Hospital based cancer registry in Cipto Mangunkusumo hospital Jakarta

(1)

Vol 9, No 3, July

-

September 2000 Cancer in Cipto Mangunkusumo Hospilal Jakarta

l8l

Hospital

based

cancer

registry in

Cipto Mangunkusumo hospital Jakarta

Wilfried

Herdin Sibuea', R

Rukmini

Mangunkusumo#,

Nurul

Akbar', Abidin

Wi-djanarko', Djajadiman

Gatoy', Endang

Windiastuti/, Mochtar

Hamzah*,Sonar

Soni Panigoroo, Joedo

Prihartono', Ening

Krisnuhono#, Lisnawati#, Sri

Mulya

Sekar

Utamiv, Irwan Ramliv,

A

rerdi

Roezin*, Sigit

Pribadin,

Iik

Wilarsoe,

I

Made Nasar#, Santoso Cornain#

Abstrak

Règistrasi kanker berbasis rumah sakit di RSUPN Cipto Mangunkusumo, Fakultas Kedokteran Ilniversitas Indonesia, telah dimulai tahun 1997, bertujuan untuk memberi data bagi program pengendalian kanker dan membantu perencanaan rumah sakit. Makalah ini menyajikan registrasi kanker sepanjang tahun 1997-1998. Data

dari

semua pasien kanker yang baru terdiagnosis dicatat pada

Formulir

Registrasi

Kanker.

Yang

didata

ialah

identitas pasien, demografi

dan kultur, penilaian tumor dan usia,

serta penatalaksanaan. Terdapat 2144 (0.45%ù penderita kanker diantara 444.178 pasien baru yang berobat ke RSCM. Perbandingan perempuan dan laki-laki adalah 1.7

: L

Ilsia terbanyak pada perempuan adalah 35-44 tahun, pada laki-laki 45-54 tahun. Usia rata-rata saat terdiagnosis umumnya lebih muda dibanding senter lainnya. Pada perempuan, kanker terbanyak adalah kçnker servil<s, disusul oleh payudara dan nasofaring sedang pada lakiJaki terbanyak nasofaring, sumsum tulang dan hati. Pada anak, terbanyak adalah leukemia limfositik akut, leukemia non limfositik akut, retinoblastoma dan nefroblastoma. Pendidikan penderita perempuan lebih rendah dibanding laki-laki. Perempuan penderita kanker serviks, kuli!, sumsum tulang, kelenjar getah bening dan laki-laki penderita kanker sumsum tulang, kelenjar getah bening dan mata mempunyai pendidikan yang lebih rendah. Sebanyak 85% diagnosis ditegakkan secara mikroskopik. Jumlah kanker stadium awal lebih rendah dibanding stadium lanjut (47% vs 53%o). Pada tahun 1998

terapi awal yang

paling

banyak diberikan adalah berturut-turut radiolerapi, bedah dan kemoterapi. Hanya 45oÀ pasien yang memperoleh terapi dalam 3 bulan perlama setelah diagnosis.

Abstract

The Hospital Based Cancer Registry in Registry

in

Cipto Mangunkusumo National Center General Hospital (RSCM), the teaching hospilal ol the Faculty of Medicine University of Indonesia, was set up in I 997. Its aims were to provide information on lhe magnilude of cartcer problems, and data _for_{focussing cancer control programs,}to _facilitatethe

follow

up and to help plan _{hospital facilities.} This paper presents a summary ofthe cancer registry data collected during the period of 1997-1998. Datafrom al newly diagnosed cancer patients was recorded in Cancer Registration Forms by the oncologt doctors. The collected items of information were patient's identification, demographic and cultural items, the tumor and its investigalions, and the treatment. There were 2144 (0.48%o) cancer patients among 444,178 new patients treated in RSCM hospilal. The _{female to male palients}

ralio

was 1.7

:

1. The age peaked in females within 35-44 years, and in males within 45-54 years. In general, the mean age al diagnosis ofvarious cancer was younger compared to other centers. Infemales, the most common cancers were cervical, breast, and nasophayngeal, and in males, they were nasopharyngeal, bone maruow, and liver cancers. In children, the most common cancers were acute lymphocytic leukemia, acute non-lymphocytic leukemia, acute non-non-lymphocytic leukemia, retinoblastoma, and nephroblastoma. Female patients had lower educational level than males. Females with cervical, skin, bone maruow, lymph nodes cancer and males with bone maruow, lymph nodes and eye malignancy had lower educational level. There were 85oÀ

palients

diagnosed

by

microscopic examinalion. The number of early slage cancer was lower comed to late stage cases (47o% vs 53%o).

In

1998, the mostfrequen! initial treatment was radiotherapy,followed by surgery and chemotherapy, and only 45% patients received treatments within 3 months after diagnosis.

Keywords: Cancer registry, site, ape, education, staging, diagnosis, trealmenl

v _{Department of}_{Radiologt, Faculty}_of_Medicine_{University of Indonesia,}

Jokarta.

Indonesia

The incidence

of

cancer

in

Indonesia

has

been

* _{Departmenrof ENT,Facuttyof Medicine(Jniversityof}

Indonesia,

observed

to

increase

every year. According

to

_the

Jakarta,

Indonesia

estimation of

_the

Ministry of

Health

_{the incidence rate}

'o;i,ï:::;',f,fl!;:::';:r:#,fl,T:;:"!:y,;o*

ttvorMedicine

of

_cancer

was about

looper

_{100.000 people-r}

As

_the

t _co^put",_Sii*ce_{Center, IJniversity of Indones'a,}

Jakarta

people's

awareness

about this dreaded

disease

_is

'

Department of Internal Medicine, Faculty of Medicine University of

I ndo nes ia, Jakarta, I ndo nes ia

n Department of Anatomic Pathologt, Faculty of Medicine IJniversity of I ndo nes ia, Jaka rta, I ndo nes ia

I

_Department_of_{Pediatric, Faculty}_of_Medicine_{[Jniversity of Indonesia,} Jakarla, Indonesia

- _{Department of}_{Dermalologt, Faculty}_of_Medicine_University_of

I ndo nes ia, J ako rta, I ndo nes ia

t

_{Department of}_Surgery,_{Faculty of Mediéine University of Indonesia,} Jakarta, Indonesia

(2)

182

Sibuea et al

growing,

it

is of

interest

to

see

that

several

social

organization

for

cancer

control

have been established such as

Nederlands Indische Kanker

Instituut

in

1933

in

Bandung, Cancer foundations

in

several

cities

in

In-donesia, Wisnuwardhana

Cancer

Foundation in

Surabaya, and Indonesian Cancer Foundation (Yayasan

Kanker Indonesia)

in

1977

in

Jakarta,

followed

by

establishment

of

its

branches

in

27

provinces in

Indonesia.2

Since

1989

the Ministry

of

Health

has

actively

par-ticipated

in

Cancer

Control

and

instructed to

establish

a

hospital-based Integrated

Cancer

Control

Team

(ICCT) in

every

big hospital.

