 2020 | Volume
| Issue : 2 | Page : 52-55
Retrospective analysis of incidence of gallbladder cancer in North-Western India over 5 years
Guncha Maheshwari1, Vansh Arora1, Aditya Dhanawat2, Shankar Lal Jakhar1, Neeti Sharma1, Harvindra Singh Kumar1
1 Department of Radiation Oncology, Sardar Patel Medical College, Bikaner, Rajasthan, India
2 Department of Internal Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
|Date of Submission||14-Apr-2020|
|Date of Acceptance||21-Apr-2020|
|Date of Web Publication||23-Jun-2020|
Dr. Shankar Lal Jakhar
Department of Radiation Oncology, Sardar Patel Medical College, Bikaner, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: Gallbladder cancer (GBC) is one of the leading cancers among gastrointestinal malignancies. GBC occurs more frequently in females worldwide. There are very few studies on the incidence of GBC in the state of Rajasthan. The present study evaluates its temporal variation and area-wise distribution. Materials and Methods: Five-year retrospective data on GBC incidence were obtained from Hospital-Based Cancer Registry of Regional Cancer Centre (RCC), Bikaner, from January 2014 to December 2018. Linear regression was applied to determine the trend of GBC incidence over these 5 years. District- and tehsil-wise distribution of patients was also analyzed. Results: Of 31,553 cases registered at RCC, Bikaner, from January 2014 to December 2018, there were 1199 cases of GBC accounting for 3.8% of the total. Among these, there were 333 males and 866 females which contributed approximately 1.8% and 6.4% of all male and female cancer cases, respectively. The median age at the diagnosis of GBC was 60 years in both the sexes. Linear regression analysis showed an increasing trend of GBC incidence over 5 years. The highest incidence rate was found in the districts of Sri Ganganagar, Hanumangarh, and Bikaner, with most patients coming from Ganganagar and Suratgarh tehsils of Sri Ganganagar district. Conclusion: GBC cases have shown an increasing trend in the past 5 years in Rajasthan with a higher incidence in the North-Western districts irrigated by canal water. There is a need to correlate the water chemistry and find out solutions for reducing the risk of GBC in future.
Keywords: Bikaner, gallbladder cancer, incidence, Rajasthan, trend
|How to cite this article:|
Maheshwari G, Arora V, Dhanawat A, Jakhar SL, Sharma N, Kumar HS. Retrospective analysis of incidence of gallbladder cancer in North-Western India over 5 years. J Radiat Cancer Res 2020;11:52-5
|How to cite this URL:|
Maheshwari G, Arora V, Dhanawat A, Jakhar SL, Sharma N, Kumar HS. Retrospective analysis of incidence of gallbladder cancer in North-Western India over 5 years. J Radiat Cancer Res [serial online] 2020 [cited 2020 Aug 15];11:52-5. Available from: http://www.journalrcr.org/text.asp?2020/11/2/52/287445
| Introduction|| |
Gallbladder cancer (GBC) is the most common biliary tract malignancy worldwide, accounting for 80%–95% of the cases. Ninety to ninety-five percentage of GBCs are adenocarcinomas, whereas a small proportion is contributed by squamous cell carcinomas. The global GBC incidence is approximately 2.1/100,000 with the highest rates being found in Northern India and Pakistan, East Asia (Korea and Japan), Eastern Europe, and South America (Columbia and Chile). Of the total GBC cases in the world, 45% is contributed by Eastern Asia alone., In India, GBC is the most common gastrointestinal malignancy in women and varies widely with the population-based cancer registries data revealing high incidence rates in North India, especially Ganga belts. The incidence of GBC in females in Northern India is as high as 9/100,000/year as compared to only 1/100,000/year in Western and Southern regions. There have been very few studies on the incidence of GBC in the state of Rajasthan.
Most of the patients with GBC are diagnosed at an advanced stage due to vague signs and symptoms which mimic gallstone or acid peptic disease that are often neglected and complicated by difficulty in early diagnosis with routine abdominal ultrasonography. The prognosis is dismal with median overall survival after a diagnosis of advanced disease being around 6 months and a 5-year survival rate of around 5%. A close association of GBC has been found with gallstones, while other risk factors described in various studies are old age, female sex, obesity, dietary habits, environmental factors, genetic, female reproductive factors, and chronic inflammation.,,
The present study evaluates the temporal variation of GBC incidence over a period of 5 years (2014–2018) and its district- and tehsil-wise distribution in Rajasthan. To study the GBC incidence variation in Rajasthan, a time trend analysis using linear regression model was performed. In addition, the estimated incidence was also forecasted for the next 5 years up to the year 2023.
| Materials and Methods|| |
It was a single-center, retrospective study which involved 5-year data of GBC incidence from the Hospital-Based Cancer Registry (HBCR) of Regional Cancer Centre (RCC), Bikaner, India, from January 2014 to December 2018. Being a retrospective study, no ethical approval was required for the study as all the patients were treated with the standard departmental protocol.
