TUMOR REGISTRY - kfshrc.edu.sa · commitment to fundamental research in cancer biology and stem cell transplantation, Oncology Centre, ... Research Unit Director Oncology Centre Oncology

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Oncology Centre Research Unit

TUMOR REGISTRY ANNUAL REPORT

2014

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INTRODUCTION We are pleased to present 2014 Annual Tumor Registry Report for the King Faisal Specialist Hospital & Research Centre’s Oncology Centre in Riyadh. The Cancer Registry maintains a complete database of information on all cancer cases diagnosed and/or treated at KFSH&RC. This report highlights the statistical overview of newly diagnosed cancer cases by site, gender, and AJCC Staging for both analytic and non-analytic cases. During 2014, the Tumor Registry abstracted 2,933 new cancer cases; 2,543 were analytic and 390 were non analytic. The highest incidence of cancer among males by site was Leukemia, Colorectal, and HL and among females was carcinoma of the Breast, Thyroid, and Colorectal. This year’s retrospective outcome study is focused on 1,970 renal cancer cases treated at the Oncology Center since 1975. The Tumor Registry database includes over 80,978 cases and reports to the Saudi Cancer Registry (SCR). Oncology Centre continues to provide most advanced, comprehensive, and multidisciplinary cancer care encompassing state-of-the-art radiation therapy, chemotherapy, hematopoietic stem cell transplantation, palliative and rehabilitation to our patients. Accredited by the World Health Organization (WHO) as a Collaborating Centre for Cancer Prevention and Control, the Oncology Centre continues to be the Center of Excellence in clinical research. Involvement in cutting edge clinical trials allows our physicians and researchers to play a pivotal role in advancing new cancer treatments, offering innovative and most promising treatment options to our patients. We have maintained our international cooperative group affiliations as members of Southwest Oncology Group (SWOG), NRG Oncology, Canadian Blood & Marrow Transplantation Group (CBMTG), Center for International Blood & Marrow Transplant Research (CIBMTR) and European Group for Blood and Marrow Transplantation (EBMT). KFSH&RC has spearheaded the local and regional research consortiums as well, notably, Gulf Oncology Regional Group (GORG) and Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) Group. Oncology Center is committed to serve as the pinnacle of excellence in the region as we move to the new King Abdullah Centre for Oncology and Liver Diseases (KACOLD); an integrated and most modern facility for diagnostic and therapeutic areas of cancers and liver diseases. As strong advocates for a continued commitment to fundamental research in cancer biology and stem cell transplantation, Oncology Centre, actively encourages and promotes translational research to enhance clinical applicability of research findings. Major achievements for the last year include fully operational Intra-Operative Radiation Therapy (IORT), Tomotherapy, Cyberknife and operational Brachytherapy for HDR imaging. Radiation Oncology has also introduced Deep Inspiration Breath Hold (DIBH) cardiac sparing technique to treat left-sided breast cancers and Gold plaque Iodine125 brachytherapy for ophthalmic tumors. Society of Clinical Research Associates (SOCRA) Saudi Arabia chapter continues to meet the educational and certification needs of clinical research professionals of the region. As we look to the future of cancer care in the Kingdom, Oncology Centre will continue to deliver evidence based care centered upon the state-of-the art clinical and translational research as per vision 2030. We are extremely grateful to the dedicated staff of the Tumor Registry for their hard work and commitment throughout the year. Special thanks are due to the superb staff of Medical Records, a key component of the Registry’s continued success. Hats off to our committed physicians, nurses and support staff; it is their dedication and perseverance that is the foundation for our success. This report can also be accessed online via Oncology Centre’s website at http://www.kfshrc.edu.sa. Comments and suggestions are welcome to improve our future reports and can be sent to [email protected].

Fazal Hussain, MD, MPH Naeem Chaudhri, MD Mohammad AlShabanah, MD Research Unit Head, Research Unit Director Oncology Centre Oncology Centre Oncology Centre

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I. KING FAISAL SPECIALIST HOSPITAL & RESEARCH CENTRE TUMOR REGISTRY The Research Unit encompasses Tumor Registry & Clinical Research sections. The King Faisal Specialist Hospital and Research Centre (KFSH&RC) opened in June 1975 to provide specialized medical treatment to the people of Saudi Arabia and to promote the prevention of disease through research and education. It is a national and international tertiary care hospital for Oncology and the principal center for cancer therapy in Saudi Arabia. The mission of the Tumor Registry, a hospital-wide data system, is to describe the burden of cancer in KFSH&RC by collecting complete and high quality cancer data and compiling timely statistics so that data-driven, evidence-based cancer prevention and control programs can be implemented to reduce cancer morbidity and mortality. The Registry was established to meet one of the requirements for an Approved Cancer Program of the American College of Surgeons (ACoS). The database now includes 80,978 malignant cases seen at KFSH&RC from June 1975 through December 31, 2014, as well as cases seen at the Children’s Cancer Centre since its opening in March 1997. The Registry is primarily staffed with certified tumor registrars who support the database in case ascertainment, abstracting, follow up and statistical analyses. The basic source document is the patient's medical record from which pertinent information is abstracted for use in the Registry. The electronic data system used was the Cansur 3.0 designed by the ACoS, for cases seen from 1975 to 2007. Starting with 2008 cases, the software being used is CNExT, developed by C/NET Solutions which is part of the U.S. Public Health Institute. The data maintained in the Tumor Registry provides the statistics for the publication of the KFSH&RC Annual Report which summarizes the hospital's cancer experience. The data also supports a wide variety of reports at the request of physicians, researchers and ancillary personnel. These reports support patient management and outcome, basic and clinical research investigations, educational publications and presentations, and resource utilization. In 2014, the Tumor Registry supported myriad of data requests (see Appendix for a listing of requests for Tumor Registry data). It also identified and reported to the Saudi Cancer Registry 2,933 new cases seen in 2014.

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II. ACKNOWLEDGEMENTS The cancer program is a combined effort of the extraordinary team of professionals at the King Faisal Specialist Hospital and Research Centre. It is not possible to enumerate all those involved in providing hope and healing to cancer patients and their families. The Tumor Registry staff greatly appreciates the tireless efforts of all the caring professionals from all disciplines for their dedication, commitment and collaboration to ensure highest standards in community outreach, clinical trials, staff education, patient care improvement, outcome analysis and tumor registry quality. The clinical expertise and proficiency demonstrated by our team, coupled with an incredible dedication to patient care and service excellence, allows the Oncology Centre to achieve remarkable outcomes and to consistently exceed the needs and expectations of patients and their families. The information in this report includes cancer incidence, site, and extent of disease at diagnosis, treatment, cancer trends, and outcomes to better understand the changing patterns of cancer. The following departments have assisted throughout the year and without their support this report would not have been possible. The Tumor Registry staff takes pride in acknowledging these departments:

Department of Pathology and Laboratory Medicine Medical Records Services Information Technology Affairs Department of Pediatric Hematology/Oncology Central Data Unit, Dept. of Ped Hem/Onc Saudi Cancer Registry Home Health Care Oncology Centre

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III. KFSH&RC CANCER PATIENT POPULATION A total of 2,933 cases were accessioned in 2014, with 1,318 males and 1,614 females or a male/female ratio of 0.8:1.