In

1996, such a team has

been

established

in

Cipto

Mangunkusumo National

Center General

Hospital (RSCM) which

functions

as

the

teaching hospital

of

Medical Faculty

of University

of

Indonesia

and

the top

referral hospital

in

the

Western

part

of

Indonesia

by

the

director

of

the

hospital

and

with

the

approval of

the Dean

of

Medical

Faculty,

University

of

Indonesia. One

of

the

tasks

of

this

team

is

to

perform hospital

based cancer

registry,

which

will

provide information on the

magnitude

of

cancer problems

and

data

for

focussing

cancer

control,

i.e.

the

total number

of

patients annually,

site

of

cancers,

data

on

survival

of

patients,

the

ratio

between

localized

and

advanced cases

at

the

time

of

diagnosis.3

In

addition,

to

facilitate the

follow

up

of

all

patients

and

to

furnish

information about

the

demands

made

by

cancer patients

on

the

facilities,

equipment and human resources

of

the hospital.

This

paper presents

a summary

of

the

cancer

registry

data

collected during

the period

of

1997-1998.

Ten most

frequent tumors were given according to

gender.

The

data was analyzed against age,

clinical

and

histo-pathological diagnosis, extent

of diseases

and

the

nature

of initial

treatment

given to

cancer patients

in

1998.

They were

also evaluated against demographical data

in particular

educational

background

and age.

MATERIALS

AND METHODS

The

Hospital

Based Cancer

Registry

in

Cipto

Mangun-kusumo

Hospital was

officially

established

in

1997.

To

enasure

an

easy

collection

of

data

from

different

department

which

were treating cancer,

a Cancer

Registration

Form

(CRF)

was developed based on the

form

issued

by

the

Ministry

of Health

in

1995.

Data from

all

newly

diagnosed cancer patients who

visited Cipto

Mangunkusumo

Hospital from

January

l,

1997

until

December

31,

1998

was

recorded in

Med J Indones

CRF.

Table

1 shows

the

items

of

information

which

should be collected.a

Table l. Items of Patients Information which should be collected in

the Registration Form

No. Items of Information No. Items of Information

l.

Name of Hospital

2. Code of Hospital 3. Medical Record Number

4. Cancer Registry Number 5. Name of Patient 6. Number of Identity Card 7. Gender

8. Date of Birth

9. Address

10. Racial Group I

l.

Religion

12. Marital Status

13. Education

14. Occupation

15. Type ofPatient 16. Incidence Date

17. Most Valid Diagnosis

18. Clinical Diagnosis

19. Primary Site: Topography (ICD-O) 20. Histological Diagnosis 21. Morphology (ICD-O)

22. Clinical Extent of Disease before Treatment

23. Multiple Primary Neoplasm 24. Dateof Death

25. Cause of Death (ICD)

26

Name of Oncologist

27

Name ofSupervisor

The

form

were sent

to

cancer

treating

departments and

were

filled

and

completed

by

the treating

medical,

surgical

or radiation oncology

doctors

and

approved

by their

supervisors. Then these

forms

were forwarded to the

Hospital

Cancer

Registry

for further

pJocessing:

coding,

verification, analyiis

and reporting.s'6

For

the

coding

of all

registered

tumors, the

second

edition of

the

International Classification

of

the

Diseases

for

Oncology

(ICD-O)

was used.7

In

this

study the

level

of

education

from

all

patients was recorded and was used

to

examine whether

there was a

differential

change

in

cancer

prevalence

across

educational categories.

It

was

categorized

into

illiterate

(unable

to

read and

write),

able

to

read

and

write,

elementary

school

graduate

(six

years

of

schooling completed),

junior high

school

(9

years

of

schooling completed), senior

high

school

graduate

(twelve

years

of

schooling completed),

academy or

university

graduate

(more

than

15 years

of

schooling

completed). Beginning

from

1998

on, the information

about the nature

of

initial

therapy and

the data

on

which

therapy commenced were also

collected.

RESTJLTS

AND DISCUSSION

A

descriptive study

was

completed

from January

I,

1997

until

December

31,

1998. There were 444.178

new

patients suffered

from

various

diseases who

visited Cipto

Mangunkusumo

Hospital,

among

them

2144

(O.48Vo)

were

cancer

patients, consisting

of

798

(0.l8Vo)

males

and

1346

(0.30Vo)

females.

Sukardja

reported

2.957o cases

of

the total admitted

patien-ts')

(3)

Vol 9, No 3, July

-

September 2000

was

l.2Vo.

The

female

to

male

ratio

was

3.4:2

(1346:798),

the

similar ratiorwas

reported

by

Sukardja

but it

was 2:3

in Singapore."

Age and Site of Malignant Neoplasm

The

number

of

cases

by

primary site and age

in

females

and

males

are

shown

in

table

i

and

ii

(appendix), respectively. Cancer could

be

found

at

any

age.

The

age ranged

from

several

months to

over

65

years,

with

a preponderance

of

cases between

35

-64 years and a peak

within

35 -

44

years

in

females,

<5

5.-14

15-24

25-34

35-44

45-54

55-64

>65

[image:3.595.77.571.88.705.2]

100 1

50

200

2s0 Figure

I.

Age distribution of malignant neoplasm in 2 I 44 patients.

Cancer'in Cipto Mangunkusumo Hospital

Jakarta

₁₈₃

while

in

males

the

preponderance

of

cases

was

more than

45

years

of

age and a

pea\ within 55

-

64

years

(figure

1). The study

of

Sukar-djae showed preponderance

of

cases between 35

-

64 years and a

peak within

45

-54 years

in

males as well as

in

females. These

ages were younger than

in

the developed

countries, over

75

years

in

the

Philippiner2

and

in

Singapore."

The number

of

cases occurred

in children before

5 years

of

age

were

95

(4.4Vo)

and

in

the

age

group

of

5

-

14

years

were

128 (6Vo).

The

number

of

males

was higher than females. These

figures

were

similar to

that

in

Singapore.rr

300

350

798 males and l346females 400

Table 2. Number of New Cases in Ten Most Frequent Cancers by Age and Site

ffi

h{al*

{],J

Fenr*ie

Age

Topography _Total _Rf*)

<5 5-14

t5-24

25-34

35-44 45-54

5s-64 >65

Cervix uteri

Nasopharynx

Breast

Bone marrow Colorectal Lymph nodes

Skin Liver Thyroid Eye

0 0 0 45 0

,6

3

0 0

t2

I 6

0 64 0

10

I

0

9

I t6 2 t2 5 7 I

0

6 1

JJ

23

^/.3 12

19 t4 3 5

22

6

94 27 JI

13

3l

l8

35

29

13

9

39

ll

8

2

1',l

9

38

21

5

7

164

150

55

57

61

41

13

10

21

28

16

912

14

20

18

13

5

13

482

22.48

195

9.09

172

8.02

171

7.98

114

5.32

108

5.04

102

4.76

90

4.2

't7

3.59

62

2.89

Total 66 92 51 160

388 353

306 157 t573

Percentage

*) Rf = Relative frequency

(4)

184

Sibuea et

al

The number

of

ten most frequent cancers was

1573 cases, representing 73Vo

(1573

:2144) of

all cancers

(table 2). The most frequent

canber encountered was

cervical (22.5Vo),

followed by naso-pharyngeal

(9Vo),

breast (87o),

bone marrow (8Vo), colore*tal

(5.3Vo),

lymph nodes (57o),

skin (4.87o),

liver

(4.2Vo), thyroid (3.67o) and eye (2.9Vo).

Cervical carcinoma and breast

cancers were more frequent

in the age group of 35-44

years, nasopharyngeal

cancer

in

45-54 years,

bone

marrow

in

0-15

years and

colorectal

in

55-64 years.

