Journal of Datta Meghe Institute of Medical Sciences University

ORIGINAL ARTICLE
Year
: 2017  |  Volume : 12  |  Issue : 1  |  Page : 41--44

Clinical profile of lung cancer at Acharya Vinoba Bhave Rural Hospital


Tarushi Sharma, Babaji Ghewade, Ulhas Jadhav, Swapnil Chaudhari 
 Department of Respiratory Medicine, Jawaharlal Nehru Medical College, DMIMS (DU), Wardha, Maharashtra, India

Correspondence Address:
Tarushi Sharma
Department of Respiratory Medicine, Jawaharlal Nehru Medical College, DMIMS (DU), Sawangi (M), Wardha, Maharashtra
India

Abstract

Background: Lung cancer has been the most common cancer in the world for several decades. It is probably one of the most important life threatening conditions responsible for the death of millions of people in today's world. An increasing incidence of lung cancer has also been observed in India. The objective of the present project was to study the clinical profile of lung cancer in histopathologically diagnosed lung cancer patients in AVBRH, Sawangi (Meghe), Wardha. Study Design: The study was conducted at Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe) in indoor patients of Lung Cancer. This was an observational study which included 62 patients in total who were admitted in AVBRH. A structured standard proforma was used for recording the history, clinical signs, radiological & histopathological findings of patients. Results: Out of the total 62 patients, 59.68% were males and 40.32% were females. Most of the patients presented with cough as chief complaint along with breathlessness, chest pain, fever and loss of weight/appetite were other common symptoms. Majority of males were smokers. On Chest X-ray, right lung was the most commonly involved and right lower lobe was the most common area involved. Adenocarcinoma was the most common subtype found in 51.61% of patients and small cell carcinoma was second most common found in 24.19% of patients. Majority of patients (51.61%) presented in stage 4 of lung cancer. Conclusion: The study shows that smoking is strongly associated with lung cancer. Cough was the most common symptom while presence of mass and right sided effusion were the most common findings in chest x-ray. Adenocarcinoma predominated both in males and females. Most of patients presented in late stages (Stage 3b and 4) thus leading to poor survival rates and poor prognosis among them.



How to cite this article:
Sharma T, Ghewade B, Jadhav U, Chaudhari S. Clinical profile of lung cancer at Acharya Vinoba Bhave Rural Hospital.J Datta Meghe Inst Med Sci Univ 2017;12:41-44


How to cite this URL:
Sharma T, Ghewade B, Jadhav U, Chaudhari S. Clinical profile of lung cancer at Acharya Vinoba Bhave Rural Hospital. J Datta Meghe Inst Med Sci Univ [serial online] 2017 [cited 2019 Dec 11 ];12:41-44
Available from: http://www.journaldmims.com/text.asp?2017/12/1/41/211581


Full Text

 Introduction



Lung cancer, also known as carcinoma of the lung or pulmonary carcinoma, is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. Lung cancer is probably one of the most important life-threatening conditions responsible for the death of millions of people in today's world.

Lung cancer has been the most common cancer in the world for several decades. There are estimated to be 1.8 million new cases in 2012 (12.9% of the total), 58% of which occurred in the less developed regions.[1]

An increasing incidence of lung cancer has been observed in India. In the beginning of the century, lung cancer was considered to be rare.[2] However, now, it has reached epidemic proportions. Tobacco smoking continues to be the leading cause of lung cancer worldwide. There is a dramatic increase of lung cancer in Western countries, and this is attributed to increase in cigarette consumption that is a well-known major risk factor for the development of lung cancer.[3]

According to GLOBOCAN 2012, 70,000 new cases were detected in India in the year 2012, of which 54,000 (77.14%) were in males and 17,000 (22.86%) were in females. There were 64,000 deaths in India due to lung cancer.[1]

Aims and objectives

To study the clinical profile of lung cancer in histopathologically diagnosed lung cancer patientsTo assess and compare variations in relation to clinical, radiological, and histological presentation among themTo study the age and sex-wise distribution among themTo study and correlate any association with occupational and smoking exposure.

 Materials and Methods



The study was conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi (Meghe) in indoor patients of lung cancer. This was an observational study which included 62 patients who were admitted in AVBRH.