FIGURE 1

DISTRIBUTION OF CASES ACCESSIONED BY YEAR 1975 – 2014 (TOTAL CASES = 80,978)

From the opening of the hospital (mid 1975) until December 2014, 80,978 cancer cases were registered (40,431 males and 40,546 females) with a male/female ratio of 0.9:1. There were 10,373 (12.8%) pediatric cases (0 to 14 years of age) and 70,605 (87.2%) adults (15 years old and above). In 2014, the proportions were 8.8% (259) for pediatrics and 91.2% (2,674) for adults.

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III. KFSH&RC CANCER PATIENT POPULATION A total of 2,933 cases were accessioned in 2014, with 1,318 males and 1,614 females or a male/female ratio of 0.8:1.

FIGURE 1

DISTRIBUTION OF CASES ACCESSIONED BY YEAR 1975 – 2014 (TOTAL CASES = 80,978)

From the opening of the hospital (mid 1975) until December 2014, 80,978 cancer cases were registered (40,431 males and 40,546 females) with a male/female ratio of 0.9:1. There were 10,373 (12.8%) pediatric cases (0 to 14 years of age) and 70,605 (87.2%) adults (15 years old and above). In 2014, the proportions were 8.8% (259) for pediatrics and 91.2% (2,674) for adults.

FIGURE 1

DISTRIBUTION OF CASES ACCESSIONED BY YEAR1975-2014 (TOTAL CASES = 80,978)

NU

MBE

R O

F CA

SES

YEAR

3,000

2,500

2,000

1,500

1,000

500

00

500

1000

1500

2000

2500

3000

1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

NUMBE

ROFCA

SES

YEAR

FIGURE1

DISTRIBUTIONOFCASESACCESSIONEDBYYEAR1975-2014(TOTALCASES=80,978)

FEMALE

MALE

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TABLE 1 CASES SEEN AT KFSH&RC (MALE/FEMALE & PEDIATRICS/ADULTS) BY 5-YEAR

PERIOD

1975 – 2014

Saudi nationals totaled 2,826 (96.4%) in 2014 and the non-Saudi, 107 (3.6%). During the period 1975 to 2014, the former accounted for 89.4% (72,416) while the latter, 10.6% (8,562).

FIGURE 2

DISTRIBUTION OF CASES BY NATIONALITY1975 - 2014 (TOTAL CASES = 80,978)

FIGURE2

DISTRIBUTIONOFCASESBYNATIONALITY1975-2014(TOTALCASES=80,978)

SAUDI72,416(89.4%)

NON-SAUDI8562(10.6%)YEMENI2,304(2.8%)LEB,SYR,PAL,JORD1,820(2.2%)AFRICAN1,124(1.4%)EGYPTIAN989(1.2%)GCC844(1.0%)ALLOTHERS1,481(1.8%)

2014 (TOTAL CASES = 2,933)

NON-SAUDI 8562 (10.6%)

YEMENI 2,304 (2.8%)LEB,SYR,PAL,JORD 1,820 (2.2%)AFRICAN 1,124 (1.4%)EGYPTIAN 989 (1.2%)GCC 844 (1.0%)ALL OTHERS 1,481 (1.8%)

NON-SAUDI 107 (3.6%)

YEMENI 16 (0.5%)GCC 6 (0.2%)LEB,SYR,PAL,JORD 13 (0.5%)AFRICAN 6 (0.2%)EGYPTIAN 22 (0.8%)ALL OTHERS 44 (1.5%)

SAUDI 72,416 (89.4%)

SAUDI 2,826 (96.4%)

2014(TOTALCASES=2,933)

SAUDI2,826(96.4%) NON-SAUDI107(3.6%)

YEMENI16(0.5%)GCC6(0.2%)LEB,SYR,PAL,JORD13(0.5%)AFRICAN6(0.2%)EGYPTIAN22(0.8%)ALLOTHERS44(1.5%)

TABLE 1

CASES SEEN AT KFSH&RC (MALE/FEMALE & PEDIATRICS/ADULTS) BY 5-YEAR PERIOD1975 - 2014

1975-1976* 1977-1981 1982-1986 1987-1991 1992-1996 1997-2001 2002 - 2006 2007-2011 2012-2014 TOTAL

MALE 280 2,980 4,150 4,969 5,562 6,427 6,529 5,819 3,715 40,431FEMALE 135 1,945 3,358 4,341 5,347 6,753 7,199 6,952 4,516 40,546

TOTAL 415 4,925 7,508 9,310 10,909 13,180 13,728 12,771 8,231 80,977

M/F RATIO 2.1:1 1.5:1 1.2:1 1.1:1 1.0:1 1.0:1 0.9:1 0.8:1 0.8:1 0.9:1

PEDIATRICS** 55 593 985 1164 1397 1892 1893 1566 828 10,373(%) 13.3% 12.0% 13.1% 12.5% 12.8% 14.4% 13.8% 12.3% 10.1% 12.8%

ADULTS 360 4,332 6,523 8,146 9,512 11,288 11,835 11,205 7,404 70,605(%) 86.7% 88.0% 86.9% 87.5% 87.2% 85.6% 86.2% 87.7% 89.9% 87.2%

TOTAL 415 4,925 7,508 9,310 10,909 13,180 13,728 12,771 8,232 80,978

* First two years of KFSH&RC partial operation.** Pediatrics = 0 to 14 years of age; Adults = 15 years and above.

*** One Pediatric Transgender Case was excluded from any specific classification analysis on the basis of gender.

TABLE 1

CASES SEEN AT KFSH&RC (MALE/FEMALE & PEDIATRICS/ADULTS) BY 5-YEAR PERIOD1975 - 2014

1975-1976* 1977-1981 1982-1986 1987-1991 1992-1996 1997-2001 2002 - 2006 2007-2011 2012-2014 TOTAL

MALE 280 2,980 4,150 4,969 5,562 6,427 6,529 5,819 3,715 40,431FEMALE 135 1,945 3,358 4,341 5,347 6,753 7,199 6,952 4,516 40,546

TOTAL 415 4,925 7,508 9,310 10,909 13,180 13,728 12,771 8,231 80,977

M/F RATIO 2.1:1 1.5:1 1.2:1 1.1:1 1.0:1 1.0:1 0.9:1 0.8:1 0.8:1 0.9:1

PEDIATRICS** 55 593 985 1164 1397 1892 1893 1566 828 10,373(%) 13.3% 12.0% 13.1% 12.5% 12.8% 14.4% 13.8% 12.3% 10.1% 12.8%

ADULTS 360 4,332 6,523 8,146 9,512 11,288 11,835 11,205 7,404 70,605(%) 86.7% 88.0% 86.9% 87.5% 87.2% 85.6% 86.2% 87.7% 89.9% 87.2%

TOTAL 415 4,925 7,508 9,310 10,909 13,180 13,728 12,771 8,232 80,978

* First two years of KFSH&RC partial operation.** Pediatrics = 0 to 14 years of age; Adults = 15 years and above.