The data

collected

by Sukardja

in

East Java shpwed

that

the

most frequent cancer was cervical

cancer,

followed by liver

and breast

"ancer.n

Table

3.

Mean and Median Age at Diagnosis in Ten Most Frequent Cancers

Cancer

Total

Cases

Mean Median' Cervix uteri

Nasopharynx Breast Bone marrow Colorectal Lymph nodes Skin Liver Thyroid Eye

[image:4.595.80.573.400.707.2]

ln years

Table 4. Number of New Cases in Ten Most Frequent Cancers in Females by Age and Site

Med J Indones

The mean age at diagnosis

of cervical

cancer was 47.8

years and breast cancer was 45.5

years (table 3). In

USA

these cancers

were diagnosed at older

age,la'ls

while the

mean age

of

cervical cancer and

breast

cancer

was

54

years

and

57

years

respectively.

According to Ramli,le the mean age

of

breast cancer

was 46.9 years. The median age

of

nasopharyngeal

carcinoma was 43 years, younger than

the study

of

Sudipto

et al who found 50years as the median age.r6

In

females

the total

number

of ten

most frequent

cancers was 1102 (82Vo), and the most

frequent cancer

encountered

was cervical cancer and

the second was

breast cancer (table

4). In other countries of Asia like

the

ast,

cervical

rs were

the

ones,

and

y

were

cer

esophageal

iupunt3

and

USA,

cancer

of

the cervix

has been steadily

decreased.

In

USA,

it

only ranked

as cancer number eight.ra

In Japanl3

and Singaporell

breast

cancer was

also increasing

while

in

USA

it

was

32Vo

of

all

cancers in females.15

482

47.8

47

195

42.9

43

r72

45.5

44

t7

|

18.5

l0

tt4

48.5

49.5

I

l0

39.3

42

r02

58.2

60

90

54.2

5'l

77

41.6

39

62

34.9

36.5

Age

Topography Total

Rf

<5

5-14 t5-24

25-34 35-44 45-54

55-64

> 65 Cervix uteri

Breast Nasopharynx Throid

Colorectal

Skin

Bone marrow Ovary Lymph nodes Placenta

0

0 0

I 20 0 2

0 I 0 I 0 0 I

l3

2

0

33

23

7

l9

t64

6l

20

l6

ll

4

6

l8

l6

8

150

4l

2l

11

ll

5

94 36 7

9

t7

2l

7

l0

7

0 39

8

2

4

1l

27 0

J I

0

482

t7l

63 63

62 62 59 59

35.8 12.7 4.68

4.68 4.6t

4.61 4.38

4.38 1

2

5

4

5

I

3

8

3

7

4

8

0 ,|

2 6

t0

6

21

45

3.34

36

2.6',1

(5)

Vol 9, No 3, July

-

September 2000 Cancer in Cipto Mangunkusumo Hospital

Jakarta

185

Table 5. Number of New Cases in Ten Most Frequent Cancers in Males by Age and Site

Age

Topography Total

Rf

<5

5-t4

15-24

25-34

35-44

45-54 55-64 >65

Nasopharynx Bone marrow Liver Lymph nodes Colorectal Skin Eye Bladder Prostate giand Kidney

0 25 0 4 t, 2

9 0 0 5

5

5l

I 8 0 0 7

0 0 I

36 6

18 8

10 7 6

8 2

2 20

6

l8

ll

14 14

7

t4

7

3

9 2

l9

8

6

l1

4

,7

20 2

16.5

l4

8.77 '1.89 6.52 5.01 4.64 4.51 3.63 2.26

il

9 0 4 0 0

I I 0 0

132 112 70 63 52 40 37 36 29

l8

16

35

67

4

l0

812

t2

10

l5

I.J J

33

00

32

589 88

88

l14

87 53

26 73

45

Total

The number

of

ten most frequent

cancers

in

males

was 589

represented 14Vo

of all

cancers

in

males

(table

5).

Nasopharyngeal carcinoma

(NPC)

was

the

most frequent cancer

encountered,

followed by

bone

marrow

and

liver

malignancy.

Nasopharyngeal

malignancy

was more

frequent

in

the age group

of

45-54

years,

bone marrow

in 0-14

years and

liver

in the

age

group

of >65

years.

The

number

of NPC's

cases

Tabel 6. Number of New Cases in Four Most Frequent Cancers in Children by Age and Site

ICD-O

Site

cD2t

Bone

Marrow

Acute leukemia, NOS Acute lymphocytic Acute non-lymphocytic Chronic lymphocytic Chronic myelogenous

Lymph nodes

Burkitt's lymphoma, NOS Hodgkin's disease, NOS Non Hodgkin's lymphoma Carcinoma, unditïeren ti ated Squamous cell carcinoma Eye

Neuroblastoma

Squamous cell carcinoma Rhabdomyosarcoma Retinoblastoma

Kidney

Nephroblastoma, NOS Neoplasma, malignant Carcinoma, NOS

Clear cell sarcoma of kidney c770-779

in

males

were

132 and

in

females were 63 cases.

Male

to

female

ratio

was 2.1:1.

Accordrng to the

study

of

Sutjipto

et

al,

the

number

of

NPC

in

the year

of

1980-l98l

in

our hospital

was 219 cases, 154 males and 65

females,l6

but the male

to

female ratio was

similar.

This

cancer

ranks number

five

in

Singapore

and

number

seven

in

the Philippines but

in

Indonesia

it

remains the most

fiequent

cancer

in

males.

Total

All

M

All

<5

M Age

c690-699

20 25

45

000

t2 23

35

628

000

202

246

000

t45

t0l

000

39t2

000

0ll

38il

358

257

l0l

000

33

76

0l

20

6l

ll

12

00

22

4t2

1t

02

28

l0

0l

165

02

00

t5

ll

2

69

'75

l0

0l

109 I

8l

23 0 4

t6

2 2

l0

I I

2t

2

0

6

l3

15

l2

13 51

64

011

83846

5 r0

15

000

022

2810

lt2

022

t45

000

0ll

279

022

000

055

202

617

4t5

000

r05

t0t

[image:5.595.72.578.101.274.2] [image:5.595.79.571.389.714.2]

(6)

186

Sibuea et al

In

children, malignancy

of

the bone marrow,

eye,

lymph

nodes

and

kidney

were

the

most common

cancers

[table 6

and

table

iii

(appendix)]. The male of

female

ratio was 1.6

:

1. Among 109

cases

of

bone

marrow malignancy,

there

were lO5

(96.3Va) cases

of

acute leukemia consisting

of

8l

(74.3Vo) cases of

acute

lymphocytic leukemia,

and

23 (2l.l%o)

cases

of

acute

non-lymphocytic leukemia. There were 4

cases

of

chronic myelocytic leukemia.

Thirty

five

(35) patients

of

acute

lymphocytic leukemia

aged less than

5 years and 48

cases

were

in

the

age

group

of

5-14

years (table

6).

Male

to

female

ratio

was

3:l;

the mean age

at the time

of

diagnosis was 6

years (table

7\.

These

fisures were similar

to

dala

in

the

Pirilippines'2

u"no

us,q..'o The most common tumor

of

the

eye was

retinoblastoma

(62Vo)

in which

female

to

male ratio was 5.5:1, and

the mean age

at

the

time of

diagnosis was

4

years.

There were

ll

(84.6Vo) patients

aged

below

5

years.