Patients included in the study were those who were diagnosed with GBC above the age of 20 years irrespective of the stage and histology. Patients from outside the state of Rajasthan or patients with second malignancies were excluded from the study. A total of 1199 GBC cases were collected. The district- and tehsil-wise distribution of GBC was also mapped.
Linear regression method was applied to determine the trend of GBC incidence over these 5 years as well as to predict the incidence over the next 5 years until the year 2023 using GraphPad Prism, version 6.0 (GraphPad Software, San Diego, CA, USA)
| Results|| |
GBC contributed 3.8% of total cancer cases (n = 31,553) registered at RCC, Bikaner. from January 2014 to December 2018. In the last 5 years, 1199 GBC cases, with a male (n = 333)-to-female (n = 866) ratio of 2.6:1, were registered which contributed approximately 1.8% and 6.4% of all male and female cancer cases, respectively [Table 1]. The median ages at diagnosis of GBC were 60 ± 12.2 years and 60 ± 12.6 years in males and females, respectively. In our study, the highest incidence was found in the fifth–seventh decades [Table 2]. Linear regression analysis showed an increasing trend of GBC incidence over 5 years [Figure 1]. The area-wise distribution showed a high incidence rate in the districts of Sri Ganganagar, Hanumangarh, and Bikaner [Figure 2], among which the maximum cases were reported from Ganganagar and Suratgarh tehsils of Sri Ganganagar district [Table 3].
|Table 1: Year-wise distribution of gallbladder cancer patients in Rajasthan|
Click here to view
|Table 2: Age- and gender-wise distribution of gallbladder cancer patients in Rajasthan|
Click here to view
|Figure 2: Area-wise distribution of gallbladder cancer patients in Rajasthan|
Click here to view
|Table 3: Tehsil-wise distribution of gallbladder cancer patients in Sri Ganganagar district|
Click here to view
| Discussion|| |
The time trend analysis revealed a significant increase in GBC over 5-year period in Rajasthan among both genders, with other population registries in India showing similar increasing trends. Female predominance has been reported within the country as well as worldwide. The majority cases were diagnosed in the fifth to seventh decades, which conformed to a study reported from Delhi.
The incidence of GBC was relatively less among the younger population (<35 years) than the older age groups, which was similar to incidences reported in other studies., The median ages for males and females were 60 ± 12.2 years and 60 ± 12.6 years, respectively, which were higher in Rajasthan compared to a North-Eastern study.
Various risk factors have been implicated in the pathogenesis of GBC, among which cholelithiasis (gallstone) is the most closely associated and almost 80% of GBC cases have cholelithiasis; however, only a fraction (0.5%–3%) of patients with cholelithiasis develop GBC in future. The other risk factors for GBC fall into modifiable and nonmodifiable categories. The nonmodifiable risk factors include old age, female sex, family history, and menopause, whereas modifiable factors include obesity, smoking, alcohol consumption, dietary intake pattern, and exercise. Other factors responsible for GBC include bacterial infection, history of typhoid, gallbladder polyps, primary sclerosing cholangitis, genetics, stone size, and duration of gallstone as described in various studies.,,
Bile is the main source for removing toxic metabolites including environmental carcinogens which might increase the likelihood of GBC. Heavy metals such as cadmium, chromium, and lead in drinking water are known chemical carcinogens which have been found significantly higher in patients of GBC in a study by Shukla et al. In another population-based study from the rural Gangetic basin by Unisa et al., the consumption of food items such as chickpeas and drinking unprotected water from wells, ponds, and rivers were significant local factors leading to gallbladder disease. The analysis also showed a significant association with the levels of heavy metals, i.e. nickel, chromium, and cadmium in the water and high levels of Dichloro Diphenyl Trichloroethane (DDT), an organochloride pesticide in the soil. The main source of irrigation for Northern Rajasthan is the Indira Gandhi Canal, the largest canal of India, which comes from the confluence of Sutlej and Beas rivers; both these rivers are now contaminated with industrial waste and pesticides and contain several heavy metals which could be a cause of the highest prevalence of GBC in Sri Ganganagar and Hanumangarh districts.