*** One Pediatric Transgender Case was excluded from any specific classification analysis on the basis of gender.

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Geographically, the referral pattern in 2014 was mainly from the Riyadh region with 42.2% of all cases, followed by the Asir region and the Eastern Province with 10.3% and 8%, respectively. During the 39 years in review, 35.9% were referred from Riyadh, 14.3% from the Eastern Province and 10.7% from Mekkah. These percentages reflect the KFSH&RC actual experience rather than adjusted to reflect the population of those regions.

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TRENDS IN RELATIVE FREQUENCY OF CANCER AT KFSH&RC The crude relative frequency is the proportion of a given cancer in relation to all cases in a clinical or pathological series. Although such frequencies are subject to many biases, historically many elevated frequencies have been confirmed when complete cancer registration was introduced. Acceptance of cases to KFSH&RC is based on eligibility criteria, considering the nature of disease and availability of services. Breast cancer led the list of total cancer cases seen from 1975 to 2014 with 12%, followed by leukemia (8.6%), non-hodgkin’s lymphoma (7.4%), thyroid (7%) and colon, rectum (5.3%).

FIGURE 4

DISTRIBUTION OF 20 MOST COMMON MALIGNANCIES 1975 – 2014 (TOTAL CASES = 80,978*)

*One Pediatric Transgender Case was excluded from any specific classification analysis on the basis of gender.

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TRENDS IN RELATIVE FREQUENCY OF CANCER AT KFSH&RC The crude relative frequency is the proportion of a given cancer in relation to all cases in a clinical or pathological series. Although such frequencies are subject to many biases, historically many elevated frequencies have been confirmed when complete cancer registration was introduced. Acceptance of cases to KFSH&RC is based on eligibility criteria, considering the nature of disease and availability of services. Breast cancer led the list of total cancer cases seen from 1975 to 2014 with 12%, followed by leukemia (8.6%), non-hodgkin’s lymphoma (7.4%), thyroid (7%) and colon, rectum (5.3%).

FIGURE 4

DISTRIBUTION OF 20 MOST COMMON MALIGNANCIES 1975 – 2014 (TOTAL CASES = 80,978*)

*One Pediatric Transgender Case was excluded from any specific classification analysis on the basis of gender.

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

NUMBE

ROFCA

SES

FIGURE4DISTRIBUTIONOF20MOSTCOMMONMALIGNANCIES

1975-2014(TOTALCASES=80,978)

FEMALE

MALE

MALIGNANCIES

BREAST

LEUKEMIA NHL

THYROID

COLON, RECTUM

BRAIN, CNS

ORAL CAVITY

HODGKIN’S LYMPHOMA

LUNG, BRONCHUSLIVER

NASOPHARYNX

BLADDER

SOFT TISSUE

STOMACH

ESOPHAGUS

KIDNEY, URINARYBONE

OTHER SKIN CANCEROVARY

CERVIX UTERI

10,000

9,000

8,000

7,000

6,000

5,000

4,000

3,000

2,000

1,000

0

NU

MBE

R O

F CA

SES

MALIGNANCIES

FIGURE 4

DISTRIBUTION OF 20 MOST COMMON MALIGNANCIES 1975 - 2014 (TOTAL CASES = 80,978)

12

0

500

1000

1500

2000

2500

3000

3500

00-09 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

NUMBE

ROFCA

SES

AGEINYEARS

BREASTCANCERCASES

REGIONAL4,842(49.7%)

LOCALIZED2,254(22.6%)

UNSTAGEABLE649(6.7%)

DISTANT1,727(17.7%)

INSITU272(2.5%)

BREAST CANCER CASESN

UM

BER

OF

CA

SES

AGE IN YEARS

3,000

3,500

2,500

2,000

1,500

1,000

500

000-09

00-09

10-19

10-19

20-29

20-29

30-39

30-39

40-49

40-49

50-59

50-59

60-69

60-69

70-79

70-79

80-89

80-89

90+

90+

0

500

1000

1500

2000

2500

3000

3500

00-09 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

NUMBE

ROFCA

SES

AGEINYEARS

BREASTCANCERCASES


LOCALIZED2,254(22.6%)


DISTANT1,727(17.7%)

INSITU272(2.5%)

FIGURE 5

DISTRIBUTION OF FIVE MOST COMMON MALIGNANCIESBY AGE AT DIAGNOSIS AND SEER SUMMARY STAGE

(1975 - 2014)

IN SITU 272 (2.5%)

REGIONAL 4,842 (49.7%) UNSTAGEABLE 649 (6.7%)

DISTANT 1,727 ( 17.7 %)

LOCALIZED 2,254 (22.6%)

0

500

1000

1500

2000

2500

00-09 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

NUMBE

ROFCA

SES

AGEINYEARS

LEUKEMIACASES1975-2014

NU

MB

ER O

F C

ASE

S

LEUKEMIA CASES 1975-2014

AGE IN YEARS

2,500

2,000

1,500

1,000

500

0

13

0

200

400

600

800

1000

1200

1400

1600

00-09 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

NUMBER

OFCA

SES

AGEINYEARS

THYROIDCANCERCASES

[CATEGORYNAME][VALUE]([PERCENTAGE])

LOCALIZED2,440(43%)

REGIONAL2244(39%)

UNSTAGEABLE508(9%)

DISTANT497(9%)

0

200

400

600

800

1000

1200

1400

1600

00-09 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

NUMBE

ROFC

ASES

AGEINYEARS

THYROIDCANCERCASES

[CATEGORYNAME][VALUE]([PERCENTAGE])

LOCALIZED2,440(43%)

REGIONAL2244(39%)

UNSTAGEABLE508(9%)

DISTANT497(9%)

00-09

00-09

10-19

10-19

20-29

20-29

30-39

30-39

40-49

40-49

50-59

50-59

60-69

60-69

70-79

70-79

80-89

80-89

90+

90+

0

100

200

300

400

500

600

700

800

900

1000

00-09 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

NUMBE

ROF

CASES

AGEINYEARS

NON-HODGKIN'SLYMPHOMACASES

DISTANT3,041(51%)

LOCALIZED927(15.6%)



0

100

200

300

400

500

600

700

800

900

1000

00-09 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

NUMBE

ROFCA

SES

AGEINYEARS

NON-HODGKIN'SLYMPHOMACASES

DISTANT3,041(51%)

LOCALIZED927(15.6%)



NU

MB

ER O

F C

ASE

S

AGE IN YEARS

NON-HODGKIN’S LYMPHOMA CASES

0

100

200

300

400

500

600

700

800

900

1000

NU

MB

ER O

F C

ASE

S

AGE IN YEARS

THYROID CANCER CASES

LOCALIZED 927 (15.6%)

REGIONAL 1,659 (27.8%)

UNSTAGEABLE 330 (5.5%)DISTANT 3,041 (51%)

REGIONAL 2244 (39%)

DISTANT 497 (9%)

UNSTAGEABLE 508 (9%)

LOCALIZED 2,440 (43%)

1,400

1,600

1,200

1,000

800

600

400

200

0

14

0

200

400

600

800

1000

1200

00-09 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

NUMBE

ROF

CAS

ES

AGEINYEARS

COLON,RECTUMCANCERCASES

REGIONAL1,938(46%)

LOCALIZED512(12.0%)

UNSTAGEABLE456(11%)

INSITU17(0.4%)