In

Surabaya,

the

number

of

retinoblaçtoma patients

were 29.5Vo

of all

eye cancers

and female

to

male

ratio

was

1.5:1.2r

In

USA,

the

number

of

females was higher than males,

the

age peaked

at

l7

months,

and 90Vo

of

the

cases occurred

below

5 years

of

age.22

The most frequent

cancer

of

the

kidney

was nephroblastoma (80Vo), female

to

male

ratio was

1.4:1, the mean age at

the time of

diagnosis

was 3

years,

and the

age peaked less than

5

years. In

USA, the

mean age

at

diagnosis was

2.5

yeurr."

Among

the

malignancy

of

lymph

nodes,

non-Hodgkin's

lymphoma

was

the

most frequent

one (22.2Vo).

The

mean ag_e at the

time of

diagnosis was 5

Med J Indones

years

and

male to female ratio

was 4:1.

In

USA,

the

ag

and

it

was

2.5 times

greater

in

Table 7. Mean

and

Median

Age

at

Diagnosis

in Four

Most

Frequent Cancers

Cancer Total

cases Mean*

Median'

Acute lymphocytic Acute non-lymphocytic Retinoblastoma Nephroblastoma, NOS Non-Hodgki n's lymphoma * in years

[image:6.595.96.538.455.695.2]

Education

Figure

2

presents

the number

of new

cases

according

to educational level and gender in 2144 patients,

798 males

and

1346 females.

There were 280

(35Vo)

mgle

patients

who

belonged

to

lower

educated

group

(illiterate-elementary)

and 375

(477o)

to

higher

educated

group

(high

school-university),

but

in

females, thera

were

643 (48Vo) patients

with low level

of

education and

509

(38Vo)

parients with high level

of

education.

It

is

clear

that the

number

of

male patients

in

the

higher

educated

group

was greater than

in

the

lower,

while

among

female

patients the

number

of

lower

educated

group was

greater

than the higher

one.

81

23

13

t2

l0

65

66

43

JJ

54

Not

Known

Acad/Univ

High School

Elementary School

llliterate

lJ {::ctnair

Figure 2. Distribution of New Cancer Cases according to education and greater

(7)

Vol 9, No 3, July

-

September 2000

Table 8. Education Level in Ten Most Frequent Cancers in Females

Cancer in Cipto Mangunkusumo Hospital Jalcarta 187

Topography Illiterate Elemertary

School

Academy/

University KnownNot High

School Total

482

t7t

63 63 62 62 59 59 45 36 27

43

ll

t7

4 7 23

2 25

0 10

1l 2 4 5 0 0 4

I

3

154 82 25

2l

3l

15 6 22

6 23 218

30

2t

17

t4

23 10 22

t2

8

'13

5

4 4

8 t7

20 9

I

2 Cervix uteri

Breast Nasopharynx Thyroid Colorectal Skin Bone marrow Ovary Lymph nodes Placenta

Total t43 375 159

lt02

Percentage t3 34.0 34.9 3.6

144

100

ln

females,

the

number

of

patients

with

cervical

(60Vo),

skin

(64Vo),

ovary

(52Vo)

and bone

marrow

(5OVo) cancer was

higher

in

lower

educated group,

but

more patients

with

breast, thyroid,

nasopharyngeal

and

colorectal

cancers

were found

in

higher

educated group (table

iv

and 8). Figure 3 shows the most frequent cancers

in females

with low level

of education.

Low

educational

level

of cancer patients was

a

significant

risk factor

for

cervicalls

and breast cancers.re

Table

v

and

table 9

show the

number

of

new

cases

by

primary

sites

and

education

in all

and ten

most

Ceruix uteri

frequent cancers

in

males

respectively. The number of

patients

with

bone marrow,

lymph

nodes

and

eye

malignancies

was higher

in

lower educated

group,

while the

other numbers were

in

higher

educated group.

Most

of patients

with

bone

marrow malignancy

were

acute

leukemia

(l}4lll2 -

93Vo)

with

the

mean age at

diagnosis

was

in

the preschool

period (6

years

of

age),

so they

could

not be

included

in

lower

educated

group.

The similar fact

also occurred

in

eye

malignancy.

[)

Lriv

r'"ifrir;rriiçrrli ievûi ffi i llr".11

edLitliili"lrtl

ietrÇ,1

Bone

marrow

Ovary

350

300

250

200

150

100

50

0

[image:7.595.78.570.100.300.2] [image:7.595.145.561.498.696.2]

(8)

I

88

Sibuea et aI

Table 9. Education lævel in Ten Most Frequent Cancers in Males

Med J Indones

Topography _Illiterate Elementary

School SchoolHigh

Academy/

University KnownNot Total Nasopharynx

Bone marrow Liver Lymph nodes Colorectal Skin Eye Bladder Prostate Kidney

5 30 4 6 0 4 24 I

1

4

31 36 9

13

l4

I2

2 1l

l0

I

60

t4

23

l4

30

I7

8 l'7 8 8

t4

I

l0

2 4

5

1 6 t0 4

22

3l

24 28 4

2 2 I 0 l

132 112 70 63 52 40 37 36 29

t8

589 115

57

le9

139 79

Total

Percentage 13.4 23.6 33.8 9'7 19.5 ₁₀₀

Clinical Extent

of the

Disease

Table

vi

presents

the

number

of 1617

new cases

by

primary sites and staging.

The number

of

_cancer

patients

with

stage

0

I

(localized)

43.85Vo,

₎

22.02Vo, stage

trI

(regio

₎

2l.83Vo

and stage

fV

There were

i71

cases

of

bone

mzrrrow malignancy

consisting

of 131

(76.6Vo) cases

of acute

leukemia,

24

Table 10. Primary site and staging in ten most frequent cancers

(l4%o) cases

of chronic leukemia,

I

_(0.6Vo)

leukemia

NOS,

6

(3.5Vo)

multiple

myeloma,

6

_(3.5Vo)

polycythemia vera

and

3 (l.8Vo)

others.

The

data

of

ten most frequent

cancers

as

presented

in

table

l0

showed

two different

patterns,

namely tumors mostly

found

in the

early

stage (stage 0-I) and

tumors mostly

found in

the

late stage (stage

II-IV).

The former

_one

consisted

of

cervical, skin, thyroid, ovary and

eye

(figure 4), while the latter

were nasopharynx,

breast,

colorectal, lymph

nodes and liver cancers

(figure

5).

Extension

sr.0

_st._I _sr.₂ _sr.₃ _sr.₄ _Total Cervix Uteri

Nasopharynx Breast Colorectal Lymph nodes Skin Liver Thyroid gland Eye

Ovary

14 0

5

4 0 6 0 0 5 4

234

8 73 42

5 60 6 45 23 25

162

l9

6 20 8 15

2 6

l5

l8

t'7

14t

53 14 93 8

8l

l8

4 2

8

4 24 t7 4 I I 4 5 J

435 t72

161 97 110 90 90 t3 52 52

Total 38 521 271 _7t 71 _t332

Pecentage

St _{= Staging}

[image:8.595.72.517.510.713.2]

(9)

Vol 9, No

j,

July

-

September 2000

300

250

200

[image:9.595.83.573.85.466.2]

Ceryix

Uteri

Skin

Figure 4. Five most _frequentcancers _{found in}the early stage

200

150

100

50

0

Nasopharynx

Breast

Figure 5. Five most _frequentcancers _{found in}the late stage

Table

vii

shows

the number

of

all cancer

patients by

sites, education and staging.