Data in the present study have been obtained from a HBCR of RCC, Bikaner, and might not represent the exact area-wise distribution of GBC cases in the state.
| Conclusion|| |
GBC cases have shown an increasing trend in the past 5 years in the state of Rajasthan. High incidence is seen in the North-Western districts irrigated by canal water. There is a need to analyze and identify various heavy metal carcinogens in the water and control the modifiable risk factors for reducing the incidence of GBC in Rajasthan.
The authors would like to thank the doctors and support staff of the Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hundal R, Shaffer EA. Gallbladder cancer: Epidemiology and outcome. Clin Epidemiol 2014;6:99-109.
Goetze TO, Paolucci V. Adequate extent in radical re-resection of incidental gallbladder carcinoma: Analysis of the German Registry. Surg Endosc 2010;24:2156-64.
National Cancer Registry Programme. Two-year Report of the Population Based Cancer Registries 1997–1998. New Delhi: Indian Council of Medical Research; 2002.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al
. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.
Kapoor VK, McMichael AJ. Gallbladder cancer: An 'Indian' disease. Natl Med J India 2003;16:209-13.
Sikora SS, Kapoor R, Pradeep R, Kapoor VK, Saxena R, Kaushik SP. Palliative surgical treatment of malignant obstructive jaundice. Eur J Surg Oncol 1994;20:580-4.
Kapoor VK, Pradeep R, Haribhakti SP, Sikora SS, Kaushik SP. Early carcinoma of the gallbladder: An elusive disease. J Surg Oncol 1996;62:284-7.
Pandey M. Risk factors for gallbladder cancer: A reappraisal. Eur J Cancer Prev 2003;12:15-24.
Pandey M, Shukla VK. Lifestyle, parity, menstrual and reproductive factors and risk of gallbladder cancer. Eur J Cancer Prev 2003;12:269-72.
Tamrakar D, Paudel I, Adhikary S, Rauniyar B, Pokharel P. Risk factors for gallbladder cancer in Nepal a case control study. Asian Pac J Cancer Prev 2016;17:3447-53.
Murthy NS, Rajaram D, Gautham M, Shivraj N, Pruthvish S, George PS, et al
. Trend in incidence of gallbladder cancer – Indian scenario. Gastrointest Cancer Targets Ther 2011;1:1-9.
Malhotra RK, Manoharan N, Shukla NK, Rath GK. Gallbladder cancer incidence in Delhi urban: A 25-year trend analysis. Indian J Cancer 2017;54:673-7.
] [Full text]
Sachidananda S, Krishnan A, Janani K, Alexander PC, Velayutham V, Rajagopal S, et al
. Characteristics of gallbladder cancer in South India. Indian J Surg Oncol 2012;3:228-30.
Henley SJ, Weir HK, Jim MA, Watson M, Richardson LC. Gallbladder cancer incidence and mortality, United States 1999-2011. Cancer Epidemiol Biomarkers Prev 2015;24:1319-26.
Bhagabaty SM, Sharma JD, Krishnatreya M, Nandy P, Kataki AC. Profiles of gall bladder cancer reported in the hospital cancer registry of a regional cancer center in the North-East India. Int J Res Med Sci 2014;2:1683-6.
Lowenfels AB. Does bile promote extra-colonic cancer? Lancet 1978;2:239-41.
Sheth S, Bedford A, Chopra S. Primary gallbladder cancer: Recognition of risk factors and the role of prophylactic cholecystectomy. Am J Gastroenterol 2000;95:1402-10.
Shukla VK, Chauhan VS, Mishra RN, Basu S. Lifestyle, reproductive factors and risk of gallbladder cancer. Singapore Med J 2008;49:912-5.
Shukla VK, Prakash A, Tripathi BD, Reddy DC, Singh S. Biliary heavy metal concentrations in carcinoma of the gall bladder: Case-control study. BMJ 1998;317:1288-9.
Unisa S, Jagannath P, Dhir V, Khandelwal C, Sarangi L, Roy TK. Population-based study to estimate prevalence and determine risk factors of gallbladder diseases in the rural Gangetic basin of North India. HPB (Oxford) 2011;13:117-25.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]