COLON, RECTUM CANCER CASES

NU

MB

ER O

F C

ASE

S

AGE IN YEARS

0

200

400

600

800

1000

1200

00-09 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

REGIONAL 1,938 (46%)

LOCALIZED 512(12.0 %)

UNSTAGEABLE 456 (11%)

IN SITU 17 (0.4%)

DISTANT 1341 (31.0%)

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TABLE 2 TEN MOST COMMON MALIGNANCIES BY AGE GROUP AT DIAGNOSIS

1975-2014

SITE AGE GROUP No % SITE AGE GROUP No %

BREAST 00 - 14 2 0.0 BRAIN, CNS 00 - 14 1,697 45.6

15 - 39 2,918 29.9 15 - 39 1,002 27.0

40 - 60 5,493 56.4 40 - 60 701 18.9

>60 1,331 13.7 >60 317 8.5


LEUKEMIA 00 - 14 3,063 44.2 ORAL CAVITY 00 - 14 45 1.2

15 - 39 2,383 34.4 15 - 39 511 14.2

40 - 60 1,103 15.9 40 - 60 1,485 41.2

>60 380 5.5 >60 1,567 43.4


NON-HODGKIN'S 00 - 14 871 14.6 HODGKIN'S 00 - 14 941 28.8

LYMPHOMA 15 - 39 1,601 26.9 LYMPHOMA 15 - 39 1,763 53.8

40 - 60 1,914 32.1 40 - 60 428 13.1

>60 1,571 26.4 >60 141 4.3


THYROID 00 - 14 109 1.9 LUNG 00 - 14 12 0.4

15 - 39 2,833 49.8 15 - 39 179 6.1

40 - 60 1,986 34.9 40 - 60 1,281 44.0

>60 762 13.4 >60 1,440 49.5


COLON, RECTUM 00 - 14 14 0.3 LIVER 00 - 14 105 3.8

15 - 39 735 17.2 15 - 39 153 5.5

40 - 60 2,078 48.7 40 - 60 179 42.4

>60 1,437 33.8 >60 1,342 48.3


BREAST 00 - 14 2 0.0 BRAIN, CNS 00 - 14 1,697 45.6

15 - 39 2,918 29.9 15 - 39 1,002 27.0

40 - 60 5,493 56.4 40 - 60 701 18.9

>60 1,331 13.7 >60 317 8.5


LEUKEMIA 00 - 14 3,063 44.2 ORAL CAVITY 00 - 14 45 1.2

15 - 39 2,383 34.4 15 - 39 511 14.2

40 - 60 1,103 15.9 40 - 60 1,485 41.2

>60 380 5.5 >60 1,567 43.4


NON-HODGKIN'S 00 - 14 871 14.6 HODGKIN'S 00 - 14 941 28.8

LYMPHOMA 15 - 39 1,601 26.9 LYMPHOMA 15 - 39 1,763 53.8

40 - 60 1,914 32.1 40 - 60 428 13.1

>60 1,571 26.4 >60 141 4.3


THYROID 00 - 14 109 1.9 LUNG 00 - 14 12 0.4

15 - 39 2,833 49.8 15 - 39 179 6.1

40 - 60 1,986 34.9 40 - 60 1,281 44.0

>60 762 13.4 >60 1,440 49.5


COLON, RECTUM 00 - 14 14 0.3 LIVER 00 - 14 105 3.8

15 - 39 735 17.2 15 - 39 153 5.5

40 - 60 2,078 48.7 40 - 60 179 42.4

>60 1,437 33.8 >60 1,342 48.3

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0

500

1000

1500

2000

2500

NUMBE

ROFCA

SES

FIGURE7DISTRIBUTIONOF10MOSTCOMMONPEDIATRICMALIGNANCIESBYHISTOLOGY

1975-2014(TOTALCASES=10,372)

FEMALE

MALE

MALIGNANCIES

0

500

1000

1500

2000

2500

3000

3500

NUMBE

ROFCA

SES

FIGURE6DISTRIBUTIONOF10MOSTCOMMONPEDIATRICMALIGNANCIES

1975-2014(TOTALCASES=10,372)

FEMALE

MALE

MALIGNANCIES

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Cancer among pediatrics (under the age of 15) accounted for 12.8% of all cases from 1975 to 2014. The five most common pediatric malignancies were leukemia (29.6%), brain/CNS (16.4%), hodgkin’s lymphoma (9.1%), non-hodgkin’s lymphoma (8.4%) and bone (6.9%).

FIGURE 6

DISTRIBUTION OF 10 MOST COMMON PEDIATRIC MALIGNANCIES 1974 - 2014 (TOTAL CASES = 10,372)

FIGURE 7

DISTRIBUTION OF 10 MOST COMMON PEDIATRIC MALIGNANCIES BY HISTOLOGY 1975 - 2014 (TOTAL CASES = 10,372)

FIGURE 6

DISTRIBUTION OF 10 MOST COMMON PEDIATRIC MALIGNANCIES1975 - 2014 (TOTAL CASES = 10,372)

FIGURE 7

DISTRIBUTION OF 10 MOST COMMON PEDIATRIC MALIGNANCIES BY HISTOLOGY1975 - 2014 (TOTAL CASES = 10,372)

NU

MB

ER O

F C

ASE

S

MALIGNANCIES

MALIGNANCIES

NU

MB

ER O

F C

ASE

S

LEUKEMIA

ACUTE LYMPHOID LEUKEMIA


NON-HODGKIN’S LYMPHOMA

ACUTE MYELOID LEUKEMIA

RETINOBLASTOMA

NEUROBLASTOMA

ASTROCYTOMA

MEDULLOBLASTOMA

NEPHROBLASTOMA

OSTEOSARCOMA

BRAIN, CNS


NON-HODGKIN’S LYMPHOMABONE

SOFT TISSUE EYE

KIDNEY, URINARY

OTHER ENDOCRINE

THYROID

3,000

3,500

2,500

1,500

1,000

500

0

2,500

2,000

1,500

1,000

500

0

2,000

17

18

19

Site

Gro

up

197

7-19

81

199

7-20

01

200

2-20

06

200

7-20

11No

%

No%

No%

No%

No%

No%

No%

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NUMBE

ROFCA

SES

AGEINYEARS

FIGURE9DISTRIBUTIONOFPEDIATRICCASESBYAGEATDIAGNOSIS

2014(TOTALCASES=259)

FEMALE

MALE

0

50

100

150

200

250

300

350

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FIGURE8AGEDISTRIBUTIONOFALLCASESBYAGEATDIAGNOSIS

2014(TOTALCASES=2933)

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20

The largest number of cases in 2014 was noted in the 5th and 6th decades of life in males and in the 4th and 5th in females. The mean age was 45.8, median age was 48, and the mode was 50 years of age. Pediatric malignancies were most common among children at less than two years of age.