The

number

of

stage 0

and

II

cases

with low

educational

level

was

greater

than the

high

one

(3.2Vo

vs lVo,

l3%o

vs l07o), while

the number

of

stage

I,

III

and

fV

cases

were

lower

in

patients

with low

educated

group

compared

to

the

high

educated

one

(2l%o

vs

22.9Vo, 8.7Vo

vs

l2%o,

4.lVo

vs 5.6Vo).

Table

11 shows the

correlation

of low

and

high

educational

level

and staging

in

1015 cases

of the

nine most frequent

cancers.

The number

of late

stage cases (stage

II-IV)

in

cervical

cancer was

higher

in

the lower

educated

group

compared

to

the

higher

educated

group (122

vs

55). The

same

comparison was found in lymph

nodes (20

vs 8), skin

(11

vs

10) and eye

malignancies (21 vs 3).

This

condition might

be related

to the fact that a great

number

of

patients

had

low

level

of

education.

Good

education would

contribute

to a good

knowledge

about

health

care and

to

a

greater chance

for

having

a

job.

On the other

hand, low educational

level would result

in

unemploy-Cancer in Cipto Mangunkusumo Hospital Jal<orta 189

i-J

firriri

:;ilrrJc

iij

i-,,ric

jïi:riiÊi

,

Thyroid

gland

Eye

Ovary

|-"1 il-1.,t ;,,,, ..-i.i f:t:

ËËi l- itli{,, ;i.:-r il{..

Colorectal

Lymph nodes

ment

and

low

socio-economical

status. Consequently,

the

health care

including

cancer screening

would

be neglected.

The

Most

Valid

Basis of Diagnosis

of Cancer

Table

viii

shows

the most

valid basis

of

diagnosis

for

selected

sites,

1366 (63.7Vo) cases

were

diagnosed

by

histopathology

of

primary

tumor, 251

(ll.7Vo)

by

histopathology

of

metastases,

265

(12.480) were

diagnosed

by

cytology/hematology,

72

(3.3Vo) were

diagnosed

by

clinical only,

173 (8.lVo)

by

clinical

investigations

(X-ray,

USG etc),

11

(0.1Vo)

by

exploratory surgery,

and 6 (O.O3Vo)

by

bochemical or

immunological

test. Thus,

there were

88Vo caes

which

were

diagnosed

by

microscopic

examinations_

and, in

fact,

was higher than

in

Singapore

(76.4Vo),11

and in

the

Philippines (52.5Vo

in

males

and

63.2Vo

in

females).''

150

'100

(10)

190

Sibuea et al

Table I

l.

Nine most frequent cancers by staging and educational level

Med J Indones

St-0 St.III St-IV

ICD.O Description

LEG* HEG** LEG HEG LEG HEG LEG HEG HEG

C539

Cervix Uteri

Cl l0-l

l9

Nasopharynx

C500-509

Breast

Cl80-218

Colorectal

C77O-7'|O

Lymph nodes

CM0-449

Skin

C2200

Liver

C739

Thyroid gland

C690-699

Eye

75134

002

I

3

t3

l3t4

003

4t14

002

0010

32t4

9l

4 45

2'l I 2l

4

2t

7

108

4

I 5

4

9 0

4

l3

47

t2

4

l4

4 6 2 I 2

l0 -50 t3

) l3

2

0

5

4

5 '74 26

l2

3

4

2

l0

0

-t

3 15

l0

I

0

4t4

150 125

94

32

8l t4 5-5 -50

4

I

4

6 3 0 3

.J 4

35

t48

221

226

l4 l6

100

34 28

134 98

9l

t5

22 22.3

l4

l6

Percentage

* _LEG_{= [,ow}_educated_group_(illiterate,_{able to}_write_{and read,}_elementary) ** _HEG_{= High}_educated_group_(unior_and_{senior high school,}_academy)

Histological

Types

Table

ix

shows

the

number

of

cases

in

ten

most frequent cancers

by histological

type.

As

the diagnosis

of

the

hepatoma

was merely made

based

on

USG

examination,

it

became

exceptional

and consequently,

the

ovarian cancer was

chosen as

tumor

number

ten.

The most frequent

histologic

subtype

of

malignancies

in

cervic the was

keratinizing

squamous

cell

carcinoma

(60.4Vo),

in

nasoprahy was

undifferentiated

carcinoma

(79Vo),

in

the

breast

was invasive

ductal

carcinoma (58.lVo),

in

the bone marrow was

acute

lymphoblastic leukemia

(50.3Vo),

in

the

colorectum

was

adenocarcinoma

(68.4Vo),

in

the skin

was

basal

cell

carcinoma

(50Vo),

in

the thyroid was

papillary

carcinoma

(63.67o)

in

eye was squamous

cell

carcino-ma

(25.8Vo),

and

in

the ovary was

adenocarcinoma (35.6Vo).

This tabulation

data can be used as guides on

histological analytical study

or for

future

research purposes.

The number

of

squamous

cell

carcinoma in

cervical cancer

was

significantly

higher

than

adenocarcinoma

of

the cervix.

In

USA,

the

annual

incidence

of

squamous

carcinoma

has been

deelining

steadily

but

adenocarcinoma

has

not. The

decline

might be

burden

to

the

department

of

radiotherapy

and

surgery.

Good

planning

and

effort

should

be

made

to

prevent

shortage

in

operating theaters

and

radiotherapy equlpment.

Table 12. Nature

of

Initial

Treatment

on

ll88

new cancer patients

in

1998

Treatment Number Percentage

Radiotherapy

Surgical treatment Chemotherapy Hormonal therapy Combination Immuno therapy

339

326

lt7

11 8

385

28.5

27.4 9.8 0.9 0.7 32.4

Total I 188

From figure 6,

it

can

be

seen

than

49I

(417o)

cases

were treated

within than

I

month,

29

(2Va)

cases

within

I

month,

ll

(l7o)

cases

within

2

months,

3

(0.27o)

cases

within

3

months

and

the

delayed

treatment consisted

more

than

4

months

after

diagnosis.

There were also 602

(517o)

cases

which

were

not known. The

delayed treatment

group

and the

not

known

status

might

be

due

to

the

poor

socio-economical

condition

of

the patients, and

it

would

increase the

risk of

treatment

failure.

[image:10.595.77.586.105.277.2] [image:10.595.335.577.458.608.2]

(11)

Vol 9, No 3, July

-

September 2000

41"/"

CONCLUSION

1.

During

the

period

of

1997-1998

out

of

444.178

patients

of all

patients treated

in

Cipto

Mangun-kusumo hospital

were 2144

(O.48Vo)

cancer

patients.

The

number

of

female patients

was

1.7

times greater than the males.

2.

The

age peaked

àt

35-44

years

in

females,

and at

45-54

years

in

males.

In

general, the

mean

age at

diagnosis

of

various

cancers

was

younger

com-pared

to

other centers.

3.

In

females

the

most common malignancies

were

cervical, breast

and

nasopharyngeal

cancers,

while

in

males

they were

nasopharyngeal, bone

marrow and

liver

cancers.

In

children the

most

common malignancies were acute

lymphocytic

leukemia, acute non-lymphocytic leukemia,

re-tinoblastoma,

nephroblastoma and

non-Hodgkin's

lymphoma.