All the histologically confirmed lung cancer patients admitted in AVBRH were included in the study. Patients in whom the primary was unknown and unwilling for consent were excluded from the study. A complete history of these patients was taken to assess the clinical profile on the basis of gender, age group, occupation, and smoking history. Patients were divided into four age groups, i.e. (1) <40 years, (2) 41–60 years, (3) 61–80 years, and (4) >80 years.

General and systemic examination was conducted in detail in regard to respiratory system, GI system, and any other. Diagnosis was made with the help of radiological imaging techniques such as Chest X-ray, contrast-enhanced computed tomography, sputum for malignant cells, fine-needle aspiration cytology, and bronchoscopy were the important diagnostic techniques used in the study to aid in diagnosis. Staging of patients was done according to the National Comprehensive Cancer Network guidelines.[4],[5]

 Observations and Results



In the present study, a maximum number of patients (50.00%) belonged to age group of 61–80 years and mean age group was 61.45 ± 12.28 (22–85 years). Out of the total of 62 patients, 59.68% of patients were males, whereas 40.32% were females. The maximum number of patients was homemakers (40.32%), closely followed by farmers (35.48%). The third most common group was of laborers (14.52%) [Table 1].{Table 1}

The most common chief complaint was cough in 69.35% of patients followed by breathlessness in 56.45% and chest pain in 54.84% of patients. All the patients had more than one chief complaint at the time of presentation. Only 32.36% of patients presented with hemoptysis. Hoarseness of voice was seen in 17.74% of patients. Among nonspecific symptoms, loss of appetite/weight was most common in 58.06% patients followed by fever in 50.00% of patients. It was found that 20.97% of patients had diabetes mellitus and 38.71% had hypertension as associated comorbidities. In the present study, it was found that 53.23% males and none of females were smokers and 1.61% males and 1.61% females were ex-smokers. Nearly 11.29% of females were passive smokers. Thus, a total of 67.7% were smokers. In nonsmokers, 6.45% were males and 25.81% were females. The total nonsmokers were 32.3%. During clinical examination, it was found that 38.71% of patients had lymphadenopathy. Almost 35.48% were found to have clubbing. Superior vena cava obstruction, engorged veins, and edema were seen in 14.52% of patients each [Table 2] and [Table 3].{Table 2}{Table 3}

Sputum for malignant cells was positive in 38.71% patients and negative in the rest. About 74.19% patients had total leukocyte count (TLC) within normal limits, 16.13% had raised TLC, and 9.68% had TLC lower than the normal limits. Nearly 95.16% patients had raised erythrocyte sedimentation rate values and they were normal in the rest of 4.84% patients.

It was found that right lung was involved in 67.7% of the total cases. Right lower lobe was the most commonly involved with 40.32% patients having lesion in this site. The second most common area was right middle lobe (22.58%). Left lung was involved in 32.9% of patients. In the left lung, lower lobe was most commonly involved (16.13%) followed closely by left middle lobe (12.90%). Upper lobe of the right lung was the least commonly involved area (4.84%). Only one patient (1.61%) had bilateral involvement [Table 4].{Table 4}

Most common chest X-ray finding was effusion which was seen in 58.06% of patients. Almost 50.00% of patients presented with mass followed by consolidation in 30.65% patients. Collapse was seen in 17.74% of patients. The least common finding was cavitation in only 9.68% of patients. Nearly 54.84% of patients had more than one chest X-ray finding [Table 5].{Table 5}

It was found that adenocarcinoma was the most common subtype seen in 51.61% of patients. Second most common subtype was small cell carcinoma seen in 24.19% of patients. Squamous cell carcinoma was seen in 19.35% of patients and large cell carcinoma was seen in 4.83% of patients [Table 6].{Table 6}

In males, the most common histological subtype was adenocarcinoma seen in 27.42% of total cases among males. Second most common subtype was small cell carcinoma in 19.35% of total cases. There was no case of large cell carcinoma among males included in this study.

In females, the most common histological type was again adenocarcinoma in 24.19% of total cases. There were 4.84% patients of large cell carcinoma whereas small cell carcinoma and Squamous cell carcinoma accounted for 4.84% and 6.45% of the total cases, respectively.