FIGURE 8

DISTRIBUTION OF 20 ALL CASES BY AGE AT DIAGNOSIS 2014 (TOTAL CASES = 2,543)

FIGURE 9

DISTRIBUTION OF PEDIATRIC CASES BY AGE AT DIAGNOSIS 2014 (TOTAL CASES = 259)

Of the 2,933 cases in 2014, 2,543 (86.7%) were analytic (defined as cases which were first diagnosed and/or received all or part of their first course of treatment at KFSH&RC). The remaining 390 cases (13.3%) were non-analytic (defined as cases diagnosed elsewhere and received all of their first course of treatment elsewhere). Out of the 2,543 analytic cases, pediatric cases totaled 219. See Table 5 for the distribution of cases by site, sex, class of case, and stage at diagnosis and Tables 6, 7 and 8 for the distributions of analytic cases by site, sex and age at diagnosis. 20

The largest number of cases in 2014 was noted in the 5th and 6th decades of life in males and in the 4th and 5th in females. The mean age was 45.8, median age was 48, and the mode was 50 years of age. Pediatric malignancies were most common among children at less than two years of age.

FIGURE 8

DISTRIBUTION OF 20 ALL CASES BY AGE AT DIAGNOSIS 2014 (TOTAL CASES = 2,543)

FIGURE 9

DISTRIBUTION OF PEDIATRIC CASES BY AGE AT DIAGNOSIS 2014 (TOTAL CASES = 259)

Of the 2,933 cases in 2014, 2,543 (86.7%) were analytic (defined as cases which were first diagnosed and/or received all or part of their first course of treatment at KFSH&RC). The remaining 390 cases (13.3%) were non-analytic (defined as cases diagnosed elsewhere and received all of their first course of treatment elsewhere). Out of the 2,543 analytic cases, pediatric cases totaled 219. See Table 5 for the distribution of cases by site, sex, class of case, and stage at diagnosis and Tables 6, 7 and 8 for the distributions of analytic cases by site, sex and age at diagnosis.

FIGURE 8

AGE DISTRIBUTION OF ALL CASES BY AGE AT DIAGNOSIS2014 (TOTAL CASES = 2933)

FIGURE 9

DISTRIBUTION OF PEDIATRIC CASES BY AGE AT DIAGNOSIS2014 (TOTAL CASES = 259)

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29

36

98

20

049

Retro

perito

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itone

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00

00

00

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Nasa

l Cav

ity, S

inus,

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00

00

00

00

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02

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01

02

20

22

31

11

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00

11

12

74

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100

00

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00

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11

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00

00

00

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00

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Leuk

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93

28

13

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55

22

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31

00

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ft Tiss

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92

42

45

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41

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10

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26

20

22

23

43

15

52

140

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30

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92

312

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TOTA

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259

6410

297

115

145

206

280

157

258

272

205

167

136

9335

4025

43

SIT

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35-3

940

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45-4

950

-54

55-5

960

-64

65-6

970

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75-7

980

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85 +

TOTA

L

Ora

l Cav

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11

00

62

713

28

88

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137

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127

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29

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98

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049

Ret

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Leuk

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62

02

22

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31

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72

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57

57

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120

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259

6410

297

115

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206

280

157

258

272

205

167

136

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14

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10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85 +

TOTA

L

Oral

Cavit

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10

00

52

57

03

56

53

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00

00

00

00

20

17

11

05

11

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00

00

00

16

05

22

41

41

127

Small

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00

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029

Retro

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00

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10

01

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74

10

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41

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20

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Non-

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30

34

33

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34

44

77

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00

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23

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TOTA

L58

3229

5554

5650

6712

71

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8180

5425

2511

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SITE

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20-2

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40-4

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50-5

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10

01

23

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24

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Non-

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30

34

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FIGURE 11

DISTRIBUTION OF PEDIATRIC MALIGNANCIES 2014 ANALYTIC CASES (TOTAL CASES = 219)

FIGURE 12

DISTRIBUTION OF 10 MOST COMMON PEDIATRIC MALIGNANCIES BY HISTOLOGY 2014 ANALYTIC CASES (TOTAL CASES = 219)

27

FIGURE 11

DISTRIBUTION OF PEDIATRIC MALIGNANCIES 2014 ANALYTIC CASES (TOTAL CASES = 219)

FIGURE 12

DISTRIBUTION OF 10 MOST COMMON PEDIATRIC MALIGNANCIES BY HISTOLOGY 2014 ANALYTIC CASES (TOTAL CASES = 219)

2828

TABLE 10

PRIMARY SITE TABLE 2014 (INCLUDES MULTIPLE PRIMARIES)

SITE HISTOLOGY ALL

CASES ADULTS PEDIATRICS

(NOS - Not Otherwise Specified) MALE FEMALE MALE FEMALE 2,933 1189 1,485 128 130

LIP 6 4 2 0 0 Squamous Cell Carcinoma 5 3 2 0 0 Basal Cell Carcinoma 1 1 0 0 0

TONGUE 30 18 12 0 0 Squamous Cell Carcinoma 29 17 12 0 0 Mucoepidermoid Carcinoma 1 1 0 0 0

GUM 11 5 6 0 0 Squamous Cell Carcinoma 10 5 5 0 0 Malignant Melanoma 1 0 1 0 0

FLOOR OF MOUTH 4 4 0 0 0 Squamous Cell Carcinoma 4 4 0 0 0

OROPHARYNX 1 1 0 0 0 Squamous Cell Carcinoma 1 1 0 0 0

SALIVARY GLANDS, MAJOR 9 8 1 0 0 Mucoepidermoid Carcinoma 3 2 1 0 0 Adenoid Cystic Carcinoma 3 3 0 0 0 Large Cell Neuroendocrine Carcinoma 1 1 0 0 0 Carcinoma NOS 1 1 0 0 0 Hemangiosarcoma 1 1 0 0 0

TONSIL 2 2 0 0 0 Squamous Cell Carcinoma 2 2 0 0 0

NASOPHARYNX 59 42 15 1 1 Squamous Cell Carcinoma 49 34 14 0 1 Carcinoma Undifferentiated 7 6 1 0 0 Embryonal Rhabdomyosarcoma 1 0 0 1 0 Carcinoma NOS 2 2 0 0 0

HYPOPHARYNX 7 1 5 0 1 Squamous Cell Carcinoma 6 1 5 0 0 Rhabdomyosarcoma 1 0 0 0 1

OTHER SITES IN LIP, ORAL CAVITY, PHARYNX 2 0 1 0 0 Squamous Cell Carcinoma 1 1 0 0 0 Carcinoma 1 0 1 0 0

ESOPHAGUS 30 21 9 0 0 Squamous Cell Carcinoma 8 3 5 0 0 Adenocarcinoma NOS 18 15 3 0 0 Carcinoma NOS 2 1 1 0 0 Adenosquamous Carcinoma 0 2 0 0

2929

STOMACH 74 36 38 0 0

Adenocarcinoma NOS 45 27 18 0 0 Carcinoma Diffuse Type 6 2 4 0 0 Signet Ring Cell Carcinoma 17 5 12 0 0 Gastrointestinal Stromal Sarcoma 4 0 4 0 0 Neuroendocrine Carcinoma 1 1 0 0 0 Carcinoid 1 1 0 0 0

SMALL INTESTINE 20 14 6 0 0 Neuroendocrine Tumor 2 1 1 0 0 Adenocarcinoma NOS 11 7 4 0 0 Carcinoid Tumor 3 3 0 0 0 Mucinous Adenocarcinoma 1 0 1 0 0 Gastro Intestinal Stromal Sarcoma 3 3 0 0 0

