Distribution of malignancies by behavior, age group, analytical and non-analytical cases
The results of the research study indicate notable differences in the distribution of cancer cases between adults and pediatric populations. Among adult patients, 87.93% of the recorded cases were classified as malignant cancers, while a smaller proportion of 11.99% consisted of pediatric malignancies. Furthermore, the study found that the majority of benign and uncertain behavior cancers were prevalent in adults, accounting for 97.78% of the cases. In contrast, pediatric patients represented a smaller proportion of 2.21% for this category of tumors (Fig. 1A). Moreover, majority of cases, 97.8%, were classified as analytical cases, while a small proportion of 2.2% were non-analytical cases (Fig. 1B).
Distribution of malignancies by gender and age group
The results indicate the distribution of cancer cases based on gender and age groups. The data is presented as percentages of female and male patients within each age range. In the age group of 0–4 years, 38.63% of the cases were females, and 61.37% were males. Similarly, in the 5–9 years age group, 34.06% were females, while 65.22% were males. In the 10–14 years age range, 37.74% were females, and 62.26% were males. For the age group of 15–19 years, 39.2% of the cases were females, and 60.81% were males. In the 20–24 years age range, 38.98% were females, and 61.02% were males. For patients aged 25–29 years, 51.16% were females, and 48.84% were males. In the age groups of 30–34, 35–39, 40–44, 45–49, and 50–54 years, the percentage of female cancer cases gradually decreased, while the percentage of male cases increased. For patients aged 55–59, 60–64, and 65–69 years, the distribution of cancer cases between females and males was relatively balanced. In the age groups of 70–74, 75–79, and 80–84 years, the percentage of male cancer cases exceeded that of females. For patients aged 85 years and above, 23.81% were females, and a significant majority of 76.19% were males (Fig. 2).
Distribution of malignancies by geographical areas
The results indicate the distribution of cancer cases in different regions and countries. The data is presented as percentages of cancer cases in each region/country. In the Punjab region, 56.1% of the cancer cases were reported. In Khyber Pakhtunkhwa, 25.1% of the cases were recorded, while Afghanistan accounted for 13.6% of the total cases. In the Sindh region, 2% of the cancer cases were reported, and in Balochistan, the percentage was 1.1%. The Federal Capital (Islamabad) had 0.9% of the cases, while Azad Jammu and Kashmir contributed 0.8%. Lastly, cases from other countries outside Pakistan constituted 0.1% of the total cancer cases recorded in the dataset (Fig. 3).
Top 10 malignancies among all age groups
Across all age groups and genders, the top 10 most prevalent cancers are as follows: breast cancer accounting for 25.6% of the cases, colon, rectum & anus cancer with 7.6%, Hodgkin lymphoma with 7.1%, lip and oral cavity cancer with 5.1%, esophagus cancer with 4.1%, prostate cancer with 3.7%, non-Hodgkin’s lymphoma with 3.5%, leukemia with 3.1%, kidney cancer with 3.1%, and stomach cancer also with 3.1% (Fig. 4).
Top 10 malignancies among adults, children, adult males, adults females
Among adults, breast cancer ranks as the most prevalent cancer, constituting 29.1% of cases. It is followed by colon, rectum & anus cancer at 8.7%, and lip and oral cavity cancer at 5.8%. Esophagus cancer accounts for 4.7% of cases, while prostate cancer comprises 4.2% of the total. Hodgkin lymphoma and stomach cancer both contribute 3.9% and 3.5% of cases, respectively. Non-Hodgkin's Lymphoma represents 2.9% of cases, with trachea, bronchus, and lung cancer at 2.7%. Finally, kidney cancer rounds out the top 10 with 2.6% of cases among adults (Fig. 5A).
Among children, Hodgkin lymphoma is the most prevalent cancer, constituting 30.3% of cases. Acute lymphoblastic leukemia follows closely at 15.7%, while non-Hodgkin lymphoma represents 8.2% of cases. Retinoblastoma and Ewing's sarcoma/PNET both account for 7.1% of cases each. Nephroblastoma is reported in 6.1% of cases, followed by osteosarcoma at 5.8%. Germ cell tumor and glioma represent 5% and 4.7% of cases, respectively, while rhabdomyosarcoma rounds out the top 10 with 1.9% of cases among children (Fig. 5B).
Among adult males, the top 10 most prevalent cancers are as follows: Colon, rectum & anus cancer ranks highest, comprising 13.3% of cases, closely followed by prostate cancer at 9.8%. Lip and oral cavity cancer represent 8.2% of cases, while Hodgkin lymphoma accounts for 5.8%. Testis cancer is reported in 5.3% of cases, and stomach cancer follows closely at 5%. Both esophagus cancer and trachea, bronchus, and lung cancer are reported in 4.7% of cases. Non-Hodgkin lymphoma and kidney cancer are prevalent, representing 4.3% and 4.1% of cases, respectively (Fig. 5C).
Among adult females, breast cancer is the most prevalent, constituting 51.1% of cases. Following closely, colon, rectum & anus cancer accounts for 5.1% of cases, while esophagus cancer represents 4.4%. Lip and oral cavity cancer are reported in 4.1% of cases, and cervix uteri cancer follows at 3.1%. Additionally, corpus uteri & uterus cancer and thyroid cancer are reported in 3% of cases each. Ovary cancer accounts for 2.9% of cases, and Hodgkin lymphoma is prevalent at 2.5%. Stomach cancer completes the top 10 with 2.3% of cases among adult females (Fig. 5D).
Distribution and classification of malignancies by TNM stage of analytical cancer patients
The Cancer Registry utilizes the American Joint Commission on Cancer's TNM grading system to categorize all analyzed cancer cases. This system divides malignant tumors into four stages, labeled as 0, 1, 2, 3, and 4, while also including categories for cases that cannot be staged and cases deemed irrelevant (case classes 00, 10, 11, and 20). Unstageable cases arise when individuals choose not to undergo further medical tests or treatments, leading to an inability to determine the correct stage. In instances where AJCC staging information is unavailable at a specific location, "Not applicable" is used. During the year 2022, the cancer stages of the 7,222 analyzed cases (classes 00, 10, 11, 20) were distributed as follows: 1.1% of cases (78 patients) were classified as stage 0 or ad hoc, 13.9% (1,005 patients) were stage I, 27.9% (2,013 patients) were stage II, and 26.2% (1,890 patients) were stage III. Additionally, 17.2% (1,240 patients) were classified as stage IV, 3.8% (273 patients) were unstageable, and 10.0% (723 patients) were unassigned AJCC stages (Fig. 6A).
The results indicate the distribution of cancer cases based on their extent of spread or stage. Among the analyzed cases, 1% were classified as in-situ, which means the cancer was localized and had not spread beyond its original site. The majority of cases, 23%, were categorized as local, implying that the cancer had not spread far from its point of origin. Around 44.3% of cases were classified as regional, indicating that the cancer had spread to nearby lymph nodes or tissues. Approximately 20.5% of cases were categorized as distant, suggesting that the cancer had spread to distant parts of the body. Additionally, 11.2% of cases were classified as unknown, indicating that the extent of cancer spread was not specified or could not be determined for these cases (Fig. 6B).
Distribution of malignant sites in females and males
The results of the study conducted at SKMCH&RC are presented in Table 1, where malignancies are categorized by primary site, age range, and sex. The most frequent sites for malignancies observed were breast, colon/rectum/anal canal/anus, lymphoma, and lip/oral cavity.