4.

The number

of

female patients

with

low

education-al level

was greater

than the male

ones. Female

patients

with cervical, skin,

bone

marrow,

ovary,

lymph

nodes

malignancies

and male patients

with

bone

marrow,

lymph

nodes and eye malignancies had

lower

educational level.

5.

The number

of

the

late

stage cancers

in

cervical,

lymph

nodes,

skin

and eye cancers was

hrgher

in

lower

educated

group

compared

to

higher educated group.

6.

The

majority of

patients

(857o) was diagnosed

by

microscopic examination.

The

number of

the

Cancer in Cipto Mangunkusumo Hospital Jakarta 191

51%

)

tr<1

month

(41%) tr1

month

(2%)

û2

months

(1%)

E3

months (0.2%) [image:11.595.74.576.72.817.2]

tr4

months

(1%)

@> 4 months

(4%) ENot

known (51%)

Figure 6. Time between the riata of diagnosis and the initiation of cancer therapy

early

stage cancers

was lower

compared

to

the

late

stage cancers (47Vo vs 53Vo).

7.

The

most

frequent

initial

treatment

given

to

cancer patients

was radiotherapy,

followed

by

surgery and chemotherapy.

8.

In

1998, only

45Vo

patients received

treatments

within

3 months

after

diagnosis.

Acknowledgement

The

authors

would

like to

thank

Dr.

Helmy

Rustam

MM,

Dra.

Sri

Sulistyoningsih,

and

the staff

of

depart-ment

of Medical

Record,

all

doctors

from

the

cancer

treating

departments

in Cipto

Mangunkusumo

Hospi-tal

for

their excellent

care and data

collection.

Special thanks

to

Dr.

Suzanna

Ndraha

SpPD and

Mrs

Maryati

for

their

helps

in

data

computing

and secretarial works.

This

work

was

supported

by

Cipto

Mangunkusumo

National

Center General

Hospital (RSUPNCM) with

the

approval

of

the

Dean,

Faculty

of

Medicine,

University

of

Indonesia,

No.

30/SKB

|FKJUU9T,

and

was partially supported

by

the

Indonesian

Cancer Foundation.

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Comparative study of the two-period of epidemiological analysis of risk factors for breast cancers

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in

Soetomo Hospital, Surabaya, Indonesia.

In :

'Ijokronegoro

A,

_Himawan_S,_{Jusuf A,} Susworo, Aziz

MF,

Djakaria

M

(eds). Cancer

in

Asia

Pasihc,

vol l,'

Yayasan

Kanker

Indonesia, Jakarta, 1988:437-41.

Mcintosh JK, Cameron RB. Malignancies of the eye. In:

Cameron

RB.

Practical

Oncology.

Prentice

Hall International Inc., New Jersey 1994: 575-80.

Nord RG, Filmer RB.

Wilms'

tumor.

In:

Cameron RB. Practical Oncology. Prentice Hall International Inc., New Jersey 1994: 593-8.

Santana

V.

Childhood lymphoma.

In:

Cameron RB. Practical Oncology. Prentice Hall International Inc., New Jersey 1994: 588-92.

Ross

RK,

Henderson

BE,

Peters

R,

Mack

T. Epidemiology in relation to cancer control in the USA. In: ljokronegoro

A.

Himawan S, Jusuf

A,

Susworo, Aziz

MF, Djakaria

M

(eds). Cancer

in

Asia Pacific,

vol

1,

Yayasan Kanker Indonesia, Jakarta, 1988: 23-36.

5

t5

t6.

17.

t8. 6

7.

8

9

22

23.

24.

25

ll.

12.

t3

l4

19.

20.

2t

(13)

Vol 9,

llo

3, July

-

Jakarta 193

Appendix

Table

ia.

Numbers

of

new

cases

by

primary

site and

age

in

females

ICD-O

Description

<5

5-14

ls-24

2s-34

3544

45-54 55-64

>65

Totat

Rf

C0l9

Base oftongue

CO2O-O29 Oau parts of tongue

C041-049 Floor of mouth

C050-059 Palate

C060-069 Oau parts of mouth COTO-O79 Parotid gland

C080-089 Oau major salivary glands

C090-099 Tonsil

Cl0O-109 Oropahrynx

Cll0-l19

Nasopharynx Cl50-159 Esophagus Cl60-169 Stomach

CITO-179 Small intestine Cl80-218 Colorectal

C220

Liver

C239

Gallbladder

C24L

Ampulla of Vater

C250

Head ofpancrcas

C300

Nasal cavity

C3l0

Maxillary sinus

C340

Bronchus and lung

C398

Overlap.lesion ofresp. syst. and intrathoracal organs

C4O2

Long bones of lower limb

I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 I 0 0 I 0 0 0 I 0 I 0 I 0 I 0 0 0 0 0 0 0 0 I 0 0 I I I l3 0 I 0 0 0 0 I

)

0 0 0 0 0 0 0 7 0 0 0 7 l 0 I 0 0 I 0 0 0 I 6 0 2 I I 23 I I JJ

)

2 l0 2t

)

2 6

)

0 0 0 I 0 5 0 2 0 5 0 0 0 0 0 3 0 I 0 2 0 0 0 20 0 0 I

ll

4 I 0 0 0 0 0 0 0 3 6 0 4 0 0 6l 3 7 t64 0 2 l8 8 0 4 2 0 I I l6 0 I

6168

0 6 0 2 2 0 0 0 0 2l 0 0 2

ll

2 0 0 I 2 I 0 0 0 l 4 0 5 2 l I I 0 -t 0

140.3

I

13

0.97

0

I

0.07

0

8

0.59

140.3

0

5

0.37

0

I

0.07

0

3

0.22

000

2 63

4.68

I

2

0.15

0

3

0.22

o40.3

l

62

4.61

2 20

1.49

0

l

0.07

0

I

0.07

0

I

0.07

040.3

2

8

0.59

3

5

0.37

0

I

0.07

0

3

0.22

I

8

0.59

0 59

4.38

000

27 62

4.61

l

6

0.4s

040.3

0 7

4t

36 8 l7l

12.7

333130.97

56423t.1l

150 94 39

482

35.8

6

9

2 19

l.4l

2t180.59

8

l0 3 59

4.38

000362.67

01o120.89

00280.59

7

2

3 25

1.86

00020.15

2r07052

00060.45

9

4 63

4.68

0030.22

1080-59

7

t

45

3.34 20 0 I 0 I 0 3 0 I 0 0 2 0 0 I 0 0 8 7 0 0 0 0 I 0 t7

ll

0 0 0 0 2 I 0 0 I 7 0 2l 0 0 C4l0-419 Bone,jointand 4rtilcularcartilage 0

of oau sites

C42l

Bone manow

C424

Hematopoietic system Czl40-2149 Skin

C48O482 Retroperitoneumandperitoneum 2 C49O499 Connective, subcutaneuous

and

2

other soft tissues

C500-509 Breast C5l0-519 Vulva

C529

Vagina

C539

Cervix uteri

C54l-549 Corpus uteri

C559

Uterus

C569

Ovary

C589

Placenta

C&9

Kidney

C679

Bladder

C690-699 Eye C7W-709 Meninges

C710-719 Braiii

C720-729 Spinal cord, cranial nerves, and

othen parts of CNS C73O-739 Thyroià gand

C750-759 Others endocrine glands and rclated structur€s

C76O-768 Other and ill defined sites ,

C778-779 Lymph nodes

00

0l

00

o2

00

36

00

12

00

o2

32

00

l0

23

).,

ll

0 0 t9

I

I 4 I 0 3

All sites

42

s2 163 360 306 25E

123 t346

100 Percentage

3.1

3.9 t2.t 26.7 22.7 t9.2 9.1

100 Oau

=

Others and Unspecified

CNS = Central Nerves System

[image:13.595.102.549.119.807.2]

(14)

194

Sibuea et al

Table

ià.