COLON 130 64 66 0 0 Adenocarcinoma NOS 104 53 51 0 0 Mucinous Adenocarcinoma 14 7 7 0 0 Signet Ring Cell Carcinoma 2 1 1 0 0 Carcinoma NOS 4 2 2 0 0 Neoplasm Malignant 2 1 1 0 0 GI Stromal Sarcoma 2 0 2 0 0 Neuroendocrine Carcinoma 2 0 2 0 0

RECTOSIGMOID JUNCTION 16 12 4 0 0 Adenocarcinoma NOS 15 11 4 0 0 Neuroendocrine Carcinoma 1 1 0 0 0

RECTUM 84 52 31 0 1 Adenocarcinoma NOS 78 48 29 0 1 Mucinous Adenocarcinoma 4 3 1 0 0 Carcinoma 2 1 1 0 0

ANUS, ANAL CANAL, ANORECTUM 7 2 5 0 0 Adenocarcinoma 2 0 2 0 0 Squamous Cell Carcinoma 5 2 3 0 0

LIVER, INTRAHEPATIC BILE DUCT 80 40 30 4 6 Hepatocellular Carcinoma 59 30 26 1 2 Cholangiocarcinoma 8 5 3 0 0 Hepatoblastoma 7 0 0 3 4 Carcinoma NOS 1 1 0 0 0 Adenocarcinoma NOS 3 3 0 0 0 Klatskin Tumor 1 1 0 0 0 Kupffer Cell Sarcoma 1 0 1 0 0

GALLBLADDER, EXTRAHEPATIC BILE DUCT 22 7 15 0 0 Adenocarcinoma NOS 14 3 11 0 0 Carcinoma 4 1 3 0 0 Cholangiocarcinoma 4 3 1 0 0

PANCREAS 59 37 22 0 0 Adenocarcinoma NOS 38 28 10 0 0

3030

Neoplasm Malignant 4 1 3 0 0 Carcinoma NOS 10 5 5 0 0 Carcinoid 3 1 2 0 0 Infiltrating Duct Carcinoma 1 1 0 0 0 Mucinous Adenocarcinoma 3 1 2 0 0

NASAL CAVITY, MIDDLE EAR 4 2 2 0 0 Basaloid Squamous Cell Carcinoma 1 1 0 0 0 Adenoid Cystic Carcinoma 2 1 1 0 0 Neoplasm Malignant 1 0 1 0 0

LARYNX 18 18 0 0 0 Squamous Cell Carcinoma 18 18 0 0 0

LUNG, BRONCHUS 91 72 19 0 0 Adenocarcinoma NOS 41 33 8 0 0 Mucinous Adenocarcinoma 3 2 1 0 0 Mucoepidermoid Carcinoma 1 1 0 0 0 Carcinoid 4 1 3 0 0 Carcinoma NOS 5 5 0 0 0 Neoplasm Malignant 2 1 1 0 0 Rhabdomyosarcoma 1 1 0 0 0 Non-Small Cell Carcinoma 16 12 4 0 0 Small Cell Carcinoma 4 4 0 0 0 Squamous Cell Carcinoma 14 12 2 0 0

THYMUS 1 1 0 0 0 Thymoma Malignant 1 1 0 0 0

HEART 0 0 0 0 0 Synovial Sarcoma 0 0 0 0 0

BONE, JOINTS, CARTILAGE 63 24 18 10 11 Osteosarcoma 23 8 6 4 5 Chondroblastic Osteosarcoma 7 2 3 0 2 Ewing Sarcoma 11 3 2 4 2 Chordoma 1 0 1 0 0 Chondrosarcoma 2 1 1 0 0 Giant Cell Tumor of Bone 2 2 0 0 0 Hemangiosarcoma 1 0 1 0 0 Malignant Rhabdoid Tumor 1 0 0 1 0 Myxoid Chondrosarcoma 1 1 0 0 0 Periosteal Osteosarcoma 1 0 1 0 0 Primitive Neuroectodermal Tumor 2 0 0 1 1 Sarcoma NOS 5 2 2 0 1 Others 6 5 1 0 0

BONE MARROW 209 80 49 48 31 Precursor B-Cell Lymphoblastic Leukemia 51 1 5 29 16 Acute Myeloid Leukemia 56 23 17 7 9 Chronic Myeloid Leukemia 24 10 12 2 0 Precursor T-Cell Lymphoblastic Leukemia 22 13 2 7 0 Acute Monocytic Leukemia 1 1 0 0 0

3131

Acute Promyelocytic Leukemia 6 2 1 3 0

B-Cell Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

10 6 0 0 0

Hairy Cell Leukemia 1 1 0 0 0 Burkitt Cell Leukemia 3 2 0 0 1 Myelodysplastic Syndrome Polycythemia Vera 6 5 1 0 0 Precursor Cell Lymphoblastic Leukemia 3 0 0 0 3 Polymorphocytic Leukemia B Cell Type 1 1 0 0 0 Acute Myelomonocytic Leukemia 7 3 3 0 1

Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable

11 6 5 0 0

Acute Leukemia 4 1 1 0 1 Hypereosinophilic Syndrome 1 1 0 0 0 Acute Megakaryoblastic Leukemia 1 1 0 0 0 Essential Thrombocythemia 4 2 2 0 0 Refractory Anemia with Excess Blasts 1 1 0 0 0

MULTIPLE MYELOMA 26 20 6 0 0 Multiple Myeloma 26 20 6 0 0

SPLEEN 2 1 1 0 0 Non-Hodgkin's Lymphoma 2 1 1 0 0

SKIN (NON MELANOMA) 45 26 19 0 0 Squamous Cell Carcinoma 12 7 5 0 0 Basal Cell Carcinoma 23 13 10 0 0 Dermatofibrosarcoma 4 2 2 0 0 Sebacious Adenocarcinoma 1 0 1 0 0 Clear Cell Adenocarcinoma 1 1 0 0 0 Verrucous Carcinoma 1 1 0 0 0 Basosquamous Carcinoma 1 0 1 0 0 Hemangiosarcoma 1 1 0 0 0 Merkel Cell Carcinoma 1 1 0 0 0

RETROPERITONEUM, PERITONEUM 5 3 2 0 0 Carcinoid Tumor 1 1 0 0 0 Mucinous Adenocarcinoma 1 1 0 0 0 Desmoplastic Round Cell Tumor 1 0 1 0 0 Leiomyosarcoma 1 1 0 0 0 Neuroendocrine Carcinoma 1 0 1 0 0

CONNECTIVE, SUBCUTEANEOUS, SOFT TISSUES

61 32 18 6 5

Synovial Sarcoma 7 4 2 1 0 Neuroblastoma 3 0 0 0 3 Dermatofibrosarcoma NOS 4 4 0 0 0 Embryonal Rhabdomyosarcoma 2 0 0 2 0 Ganglioneuroblastoma 1 0 0 1 0 Myxoid Liposarcoma 3 2 1 0 0 Fibromyxosarcoma 4 2 2 0 0 Spindle Cell Sarcoma 2 1 1 0 0 Undifferentiated Sarcoma 1 1 0 0 0

