2014, Volume 30, Number 2, Page(s) 118-123
A Study on Distribution of Cancer Cases Diagnosed in Çorum
Yılmaz BAŞ, Pınar UZBAY, Güven GÜNEY, Behice Hande ERENLER, Dilek YILMAZ, Çiğdem ÖZDEMİR
Department of Pathology, Hitit University, Çorum Education and Research Hospital, ÇORUM, TURKEY
Keywords: Epidemiology, Cancer, Turkey
In order to help obtain accurate knowledge and to
contribute to the establishment of data for regional tumor statistics,
we aimed to determine the frequency distribution of cancer cases that
was diagnosed in Çorum province.
Material and Method: In this descriptive study, we retrospectively
reviewed the archive records of the pathology departments of one
university hospital and two private hospitals serving in the province of
Çorum. A total of 138,973 recorded pathology reports were reviewed.
Metastatic cancers with a known primary source were excluded.
A total of 2184 cases with a diagnosis of cancer were recorded by
gender, age, and system/organ and classified to 10 most frequent
types of cancer both in general and in terms of gender distribution.
Results: The male to female ratio was 1.44 and the mean age was
64.26 years. The cancer is most commonly encountered between
70 and 79 years of age (35.27%) in males whereas the second most
common interval was 60 to 69 years of age (23.88%). In females, the
cancer is most commonly encountered between 70 and 79 years of
age (24.16%) whereas the second most common interval was 60 to
69 years of age (22.60%). The top five cancers were skin (33.60%),
prostate (13.87%), stomach (9.07%), urinary bladder (8.61%) and
Conclusion: Distribution of organ/system involvement of cancer
cases that were diagnosed in Çorum is quite different from the data
regarding Turkey in general. Development of cancer registry centers,
upgrading to an active registry system and having all cancer data from
health institutions unified in a single organization are mandatory to
achieve reliable data.
Cancer is the leading cause of death in developed
countries whereas it is the second leading cause of death in
developing countries, where heart disease is still the leading
. According to the 2010 data from World Health Organization, there are 12.4 million new cases of cancer, 25
million patients with cancer and 7.6 million cancer deaths
throughout the World2
. The world has been divided into
22 regions (top 22 cancer site) by the incidence and the rate
of mortality. Turkey was included in the West Asia region
with the code number 133
. In Turkey, cardiovascular diseases are the first leading cause of death whereas cancer
is the second leading cause (15.4%)4
. According to the
Turkeys 2013 Health Statistics Yearbook from Ministry of
Health, the incidence of cancer was reported to be 281.6
cases per 100.000 people5
The fact that data from pathology departments is constantly
being recorded and also that the science of pathology had
a substantial growth in the global scale have contributed to
the construction of a substantial database of cancer records.
The previous studies that were performed in our country
during the last three decades tried to reveal the distribution
of malignant tumors by geographical, gender and organs
involved6-19. A recent study reported that age and sex
adjusted crude death rate of cancer in Çorum was 21.9220, however, there has not yet been any report regarding
the frequency and distribution of cancer subtypes in this
The present study aimed to determine the frequency
distribution of cancer cases by age groups, gender and
organ location in Çorum. We also aimed to help obtain
accurate knowledge that would be useful when conducting
future studies and also to contribute to the establishment of
data for regional tumor statistics.
We conducted a retrospective descriptive study on organ/
system distribution of cancer cases diagnosed in Çorum.
A particular permission was granted from the ethics
committee of Numune Education and Research Hospital to
review the pathology archive records of the Department of
Pathology, Hitit University Çorum Education and Research
Hospital and two private hospitals serving in the province
of Çorum (30.01.2014/ 724.112). Other than these three
departments, there is no other pathology department
in Çorum and there has not been any other facility that
receives specimens for histopathological examination.
Histopathological reports were included in data analysis if
there was no suspicion about the diagnosis. Reports were
not included if they indicated that the sampling material
was inappropriate or there was need for repeating the
sample taking. Histopathological examination reports
of 113.685 sampling materials (obtained by excision,
resection, punching, needle biopsy and body fluid
evacuation) that were examined between 01.01.2006 and
30.05.2013 in Department of Pathology, Hitit University
Çorum Education and Research Hospital were reviewed
both from the departments archive records and from the
computerized records using a specialized data automation
database which has been established in 2007. 5343 biopsy examination reports obtained between 01.11.2011 and
30.05.2013 in one private hospital and 19945 biopsy
examination reports obtained between 01.01.2010 and
30.05.2013 in the other private hospital were individually
reviewed using the computer software that uses a specific
database. Thus, a total of 138,973 recorded pathology
reports were retrospectively reviewed. If there was more
than one organ biopsy belonging to the same individual
patient, among them, the one which best represented
the diagnosis was taken into consideration. If there were
different organ biopsies in the same patient, these different
organ biopsies were included in the study. The patients who
had a diagnosis of metastatic cancer with a known primary
source were excluded. Data from the patients who were
under 16 years old were not included. A total of 2184 cases
in whom the diagnosis of cancer were made in Çorum were
recorded by gender, age, and system/organ and classified
to 10 most frequent types of cancer both in general and in
terms of gender distribution.