Numbers

of

new

cases

by

primary

site and

age

in

males

Med J Indones

ICD.O

C0l9

Base of tongue

C020-O29 Oau parts

of

tongue

C04l-049 Floor of mouth

C050-059 Palate

C060-069 Oau pans of mouth

C070-079 Parotid gland

C090-099 Tonsil

Cl00-109 Oropahrynx

Cll0-ll9

Nasopharynx

Cl50-159 Esophagus

Cl60-169 Stomach

Cl70-179 Small intestine

Cl80-218 Colorectal

C22O

Liver

C239

Gall bladder

C24l

Ampulla of Vater

C250

Head ofpancreas

C300

Nasal cavity

C3l0

Maxillary sinus

C340

Bronchus and lung

C398

Overlap.lesion ofresp. syst. and

intrathoracal organs

C402

Long bones of lower limb

C4l0-41

9

Bone, joint and artilcular cartilage of

oau sites

C42l

Bone marrow

C424

Hematopoietic system Cul40-2149 Skin

C480-482 Retroperitoneum and peritoneum

C490-499 Connective, subcutaneuous and other soft tissues

C500-509 Breast

C609

Penis

C6l9

Prostate gland

C629

Descended testis

C649

Kidney

C6'79

Bladder

C690-699 Eye

C700-709 Meninges

C7l0-719 Brain

C72O-729 Spinal cord, cranial nerves, and others

pans of CNS

C'7 30-739 ThJroid gland

Others endocrine glands and related

c750-759 _skuctures

C760-768 Other and ill dehned sites

C7'78-719 Lymph nodes

<5

5-14

15-24 25-34 35-44 45-54 55-64

>65 Total

120100

105

63

000

0 -s ll

000

010

000

00t

002

001

000

021

010

0303060.75

0010010.13

2t00140.5

00012i0.38

3

I

2 t0

1.25

0

I

0

0 I

0.t3

0031150.63

0300140.5

16 35 36 20 9 132

16.5

00t2250.63

022509t.13

1100130.38

12 l0

l0

t4 6 52

6.52

4

l0

18 l8 19 70

8.7'l

0002r30.38

0

I

0

0 I

0.t3

00t4170.88

r00328t

0002360.75

0r-s65172.t3

0001010.13

0

r060.75

0140.-5

62ltzt4

0

0 l

0.t3

t4 ll 40

5.0r

I

I -s

0.63

4

2 18

2.26

6 0 I I 2

7 0

-5

I 2

6

0

'7

0

2

0

2

0

5 3 3 0

l I

0 0

2

0

3 2 3 3 I 0 0

0 3 2 2 2 8 6

0 4 0

I 2

,7

0 3

t4

7 0

4

I

0 I

0.13

4 t4

l;75

20 29

3.63

0 14

1.75

2 t8

226

7 36

4.-s t

4 31

4.64

o 2

0.25

0 13

1.63

0 I

0.13

2

0

t

t2

2 I

4

t l4

t.75

0050.63

2tl2l.5

lr

8 63

7.89

I 8

3 8 25

0 2 I 2

51

9

l0

00

3l

00

0t

00

ll

l0

0l

7t

00

t3

00

0

0 2

-5

0 9 0

0 0

002

012

2tt

484

All sites

53

86 42 80

l4

t37 166

t20

798 100

Percentage

6.6

r0.8 53 l0

t4.3

t7

2 20.8 15

100 [image:14.595.108.554.100.755.2]

(15)

VoI 9, No 3, JuIy

-

SePtember 2000

Table

ii.

Number of

new cancer

cases

by primary

sites and

age

Cancer in Cipto Mangunkusumo Hospital

Jakarta

195

ICD-O

c0l9 Base of tongue

CO20-029 Oau parts of tongue

C04l-049

Floor of mouth

C050-059 Palate

C060-069 Oau parts ofmouth

C070-079 Parotid gland

C090-099 Tonsil

Cl00-109

Oropahrynx

Cl10-l

19

Nasopharynx

Cl50-159

Esophagus

Cl60-169

Stomach

Cl'10-179

Smallintestine

C180-218 Colorectal

C220

Liver

C239

Gall bladder

C4l0-419

Bone, joint and artilcular cartilage of oau sites

C42l

Bone marrow

C500-509 Breast

C5l0-519

Vulva

C529

Vagina

c539 Cewix uteri

C54l-549

Corpus uteri

C559

Utenrs

C569

Ovary

C589

Placenta

s-r4

15-24 25-34

35-44

45-54 55-64

>65

Total

2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

200

266

00t

222

002

351

0t0

003

030

23 55

57

001

o22

122

19 2t

2l

51420

010

l0l

002

102

t0l

015

000

l0l

232

t2

13

t0

000

3912

2t2

323

23 61

4t

133

t75

33 t64

150

206

'>))

l0

18

8

2l

80

223

002

532

522

578

6

5

13

3r0

rt6

010

22 18

13

201

221

14 28

16

0 t 0 l6 0 2 0 5 0 0 0 I 3 2 I 0 2 0 l2 0 I 0 I 2 0 0 I 0 0 8 7 I 0 I 0 I t 0 4 0 6 3 I 'l 0 0 0 0 0 0 0 0 0 0 2 0 45 2 0 0 I 0 I 0 I 0 6 0 0 0 0 I 0 0 0 I 0 0 I 3 2 64 I I 0 3 0 0 0 I 0 0 2 0 0 0 I 7 0 9 0 3 2 0 I 4 l0 2 4 0 3 I 2 I 2 0 21 3 6 I 3l 29 2 0 4 3 4 7 I I I l3 0 35 I 4 5t 3 6 94 9 I

9

0.42

19

0.89

2

0.o9

t2

0.56

'1

0.33

15

0;l

2

0.09

8

0.37

4

0.19

l

l 195

9.09

3

7

0.33

o

12

0.56

I

'1

033

t7

I

14

5.32

2t 90

4.2

I

4

0.19

0

2

0.09

l

8

0.37

2 12

0.56

5 14

0.65

8 22

1.03

o

2

0.09

0

9

0.42

2 t2

0.56

2

l'l

I

7.98

0

I

0.05

38 102

4.76

2 tr

0.51

2 22

1.03

8 t72

8.02

3 13

0.61

4 23

1.07

39 482

22.48

2 19

0.89

r

8

0.3'7

C24l

Ampulla of

Vater

0

C250

Head

ofPancreas

0

C300

Nasal

cavitY

0

C310

Maxillary

sinus

I

C340

Bronchus and

lung

0

C398

Overlap.lesion of resp. syst. and intrathor.

