SummaryBackgroundPrevious efforts to report estimates of cancer incidence and mortality in India and its different parts include the National Cancer Registry Programme Reports, Sample Registration System cause of death findings, Cancer Incidence in Five Continents Series, and GLOBOCAN. We present a comprehensive picture of the patterns and time trends of the burden of total cancer and specific cancer types in each state of India estimated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 because such a systematic compilation is not readily available.MethodsWe used all accessible data from multiple sources, including 42 population-based cancer registries and the nationwide Sample Registration System of India, to estimate the incidence of 28 types of cancer in every state of India from 1990 to 2016 and the deaths and disability-adjusted life-years (DALYs) caused by them, as part of GBD 2016. We present incidence, DALYs, and death rates for all cancers together, and the trends of all types of cancers, highlighting the heterogeneity in the burden of specific types of cancers across the states of India. We also present the contribution of major risk factors to cancer DALYs in India.Findings8·3% (95% uncertainty interval [UI] 7·9–8·6) of the total deaths and 5·0% (4·6–5·5) of the total DALYs in India in 2016 were due to cancer, which was double the contribution of cancer in 1990. However, the age-standardised incidence rate of cancer did not change substantially during this period. The age-standardised cancer DALY rate had a 2·6 times variation across the states of India in 2016. The ten cancers responsible for the highest proportion of cancer DALYs in India in 2016 were stomach (9·0% of the total cancer DALYs), breast (8·2%), lung (7·5%), lip and oral cavity (7·2%), pharynx other than nasopharynx (6·8%), colon and rectum (5·8%), leukaemia (5·2%), cervical (5·2%), oesophageal (4·3%), and brain and nervous system (3·5%) cancer. Among these cancers, the age-standardised incidence rate of breast cancer increased significantly by 40·7% (95% UI 7·0–85·6) from 1990 to 2016, whereas it decreased for stomach (39·7%; 34·3–44·0), lip and oral cavity (6·4%; 0·4–18·6), cervical (39·7%; 26·5–57·3), and oesophageal cancer (31·2%; 27·9–34·9), and leukaemia (16·1%; 4·3–24·2). We found substantial inter-state heterogeneity in the age-standardised incidence rate of the different types of cancers in 2016, with a 3·3 times to 11·6 times variation for the four most frequent cancers (lip and oral, breast, lung, and stomach). Tobacco use was the leading risk factor for cancers in India to which the highest proportion (10·9%) of cancer DALYs could be attributed in 2016.InterpretationThe substantial heterogeneity in the state-level incidence rate and health loss trends of the different types of cancer in India over this 26-year period should be taken into account to strengthen infrastructure and human resources for cancer prevention and control at both the national and state levels. These efforts should focu...

A 55-year-old postmenopausal lady presented with complaints of bleeding per vaginum and lower abdominal pain for the last 3-4 months. She also had increased body hair for last 3-4 years. She had three children and there was no history of any abnormality during her pregnancy. There was no history of any contraception and exogenous hormone intake.Past medical history was otherwise unremarkable. Family history was noncontributory. Ultrasonography revealed a hypoechoic right adenexal mass measuring 65x40x30mm. This mass was not separated from right ovary. A possibility of ovarian sex cord tumour was given. A total hysterectomy with bilateral salpingooophorectomy was done and the specimen was received in our department for histopathological examination.An already cut open gross specimen of uterus was received measuring 9x6x3.5cm in size with one tube and ovary and other fallopian tube and ovary lying separately in container. Ovarian tumour measured 6x4x3cm. It was replacing whole of the ovary without any peripheral ovarian stroma. Cut surface was solid and yellow in colour [Table/ Fig-1a&b]. Other side ovary was grossly normal. Specimen of omentum measuring 45cm in length was also received.Sections from ovarian tumour showed well circumscribed tumour comprising of large round to polygonal cells with centrally placed nuclei, prominent nucleoli and abundant amount of eosinophilic cytoplasm [Table/ Fig-2a&b]. There was no atypia, mitotic figures or necrosis noted in the tumour. Stroma was scanty. Histological features were consistent with steroid cell tumour NOS type. The cervix showed features of chronic cervicitis while the endometrium showed atrophic changes. The other side ovary and tube was unremarkable. Patient was discharged after 1 week with stable condition and was adviced follow up after 1 month. Patient's excessive hair growth reduced after few months and there were no other complaints. DisCussionThe incidence of steroid cell tumours, NOS is highest in women of child bearing age group, particularly during the third and fourth decades, but in rare cases postmenopausal women or children may also have this tumour. Androgenic manifestations are common in these tumours as they secrete hormones like androstenedione, α-hydroxyprogesterone, and testosterone [1,2].These tumours are known to produce symptoms of virilisation particularly hirsutism. So in cases where there is unexplained hirsutism, ovarian and adrenal tumour association should be ruled out as there may be occult malignancies [3]. However, there may be atypical presentations of these tumours also when they do not show any symptoms of virilisation. In these cases the diagnosis is usually made postoperatively on finding a tumour in ovary [4].These tumours have been divided into three subtypes according to their cells of origin: stromal luteoma, leydig cell tumour and steroid cell tumour, not otherwise specified (NOS). Of these subtypes, the steroid cell tumours, NOS account for about 56% of steroid cell tumours [5].A majority of steroid cell tumour NOS are ...

The State of Punjab has been in focus because of aperceived increasing rate of cancer. Both print and electronic media have created an impression that Punjab, especially the cotton belt of Malwa Region, has become a high incidence cancer region. Actually the increased number of cancer patients might be at least partly because of increasing population and heightened health awareness and reporting. The purpose of this study is to find out the pattern of cancer amongst patients registered in Mukh Mantri Punjab Cancer Rahat Kosh Scheme (MMPCRKS), under cancer registry at Rajindra Hospital Patiala from the various districts of Punjab. The study covers 500 cancer patients registered under MMPCRKS at Rajindra Hospital Patiala, for free cancer treatment. Information regarding age, gender, religion, method of diagnosis and affected sites was obtained. Results were analyzed statistically. Of the 500 patients, 65% were females and 35% were males. The most affected female age groups were 50-54 and 60-64; while males in the age groups of 65-69 and 60-64 had the highest risk. The leading cancers in females were breast followed by cervix and ovary where as in males they were were colon followed by esophagus and tongue. The commonest histological type was adenocarcinoma followed by squamous cell carcinoma. The increasing trend of cancer in Punjab is alarming. Since this study is a preliminary investigation, it could provide a leading role in prevention, treatment and future planning regarding cancer in Punjab.

ABSTRACT

Bronchoscopy is a useful diagnostic tool and fluorescent microscopy is more sensitive than ZN and cytology. On X-ray examination, other diseases like malignancy or fungus can also mimick TB. So apart from ZN staining or fluorescence microscopy, Pap and MGG stain will be worthwhile to identify other microorganisms.