Distribution of all cancer cases by organ, system and gender
was shown in Table I
. Among the whole study group, the top
five cancers were; skin (33.60%), prostate (13.87%), stomach
(9.07%), urinary bladder (8.61%) and breast (7.88%) (Table I
). Among the females (Table II
), cancers of skin (38.37),
breast (%19.24), thyroid (%12.64), colorectal (%7.83) and
stomach (%5.48) were the top five cancers whereas cancers
of skin (%30.31), prostate (%23.49), urinary bladder (12.95),
stomach (%11.55) and colorectal (%5.58) were the top five
among males (Table III
). Out of 2184 cases with a diagnosis
of cancer, 1290 were males (59.06%) and 894 were females
(40.94%). The male to female ratio was 1.44. The youngest
patient was 17 years old, the oldest one was 96 years old and
the mean age was 64.26 years.
Click Here to Zoom
|Table II: Organ/system distribution of the ten most frequent
cancers among women
Click Here to Zoom
|Table III: Organ/system distribution of the ten most frequent
cancers among men
There were 415 patients (19%) under 50 years of age and
1769 (81%) patients over 50 years of age. The frequency
peaks between 70 and 79 years of age in males and females.
Cancer was most commonly encountered between 70
and 79 years of age (35.27%) in males whereas the second
most common interval was 60 to 69 years of age (23.88%).
In females, cancer was most commonly encountered
between 70 and 79 years of age (24.16) whereas the second
most common interval was 60 to 69 years of age (22.60)
According to the systems involved, the skin at 33.31%,
gastrointestinal system at 18.45%, male genital system
at 14.65%, urinary system at 9.57% and breast at 7.88%
were the top five systems. Among the skin cancers, the patients with the diagnosis of basal cell carcinoma (521
cases, 70.98%) comprised the highest number of cases.
The squamous cell carcinoma (172 cases, 23.43%) and the
malignant melanoma (23 cases, 3.13%) were the second
and third most frequently diagnosed cancers, respectively.
This was a retrospective descriptive study in design and
reflects the latest frequency of cancer cases diagnosed in
Çorum. Distribution of organ/system involvement of cancer
cases that were diagnosed in Çorum is quite different from
the data regarding our country. The incidence rate of lung
cancer ranks first among males in Turkey whereas, in our
study, lung cancer ranked 6th with 1.97% among the study
group, ranked 6th with 3.10% among men and ranked lower
with 0.34% among women. The uterine corpus cancer is the
fourth most frequently diagnosed cancer among women
in Turkey whereas it is the 5thmost frequently diagnosed
cancer in our series after the skin cancers were excluded21
. Inconsistency in ranking of lung and uterus cancers
is misleading. The fact that it is common predilection
to apply to the superior hospitals in Samsun and Ankara
which are relatively closer to the Çorum province due to its
geographical location and also that health services remain
limited in Çorum province may possibly be main causes of
The establishment of cancer registry systems is of importance
for etiologic causes to be revealed, necessary
interventions to be made for cancer prevention and for
cancer biology studies to be developed and controlled.
The previous studies that were performed in our country
during the last three decades tried to reveal the distribution of malignant tumors by geographical, gender and organs
Cancer cases have been included to the list notifiable
diseases since 1982. The first population based cancer
registry system was established in 1992 in İzmir and
Diyarbakır. In our country, there has been 11 active Cancer
Registry Centers that collect the data through this system
since 2010. These provinces are Ankara, İzmir, Antalya,
Samsun, Eskişehir, Erzurum, Edirne, Trabzon, Gaziantep,
Malatya and Bursa4. According to the 2013 data from
the Cancer Department in the Ministry of Health of
Turkey, the most common types and their incidence rates
among women are as follows; breast (40.7), thyroid (16.2),
colorectal (13.2), corpus uteri (8.6) and lung (8.2), whereas
those among men are as follows; lung (69.2), prostate
(37.6), urinary bladder (21.7), colorectal (20.8) stomach
In our study, skin cancer is the most common tumor
among men and women. Early diagnosis on skin surface
is very easy to make. Also, because the skin surface can
easily be visualized, there is no need for superior hospital
standards for surgical procedures. Our results are similar
to those reported by others in our country6-10. This
high frequency may be related with the ease of the early
diagnosis and may also result from the prolonged exposure
to sunlight and the depletion of the ozone layer, as well.
In our study, breast cancer is the second most frequently
diagnosed cancer among women. When the cases with skin
cancer were excluded, breast cancer is the most frequently
diagnosed cancer with 31.21% and this result is similar
with the literature. The breast cancer was also the most frequently diagnosed cancer in series reported by some
others9,11-16. The studies reported by Tasdemir (11),
Basak6, Kandiloglu17 and Ozekinci8 are similar to
ours where breast cancers are the second most frequently
diagnosed cancers after skin cancers.