organs

0

C4O2

t ong bones of lower

limb

I

C424

HematoPoietic

system

0

C44O-449

Skin

3

C48O-482 Retroperitoneum and

peritoneum

3

C49O-4gg Connective, subcutaneuous and other soft

tissues

4

c609

c6l9

C629

Descended testis

C649

Kidney

C619

Bladder

C690-699 Eye

C700-709 Meninges

C71O-'I

19

Brain

l0 3 59

2.75

0

0 36

1.68

2

4 14

0.65

'7 20 29

1.35

0

0 14

0.65

4230r.4

t4 9 44

2.O5

9

7 62

2-89

0040.19

5

0 20

0.93

l

0

'l

o.33

t3 5 'l'l

3.59

0080.37

3

I

20

0.93

18 9 108

5.04

Penis Prostate gland

8 0

t2

0 0 C72O-129 Spinal cord, cranial nerves, and others parts

ofCNS

3

C'130-739 Thyroid

gland

0

C'15O-759 Others endocrine glands and related

structures

I C760-768 Other and ill defined

sites

4

C7'18-779 Lymph nodes

All sites r28 94 243

424

243

2144

100

4.41

5 97 22.1 20.1 l9 8

ll

Percentage

[image:15.595.70.559.106.707.2]

(16)

196 Sibuea et

al

C4l0-419

Bone,jointandartilculrcarrilageof

0 0

₀

I

;

oau sites

C42l

Bone marrow

Med J Indones

Table

iii.

Numbers

of

ne\4/

cases

by

primary

site and

age

in children

IC

Age

n-

D-o

:g:_î::

Ii'"I:..

0 o 0 I 0 I 0 I

UIU ,

:î:î11: larotiderand

0 o 0 I 0 I

0

C090-099Tonsil

rl^;:vrt'

-rrnrr^

o o

o

I

o

I

o

Cllo-llg Nasopharynx

0 0 0 I ;

;

i

;

C220 Liver

/r ^ ^

_^

vLLwLrvËr0000lll0l

9:99

Nasalcaviry

0 0 0 I 0

r

0

I

ç119

Maxillarysinus

I 0 I 0 0 0 0 I

_I

c398

overrap'resionofresp.syst.and

0 0 0 l 0

l

₀

I

r

intrathoracaI organs

2î??^,^

3:qTl-":"tlowerlimb I 0 I I 2 3 2 2

4

Acute leukemia,

NOS

₀

₀ Acute

lymphocytic

12

₂₃ Acute non

lymphocyric

6

₂ Chronic

lymphocytic

₀

soft tissues

C539

Cervix

uteri

₀

C569

Ovary

₀

C629

Descended

tesris

O

₂

C649

Kidney

Nephroblastoma,NOs

2

_s

Neoplasma,

malignant

I

₀

Carcinoma,NOS

6

₀

Clear cell sarcoma of

kidney

₀

c69o-699

ut_",^---^.,-

o

inoma

0

Rerinoblastoma

3

_À

CTIO-719

Brain

₀

C72O-729

_{Spinal cord, cranial}_{nerves, and others}

3

₀

00lt0ll

3583846206181

8 5 l0 15 l1 12

23

0000000

2022224

00tll0l

3101224

3000123

4033527

010t011

0202022

2011303

741s7512

100010

010501

010101

000022022

inoma000000000

RerinobrastomaSÀr1

i;iirtrf,

CTl0-7lgBrain00OZl3t23

c72o-729

spinalcord,craniarnerves,andothers

3 0 3 2 o 2 0 5

5

parts of CNS

c75o-759

othersendocrineglandsandrelated

l 0 I 0 l

l

r

l

2

structures

C760-768

Otherandill

definedsites

2 2 4 3 I

4

3

5

8

C77O-779

Lymph nodes

Burkitt's

lymph.oma,NOs

₀ Hodgkin's

disease,NOS

₀ Non-Hodgkin's

lymphoma

1

Carsinoma,undifferentiated,NOs

_I [image:16.595.78.579.96.761.2]

(17)

Vol 9, No 3, July

-

Jalarta

197

Table

iv.

Numbers

of

new

cases

by primary

site and education

in

females

ICD-O

Description

E

JH

SH Ac NK

_Total

c019 c020-029 Cc/.I-0/;9 c050-059 c060-069 c070-o79 c080-089 c090-099 cl00-109

cl

l0-l l9 cl50-159 cl60-169 ct70-179 cl80-218 c220 c239 c24t c250 c300

c3l0

c340 c398

c402 c4to-4t9

c42l c424 c440-449 c480-482 c490-499

c500-509 c510-519 c529 c539 c54t-549 c559 c569 c589 c649

c6'19

c690-699 c700-709 cTto-719

c720-'129

c730-739 c750-759

Base of tongue

Oau parts of tongue

Floor of mouth

Palate

Oau parts of mouth Parotid gland

Oau major salivary glands

Tonsil

Oropahrynx Nasopharynx

Esophagus

Stomach Small intestine Colorectal

Liver Gall bladder

Ampulla of Vater

Head of pancreas

Nasal cavity Maxillary sinus

Bronchus and lung

Overlap.lesion ofresp. syst. and

intrathoracal organs

Long bones oflower limb

100

016

001

210

001

100

001

000

4516

010

001

8212

311

000

010

002

202

001

100

I

2

6 0

t7

0

I

25

I

.,

t29

6 2

l3

4 0 4

5

I

7

I

l3

0

55

4t

63

73

89

L2

t2

99

24

73

00

13

I

00

l0

3t

44

l0

I

2

0 4 0

2

0

I

0

8

0 0

2

l0

2

0 0 0 0 0 0 0

I o

l0t4

31013

0001

Bone,joint and artilcular cartilage 0

of oau sites

Bone marrow Hematopoietic system

Skin

204

00

176

1008

1004

l0l5

0001

1003

0000

172tt63

0012

2003

1004

216362

301020

l00l

00ll

0001

0024

1038

t2l5

0001

0003

3ll8

402359

0000

80762

3006

1004

59 lt

42

r7l

2tt13

51123

75 l0

27

482

ll4t9

l0l8

134359

t43036

001r2

0308

10225

10.02

llrT

0006

184r763

2003

0018

2

0 ,1 0

I

24 J 5

79

4 I

8 9

I I

3

0

I I

J

0 Retroperitoneum and

peritoneum

2

|

Connective, subcutaneuous

and 0

I

other soft tissues

Brcast

Vulva Vagina Cervix uteri

Corpus uteri Uterus

Ovary

Placenta

Kidney

Bladder Eye Meninges

Brain

Spinal cord, cranial nerves, and others parts of CNS

Thyroid gland

Others endocrine glands and

related structures

C760-768 Other

and ill defined sites

501

C778-779

Lymphnodes

I

ll

2

4

O 26

45

All

sites

199

t52 292 189 27t 5t

lg2

1346

Percentage

t5 I1.3 21.7 t4

20

t43

100

I=iliterate

A=Able to read and write

E=Elementary

JH= Junior High School SH=Senior High School

[image:17.595.121.528.101.668.2]

(18)

198

Sibuea et al

Table v. Numbers

of

new

cases by

primary

site and education

in

males

Med J Indones

ICD-O

Description JH

SH Ac

NK

Total

cOl9 Base of tongue 3

0 0 0 0 0 0 0 0 5 0 0 0 0 4 0 0 0 0 0 0 0 0 I 30 0 4 I I 0 0 I 2 4 I t7 0 I 0 I 0 0 0 0 0 0 0 0 4 0 I 0 5 I 0 0 0 I 0 0 0 0 0 t4 0 5 I 2 0