3232

Gastrointestinal Stromal Sarcoma 1 1 0 0 0 Leiomyosarcoma 5 3 2 0 0 Malignant Peripheral Nerve Sheath Tumor 4 2 1 0 1 Round Cell Liposarcoma 1 0 1 0 0 Rhabdomyosarcoma 4 0 1 2 1 Clear Cell Sarcoma 1 1 0 0 0 Dedifferentiated Liposarcoma 2 2 0 0 0 Epithelioid Sarcoma 1 0 1 0 0 Ewing Sarcoma 1 0 1 0 0 Malignant Granular Cell Tumor 1 0 1 0 0 Malignant Fibrous Histiocytoma 1 1 0 0 0 Malignant Mesothelioma 1 1 0 0 0 Myxoid Chondrosarcoma 1 1 0 0 0 Giant Cell Sarcoma 2 2 0 0 0 PNET 1 0 1 0 0 Small Cell Sarcoma 1 0 1 0 0 Basal Cell Nodular Carcinoma 1 1 0 0 0 Chondroblastic Sarcoma NOS 1 1 0 0 0 Carcinoma NOS 1 1 0 0 0 Sarcoma NOS 3 1 2 0 0

BREAST 466 1 465 0 0 Infiltrating Duct Carcinoma 373 1 372 0 0 Lobular Carcinoma 38 0 38 0 0 Intraductal Carcinoma Noninfiltrating 20 0 20 0 0 Infiltrating Duct Mixed with Other Types of Ca 10 0 10 0 0

Infiltrating Lobular Mixed with Other Types of Ca

1 0 1 0 0

Carcinoma NOS 2 0 2 0 0 Metaplastic Carcinoma 3 0 3 0 0 Phyllodes Tumor Malignant 4 0 4 0 0 Infiltrating Duct and Lobular Carcinoma 5 0 5 0 0 Cribriform Carcinoma In Situ 2 0 2 0 0 Paget Disease Mammary 1 0 1 0 0 Malignant Neoplasm 2 0 2 0 0 Clear Cell Sarcoma NOS 1 0 1 0 0 Intraductal Papillary Carcinoma 1 0 1 0 0 DCIS Mixed With Other In Situ 1 0 1 0 0 Adenocarcinoma NOS 2 0 2 0 0

VULVA 2 0 2 0 0 Squamous Cell Carcinoma Keratinizing 1 0 1 0 0 Squamous Intraepithelial Neoplasia Grade III 1 0 1 0 0

VAGINA 1 0 1 0 0 Squamous Cell Carcinoma 1 0 1 0 0

CERVIX UTERI 43 0 43 0 0 Squamous Cell Carcinoma 26 0 26 0 0 Adenocarcinoma 5 0 5 0 0 Serous Cyst Adenocarcinoma 1 0 1 0 0 Adenosarcoma 1 0 1 0 0 Clear Cell Adenocarcinoma 1 0 1 0 0

3333

Leiomyosarcoma 1 0 1 0 0 Squamous Intraepithelial Neoplasia Grade III 7 0 7 0 0 Mucinous Adenocarcinoma 1 0 1 0 0

CORPUS UTERI 85 0 85 0 0 Endometrioid Adenocarcinoma 58 0 58 0 0 Adenocarcinoma NOS 6 0 6 0 0 Adenocarcinoma with mixed subtypes 1 0 1 0 0 Serous Cystadenocarcinoma 4 0 4 0 0 Clear Cell Adenocarcinoma 4 0 4 0 0 Endometrial Stromal Sarcoma 1 0 1 0 0 Carcinosarcoma 2 0 2 0 0 Mullerian Mixed Tumor 5 0 5 0 0 Mucinous Adenocarcinoma 1 0 1 0 0 Squamous Cell Carcinoma 1 0 1 0 0 Carcinoma NOS 2 0 2 0 0

UTERUS, NOS 13 0 13 0 0 Carcinosarcoma 3 0 3 0 0 Carcinoma NOS 1 0 1 0 0 Mullerian Mixed Tumor 2 0 2 0 0 Serous Cystadenocarcinoma 2 0 2 0 0 Spindle Cell Sarcoma 1 0 1 0 0 Leiomyosarcoma 4 0 4 0 0

OVARY 54 0 51 0 3 Serous Cystadenocarcinoma 23 0 23 0 0 Papillary Serous Cystadenocarcinoma 5 0 5 0 0 Adenocarcinoma NOS 4 0 4 0 0 Dysgerminoma 1 0 1 0 0 Germinoma 1 0 0 0 1 Mullerian Mixed Tumor 1 0 1 0 0 Mucinous Adenocarcinoma 3 0 3 0 0 Mucinous Cystadenocarcinoma 1 0 1 0 0 Carcinoma NOS 1 0 1 0 0 Clear Cell Adenocarcinoma 4 0 4 0 0 Endometrioid Adenocarcinoma 3 0 3 0 0 Neoplasm Malignant 2 0 2 0 0 Sertoli-Leydig Cell Tumor 1 0 1 0 0 Papillary Cystadenocarcinoma 1 0 1 0 0 Yolk Sac Tumor 1 0 0 0 1 Trophoblastic Epithelioid Tumor 1 0 1 0 0 Teratoma Malignant 1 0 0 0 1

PLACENTA 2 0 2 0 0 Trophoblastic Placenta 2 0 2 0 0

PROSTATE 66 65 0 1 0 Adenocarcinoma NOS 60 60 0 0 0 Carcinoma NOS 2 2 0 0 0 Neoplasm Malignant 2 2 0 0 0 Embryonal Rhabdomyosarcoma 1 0 0 1 0 Small Cell Carcinoma 1 1 0 0 0

3434

TESTIS* 33 32 0 0 0

Seminoma 15 15 0 0 0 Mixed Germ Cell Tumor 8 8 0 0 0 Hemangiosarcoma 2 2 0 0 0 Embryonal Carcinoma 1 0 0 0 0 Germinoma 2 2 0 0 0 Liposarcoma 1 1 0 0 0 Taratoma 3 0 0 0 0

KIDNEY AND RENAL PELVIS 95 54 23 7 11 Nephroblastoma 16 0 0 6 10 Clear Cell Adenocarcinoma 28 21 7 0 0 Papillary Adenocarcinoma 4 4 0 0 0 Renal Cell Carcinoma 27 14 12 0 1 Renal Cell Carcinoma Chromophobe Type 11 9 2 0 0 Renal Cell Carcinoma Sarcomatoid 1 1 0 0 0 Transitional Cell Carcinoma 2 2 0 0 0 Papillary Transitional Cell Carcinoma 2 2 0 0 0 Papillary TCC Non-Invasive 2 0 2 0 0 Spindle Cell Carcinoma 1 1 0 0 0 Malignant Rhabdoid Tumor 1 0 0 1 0

URINARY BLADDER 73 63 8 1 1 Papillary Transitional Cell Carcinoma 53 51 2 0 0 Transitional Cell Carcinoma 12 9 3 0 0 Squamous Cell Carcinoma 3 2 1 0 0 Mucinous Adenocarcinoma 1 0 1 0 0 Transitional Cell Carcinoma Spindle Cell 1 0 1 0 0 Rhabdomyosarcoma 1 0 0 1 0 Pseudosarcomatous Carcinoma 1 1 0 0 0 Embryonal Rhabdomyosarcoma 1 0 0 0 1