In our study, thyroid cancer which mainly affects women was
found in 0.70% (n=9) of men whereas it was the third most
frequently diagnosed cancer with 12.64% (n=113) among
women. This finding is similar to that in the literature and
to the data from the Cancer Department of Turkey21.
The incidence is being reported as 3-5.5/100.000 among
women and 0.5-2/100.000 among men in the literatüre22. Our findings are similar to those reported by others6,11,14, and 18. It is the second most frequently diagnosed
cancer in series of Bozkurt7, fourth in series of Özekinci8 and fifth in series of Bayram19. The doubt that the
radioactive cloud which formed as a result of a nuclear
accident occurred in a neighboring country in the mid-
1980s might also have influenced our region has given rise
to many speculations about increasing number of cancer
cases. It is known that radioactivity acts as an etiological
factor especially in thyroid carcinomas23. Although
thyroid cancer was approximately the 10thmost common
type in Black Sea Region until 1990, it has risen to top
ranks in recent years22. The improvement of the imaging
technologies for the thyroid gland and the high sensitivity
of the clinic-radiologic and pathologic needle aspiration are
of importance in the early detection of thyroid cancers.
In our study, colorectal cancer was the fourth and fifth most
frequently diagnosed cancer in both women and among
men. According to the data from the US, colorectal cancer
is the second and third most frequently diagnosed cancer
among women and men respectively, whereas it is the third
most common cancer following breast and thyroid cancers
among women and the fourth most common cancer after
lung, prostate and urinary bladder cancers among men3. Our study results are similar to the series of some
others9,10,12. Early detection of adenomatous polyps by
endoscopic methods and their removal is the key for the
prevention of colorectal cancers. The simple screening tests
such as occult blood test, barium imaging and colonoscopy
(which is the gold standard due to its high sensitivity) are
among the methods of importance in early diagnosis.
The stomach incidence and mortality have decreased in
many parts of the world and all over Europe3. It was
the third most frequently diagnosed cancer among our
study group and was the fifth and fourth most frequently
diagnosed cancer among women and men, respectively.
The increasing consumption of fresh food, vegetables and fruits, avoidance from ingestion of salt and convenience
food, eradication of H. pylori, reduction in smoking in
developed areas, endoscopic screening methods and use of
photofluorography in Japan are among the leading causes
of the decrease observed in the incidence of stomach cancer3.
The prostate cancer is the most frequently diagnosed
cancer when the skin cancer was excluded. The data from
the Department of Cancer reveal that the prostate cancer
is the second most common cancer after lung cancer and
this data is consistent with our study. Although the series
reported by Arıca9 has similar findings to that of ours,
we found unlikely that the urinary bladder cancers were
the third most frequently diagnosed cancers after prostate
cancers in our study. The prostate cancer is the fifth most
frequently diagnosed cancer in series reported by Çolak14 and Basak6. We think that widespread use of the
prostate specific antigen (PSA) test helped to achieve
significant results in early diagnosing.
In our study, urinary bladder cancer was the third most
frequently diagnosed cancer among men. It was detected
in a minority of women. Our finding that urinary bladder
cancer is four times more common among men than
women is consistent with data from Turkey24. Unlike
the developed countries, urinary bladder cancer gradually
increases in incidence in developing countries. Urinary
bladder cancer was the second most frequently diagnosed
cancer among men in the series reported by Arıca9 and
was the third most frequently diagnosed cancer in those
reported by Basak6 and Çolak14.
In conclusion, data from 3 pathology laboratories were
analyzed in our study. The high rate of thyroid cancer
among women is consistent with the literature and
this finding may be explained by the fact that Çorum
province located in Black Sea Region and it has a specific
geological landform. The ease of the early diagnosis is
of importance in these results. The low frequency of the
diagnosis frequency of lung cancer is misleading and this
may be explained by the patients predilection to apply to
the superior hospitals in Ankara. Similarly, eight patients
in this study had positive histopathological findings in
pericardial/pleural fluid samples and 11 patients had bone
metastasis. However, no other registry was found regarding
these patients. These findings do not truly indicate that these
patients had primary neoplastic involvement in pericardial/
pleural or bone tissues. Therefore, efforts should be made
for further development of an active cancer registry system.
In addition, paving the way for the development of the
pathology department within the context of molecular scale, establishing the radiation oncology department and further
improvement of medical and surgical oncology specialties
will help achieving significant results in improvement of
diagnosis and treatment stages of cancer and in decreasing
its mortality. It may be ascertained that it could be achieved
in our country as well, to obtain more reliable data if the
development of a widespread cancer registry system is
As there is no active cancer registry database and we lack
information on the total number of population at risk, this
report did not provide information about cancer incidence
and prevalence in Çorum city.
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