Lung Martin N

Incidence male with the ratio of 2:1. Lung cancer is the most com- The average age-standardized Chapter II mon malignant disease worldwide, incidence rates were 20.6 per with 900 000 new cases each year 100 000 among males and 9.3 per in males and 330 000 in females. It 100 000 among females. Lung is the major cause of death among cancer is rare before the age of 40 cancers. The five-year survival rate years. It is common at the age over for lung cancer cases is less than 60 and declines after the age of 70 15 %. The highest incidence of in both males and females. 11 lung cancer in the world was found The estimated number of new in USA, Louisiana, New Orleans; cancer cases and estimated age- Black (ASR = 107) in males and in standardized incidence rates were Canada, Northwest Territories 2 682 new cases (ASR = 25.0) and LUNG (ASR = 72) in females (from CIV 2 607 new cases (ASR = 12.1) ICD-O: C34 vol. VIII). among males and females respec- In over the period tively in 1990 (Vatanasapt et al., Nimit Martin, M.D. 1998-2000, lung cancer was the 1993), 5 500 cases (ASR = 26.5) second common cancer in males among males and 2 608 cases (ASR after liver cancer while it was the = 11.1) among females in 1993 fourth common cancer after cervi- (Deerasamee et al., 1999), 5916

cal cancer, breast cancer and liver cases (ASR = 25.9) and 2 964 IV Vol.

: cancer in females. cases (ASR = 10.0) among males Over this period, the total and females respectively in 1996 number of lung cancer was 7 911 (Sriplung et al., 2003) and 4 947 cases, 4 974 cases in males and cases (ASR = 20.6) and 2 344 cases 2 344 cases in females, accounting (ASR = 9.3) among males and fe- for 15.7% of all cancers in males males respectively in this study. and 7.0% in females. This cancer The estimated age-standardized is more common in male than fe- incidence rates of lung cancer in

Figure 2.11.1 Lung cancer in different regions, 1998-2000 CANCER IN THAILAND

9.3 Thailand 20.6 22.3 29.6 27.6 53 3.7 7

Udon Thani 8.3 26.3 Female 7.1 Male 20.6 6.5 18.4 7.5 25.1 2.8 Prachuap Khiri Khan 12.1 4.9 13.5

0 102030405060 ASR (World) 41

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Figure 2.11.2 Age-specific incidence rates of lung cancer, 1998-2000

Male Female

500 500

450 450

400 400

350 350

300 300 THAILAND CHIANG MAI LAMPANG 250 250 NAKHON PHANOM UDON THANI 200 200 KHON KAEN

Incidence per 100 000 150 150

100 100

50 50

0 0 0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75+ 0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75+ Age

500 500

450 450

400 400

Vol. IV Vol. 350 350

:

300 300 THAILAND BANGKOK 250 250 RAYONG PRACHUAP KHIRI KHAN SONGKHLA 200 200

Incidence per 100 000 150 150

100 100

50 50

0 0 0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75+ 0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75+ Age

CANCER IN THAILAND

Thailand substantial declined in cer in males (ASR = 7.0) while the South (ASR = 4.1). The North both males and females. Prachuap Khiri Khan had the low- had the highest incidence rates in The highest incidence rate est incidence rates of lung cancer both males (ASR = 30.7) and fe- was found in Lampang in both in females (ASR = 2.8). males (ASR = 17.1) while the males (ASR = 53.0) and females In this study, the highest inci- South had the lowest incidence (ASR = 27.6) followed by Chiang dence rate of lung cancer was found rates in both sexes (ASR = 11.8 and Mai (ASR = 29.6 among males and in Northern region (ASR = 30.7) 4.1 among males and females 22.3 among females), Udon Thani followed by Central region (ASR respectively). (ASR = 26.3 among males and 8.3 =18.9), Northeastern region (ASR The data quality of lung was among females), Rayong (ASR = = 14.2) while the Southern part had rather fair, the level of histological 25.1 among males and 6.2 among the lowest incidence rate (ASR = verification varied from 15% to females) and Khon Kaen (ASR = 11.8) among males. For females, 79% among males and 8.8% to 20.6 among males and 7.1 among the highest rate was found in the 84.9% among females. The level females). Nakhon Phanom had the North (ASR = 17.1) followed by of death certificate only varification lowest incidence rates of lung can- Central (ASR = 8.1), Northeast and from 0.0% to 43% in males and 42