In nonsmall cell lung cancer (NSCLC) group, majority of patients, i.e., 51.61% were in Stage 4 on presentation. Almost 22.58% of patients were in Stage 3B and only 6.45% were in Stage 3A. There were no patients in Stage 1 and 2. Among SCLC patients, 53.3% were in limited stage and 46.7% were in extensive stage [Table 7].{Table 7}

In this study, majority of adenocarcinoma patients had an Eastern Cooperative Oncology Group (ECOG) score of 3. In patients with small cell carcinoma, majority had an ECOG score of 2. Squamous cell carcinoma patients had ECOG scores ranging from 1 to 3. Large cell carcinoma patients had an ECOG score between 2 and 3. This table shows that a vast majority of patients had an ECOG score of 2 and 3 [Table 8].{Table 8}

In SCLC group, 73.3% of patients had ECOG performance score between 0 and 2. There were 26.7% patients with a score between 3 and 5. In NSCLC group, 44.68% of patients had an ECOG score between 0 and 2 and 55.32% of the patients had an ECOG score between 3 and 5.

 Discussion



This study was carried out in the Department of Respiratory Medicine, AVBRH of Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, over a period of 2 years from September 2013 to September 2015. The total number of patients included in this study was 62, in which a maximum number of patients belonged to age group of 61–80 years and mean age group was 61.45 ± 12.28 (22–85 years). Similar observations were found in the study of Mandal et al.,[6] Kumar et al., and Yogeesha et al.,[7],[8] whereas Rawat et al. found in their study that most of patients were in the age group of 41–60 years.[9]

It was found that 59.68% of patients were males whereas 40.32% were females. Similar observations were found by Mandal et al.,[6] whereas Kumar et al. found in their study that 86.84% patients were males and 13.16% were females.[7]

Categorizing according to occupation, a maximum number of patients were homemakers (40.32%), closely followed by farmers (35.48%). The third most common group was of laborers (14.52%). Similar observations were found in a study by Jindal and Behera.[10]

The most common chief complaint at the time of presentation was cough in 69.35% of patients, followed by breathlessness in 56.45% and chest pain in 54.84% of patients, similar to findings by Malik et al.[11] and Kumar et al.[7]

While taking into account the smoking history, 67.7% were smokers and 32.3% were nonsmokers. Similar observations were found in studies by Malik et al.,[11] Shukla et al.,[12] Yogeesha et al.,[8] and Mandal et al.[6]

Most common chest X-ray finding was effusion which was seen in 58.06% of patients, 50.00% of patients presented with mass, followed by consolidation in 30.65% patients. Collapse was seen in 17.74% of patients. The least common finding was cavitation in only 9.68% of patients. Adenocarcinoma was found to be the most common histological subtype seen in 51.61% of patients. Second most common subtype was small cell carcinoma seen in 24.19% of patients. Squamous cell carcinoma was seen in 19.35% of patients and large cell carcinoma was seen in 4.83% of patients. Majority of patients (51.61%) were in Stage 4 on presentation, consistent with findings of a study by Malik et al.[11]

We found that the majority of adenocarcinoma patients had an ECOG score of 3. In patients with small cell carcinoma, majority had an ECOG score of 2. Squamous cell carcinoma patients had ECOG scores ranging from 1 to 3. Large cell carcinoma patients had an ECOG score between 2 and 3. In SCLC group, 73.3% of patients had ECOG performance score between 0 and 2. There were 26.7% patients with score of 3–5, similar observations were found by Malik et al.[11]

The study shows that smoking is strongly associated with lung cancer. Majority of males had history of smoking and most of female patients were passive smokers.

Furthermore, most of the patients present with cough as the main symptom. The other common symptoms on presentation were dyspnea and chest pain. Fever and loss of appetite/weight were also seen in many of the patients. The most common findings in chest X-ray are the presence of mass and effusion in the right lower lobe. Bilateral involvement on chest X-ray was very rare and seen in only one patient in this study. The most common type of carcinoma was adenocarcinoma both in males and females. Small cell carcinoma was the second most. This may be attributed to increasing smoking practice among the patients in this area. Small cell carcinoma was the most common in farmers followed by homemakers. Squamous cell carcinoma was evenly distributed among farmers and homemakers. Large cell carcinoma was only seen among females and they were homemakers.

Most of the patients presented in late stages (Stage 4 and 3b), thus leading to poor survival rates and poor prognosis among them. This may be due to low literacy rates among patients and lack of awareness among them. ECOG performance score among majority of patients was between 0 and 2, with males showing better ECOG scores than women patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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