Nagaland tops in Nasopharynx cancer

Zhongshan City in China had the highest AAR both among males and females with 26.8% and 10.7% respectively followed by Nagaland PBCR from India with second highest AAR (6.8) among females internationally. Nasopharyngeal cancer is a rare type of head and neck cancer. Three-year report of PBCR 2012-14, released by the Indian Council of Medical Research (ICMR) on May 18, indicated that in the country, Nagaland has the number one prevalence of Nasopharynx cancer in male and female, with an alarming rate of 15.2% and 6.8% rate per 100,000 populations respectively.

In the overview of the state, the leading sites of cancer among male were Nasopharynx (15.3%), stomach (12.3%), Oesophagus (10.4%), lung (6.1%), hypopharynx (5.9%) and larynx (5.9%). Among female, the leading cancer sites of cancer were Cervic Uteri (16.7%) followed by breast (12.6%), stomach (11.0%), nasopharynx (10.8%) and thyroid (5.3%). The total number of cases registered in the state for 2012-14 was 815 (male) and 546 (female) total cases of 1361.

In the report, the childhood cancers for 0-14 group, in boys the relative proportion was lowest in Nagaland PBCR (0.7%) and highest in Delhi PBCR (5.4%), which are expressed per million children. While in reporting of cancer mortality, Nagaland has recorded incidence of 815 and mortality of only 153. 

In the PBCR Nagaland report, initially the registry covered only two districts, Kohima and Dimapur but as of now the registry covers the whole state. However, National Cancer Registry Programme (NCRP) published data only from Kohima and Dimapur districts as the cases reported meet the expected numbers.

It mentioned that since Nagaland does not have any facility for advanced cancer treatment most of the patients are referred to other hospital outside the state, while one of the main challenges of PBCR is mortality data collection.  According to state Health and Family Welfare department, the state spent Rs. 33,19,96,441 crore for Outside State Treatment (OST) cases during the last two years 2013-14 and 2014-15.

Awareness: Speaking to Nagaland Post, E.N.T. specialist and head and neck surgeon Naga Hospital Authority Kohima (NHAK), Dr. Kedozeto Punyu, said the symptoms of Nasopharynx Carcinoma were neck swelling even without pain (majority), nasal blockage or bleeding, pain in the ear, double vision or headache.

Dr. Punyu asserted that any neck swelling should not be ignored. He informed that the incidence factor could be through genetic factor, food habits and environment, like consumption of smoked/ fermented/salted food or nasal irritation from smoke and burning charcoal and pine trees.

He said that Nasopharynx cancer could be treated through radiotherapy (preferably), surgery and chemotherapy. The doctor, however, said there was only radiotherapy installed in Mokokchung without a physicist to operate. Besides that there was no radiotherapy in other government hospitals except one at Eden Medical Centre Dimapur, which is private.

He stressed on the need to make the existing National Cancer Programme pro active in the state.

Stating that as per WHO, every 10 lakh population should have one radiotherapy, the doctor said the state should have two radiotherapy as per around 20lakh population.

Specialist obstetrician and gynaecologist NHAK, Dr. Imo Temsu said that cervical cancer was caused by Human papillomavirus (HPV) transmitted sexually and showed symptoms through menstruation abnormality.

He said women could protect themselves against cervical cancer through HPV vaccine even at an early age and then have regular Pap tests recommended above 35 years of age, facilities of which are available in the state. 

Dr. Imo said diagnosis at an early stage was curable, however, at a later stage the cancer has to be treated through surgery, radiotherapy (preferable) and chemotherapy.

He lamented that most patients come late due to lack of awareness, especially in rural areas.

Dr. Imo also said that as per WHO recommendation there has to be regular immunization free of cost for age 9-13 years, whereas due to the cost factor of the HPV vaccine India could not take up the programme.