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0.0% to 53% in females. Figure 2.11.3 Histological types of lung cancer, 1998-2000 Adenocarcinoma was the Male most common type of lung cancer especially in females followed by Chiang Mai 36.4 37.1 9.2 17.2 squamous cell carcinoma and small cell lung carcinoma. For males Lampang 29.1 22.7 18.1 30.2 adenocarcinoma were the most Nakhon Phanom 11.1 55.6 0.0 33.3 common type of lung cancer except in Lampang and Songkhla, squa- Udon Thani 29.4 39.2 5.9 25.5 mous cell carcinomas were found Khon Kaen 25.3 39.2 9.5 25.9 more common than adenocarci- noma. Bangkok 27.6 37.5 10.1 24.7

Risk factors Rayong 20.3 31.3 15.6 32.8 Tobacco smoking and expo- Prachuap Khiri Khan 20.0 24.0 16.0 40.0 sure to radon gas are considered Songkhla 40.8 34.6 8.4 16.2 among risks for lung cancer. Can- cer of the lung, though rarely cur- 0%0% 10% 10% 20% 20% 30% 30% 40% 40% 50% 50% 60% 60% 70% 70% 80% 80% 90% 90 100% able, has symptoms that could be Squamous cell carcinoma Adenocarcinoma Small cell carcinoma Other well managed to enhance quality

of life. There is no screening test Female IV Vol.

: in population level for this disease. Screening has not been effective in Chiang Mai 23.4 47.6 12.0 17.0 reducing mortality. Mass screen- Lampang 24.7 36.3 10.4 28.6 ing with chest x-ray and sputum cy- tology is not recommended to con- Nakhon Phanom 25.0 25.0 50.0 trol lung cancer. Investment in Udon Thani 7.7 53.8 38.5 early diagnosis and treatment is un- likely to reduce the high mortality. Khon Kaen 5.6 59.7 4.2 30.6

Most of the patients with lung can- Bangkok 9.2 58.2 5.8 26.8 cer already have locally advanced disease or distant metastasis at di- Rayong 10.7 57.1 7.1 25.0 CANCER IN THAILAND agnosis. Prachuap Khiri Khan 100.0 Early stage tumours are treated by surgical resection. If the Songkhla 21.9 49.3 6.8 21.9 patients refuse or who are deemed 0%0% 10% 10% 20% 20% 30% 30% 40% 40% 50% 50% 60% 60% 70% 70% 80% 80% 90% 90 100% medically unfit for surgery, being Squamous cell carcinoma Adenocarcinoma Small cell carcinoma Other treated with radiotherapy. More advanced stage disease may be treated with combination of surgery and radiotherapy. The mainstay of treatment for small cell lung can- cer is chemotherapy, with concomi- tant radiotherapy. Prognosis of lung cancer was very poor. Primary prevention should be very useful by getting rid of car- cinogen, especially smoking and air pollution. 43

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Figure 2.11.4 Stage distribution of lung cancer, 1998-2000

Male

Chiang Mai 2 31 14 53

Lampang 6 29 38 27

Nakhon Phanom 16 11 16 56

Udon Thani 1 3 16 80

Khon Kaen 6 41 53

Bangkok 10 18 28 45

Rayong 6 3 14 77

Prachuap Khiri Khan 8 13 17 63

Songkhla 2 33 26 39

0%0% 10% 10% 20% 20% 30% 30% 40% 40% 50% 50% 60% 60% 70% 70% 80% 80% 90% 90 100%

Local Regional Distance Unknown

Vol. IV Vol.

: Female

Chiang Mai 3 32 13 52

Lampang 4 31 42 23

Nakhon Phanom 23 9 17 51

Udon Thani 1 3 14 83

Khon Kaen 4 49 47

Bangkok 8 17 29 46

CANCER IN THAILAND Rayong 2 12 20 66

Prachuap Khiri Khan 6 24 71

Songkhla 2 19 35 44

0%0% 10% 10% 20% 20% 30% 30% 40% 40% 50% 50% 60% 60% 70% 70% 80% 80% 90% 90 100%

Local Regional Distance Unknown

44

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