EYE, ADNEXA 23 1 3 6 13 Retinoblastoma 16 0 0 5 11 Adenoid Cystic Carcinoma 1 0 1 0 0 Rhabdomyosarcoma 2 0 0 1 1 Sebaceous Adenocarcinoma 1 0 1 0 0 Lymphoepithelial Carcinoma 1 0 1 0 0 Basal Cell Carcinoma 1 1 0 0 0 Orbital Sarcoma 1 0 0 0 1

MENINGES 2 0 2 0 0 Meningioma Malignant 2 0 2 0 0

BRAIN 91 29 31 14 17 Glioblastoma 17 8 8 1 0 Medulloblastoma 11 6 3 0 2 Glioma Malignant 11 2 1 1 7 Oligodendroglioma 7 1 6 0 0 Pilocytic Astrocytoma 1 0 0 0 1 Atypical Teratoid/Rhabdoid Tumor 1 0 0 0 1 Ependymoma Anaplastic 2 0 0 1 1

3535

Oligodendroglioma Anaplastic 6 3 3 0 0 Papillary Ependymoma 1 0 0 1 0 Ependymoma 7 3 2 1 1 Germinoma 3 1 1 1 0 Mixed Glioma 5 2 3 0 0 Astrocytoma Anaplastic 1 0 0 1 0 Astrocytoma 4 1 0 1 2 Desmoplastic Nodular Medulloblastoma 1 1 0 0 0 Medulloblastoma 11 0 3 6 2 Gliosarcoma 1 1 0 0 0 Pleomorphic Xanthoastrocytoma 1 0 1 0 0

THYROID 284 68 215 1 0 Papillary Adenocarcinoma 102 28 74 0 0 Papillary Carcinoma Columnar Cell 38 8 30 0 0 Papillary Carcinoma Follicular Variant 54 12 42 0 0 Papillary Carcinoma 6 2 4 0 0 Papillary Microcarcinoma 33 6 27 0 0 Papillary Carcinoma Encapsulated 23 5 18 0 0 Follicular Adenocarcinoma 5 2 3 0 0 Carcinoma Anaplastic 3 0 3 0 0 Medullary Carcinoma 6 2 4 0 0 Oxyphilic Adenocarcinoma 13 3 9 1 0 Non Encapsulating Sclerosing Carcinoma 1 0 1 0 0

ADRENAL GLAND 11 2 0 4 5 Neuroblastoma 9 0 0 4 5 Adrenal Cortical Carcinoma 2 2 0 0 0

OTHER ENDOCRINE GLANDS 3 3 0 0 0 Pineoblastoma 2 2 0 0 0 Germinoma 1 1 0 0 0

LYMPH NODES (HODGKIN'S LYMPHOMA) 144 72 43 16 13 Nodular Sclerosis 88 39 28 9 12 Hodgkin's Lymphoma NOS 20 9 9 2 0 Mixed Cellularity 18 13 2 2 1 Nodular Lymphocyte Predominance 18 11 4 3 0

LYMPH NODES (NON HODGKIN'S LYMPHOMA) 150 80 59 7 4 Large B-Cell Diffuse 88 50 34 3 1 Follicular Lymphoma 14 10 4 0 0 Burkitt Lymphoma 5 0 1 3 1 Non-Hodgkin's Lymphoma NOS 12 6 6 0 0

Anaplastic Large Cell Lymphoma T Cell and Null Cell Type

1 1 0 0 0

Precursor Lymphoblastic Lymphoma NOS 1 0 0 0 1 Mantle Cell Lymphoma 2 2 0 0 0 Marginal Zone B-Cell Lymphoma 5 1 4 0 0 Mature T-Cell Lymphoma NOS 4 3 1 0 0 Mycosis Fungoides (Skin) 17 6 9 1 1 T-Cell Rich Large B-Cell Lymphoma 1 1 0 0 0

3636

PRIMARY UNKNOWN 29 15 13 0 1 Adenocarcinoma NOS 9 4 5 0 0 Carcinoma NOS 6 4 2 0 0 Neuroblastoma 1 0 0 0 1 Carcinoid Tumor 1 1 0 0 0 Mucinous Adenocarcinoma 3 2 1 0 0 Neoplasm Malignant 4 1 3 0 0 Neuroendocrine Carcinoma 4 2 2 0 0 Squamous Cell Carcinoma 1 1 0 0 0

* One Pediatric Transgender Case for Testicular Cancer was excluded from this analysis

37

TABLE 11

MULTIPLE PRIMARY SITES TABLE2 0 1 4

PRIMARY SITE HISTOLOGY OTHER PRIMARIES ALL CASES MALE FEMALE

190 68 122

LIP 1 0 1Basal Cell Carcinoma* Skin - Malignant Melanoma 1 0 0

Skin -Basal Cell Carcinoma TONGUE 9 4 5

Squamous Cell Carcinoma Non-Hodgkin's Lymphoma 1 0 1Squamous Cell Carcinoma Non-Hodgkin's Lymphoma 1 1 0Squamous Cell Carcinoma Gum - Squamous Cell Carcinoma 1 0 1Squamous Cell Carcinoma Nasopharynx-SCC 1 0 1Squamous Cell Carcinoma Thyroid - Papillary Carcinoma 1 1 0Squamous Cell Carcinoma Nasopharynx - Carcinoma 1 0 1Squamous Cell Carcinoma* Gum - Squamous Cell Carcinoma 1 0 1

Colon - Mucinous AdenocarcinomaSquamous Cell Carcinoma Thyroid - Papillary Thyroid Microcarcinoma 1 1 0Squamous Cell Carcinoma Nasopharynx - Carcinoma, Undifferentiated 1 1 0

NASOPHARYNX 4 3 1Squamous Cell Carcinoma Bone Marrow - CML 1 1 0Squamous Cell Carcinoma Thyroid - Papillary Microcarcinoma, 1 0 1Squamous Cell Carcinoma Rectum - Adenocarcinoma 1 1 0Squamous Cell Carcinoma** Thyroid - Papillary Microcarcinoma 1 1 0

Glottis - Squamous Cell CarcinomaRetromolar Area - SCC

MOUTH 9 4 5Squamous Cell Carcinoma Tongue - Squamous Cell Carcinoma 1 0 1Squamous Cell Carcinoma Cheek Mucosa - SCC 1 1 0Polymorphous Adenocarcinoma Thyroid - Papillary Microcarcinoma 1 0 1Mucoepidermoid Carcinoma Cheek - Mucoepidermoid Carcinoma 1 0 1Squamous Cell Carcinoma Tonsil-SCC 1 1 0Polymorphous Adenocarcinoma Thyroid - Papillary Microcarcinoma 1 0 1Mucoepidermoid Carcinoma Cheek - Mucoepidermoid Carcinoma 1 0 1Squamous Cell Carcinoma Tongue - SCC 1 1 0Squamous Cell Carcinoma Tongue - SCC 1 1 0

GUM 2 0 2Squamous Cell Carcinoma* Tongue - Squamous Cell Carcinoma 1 0 1Squamous Cell Carcinoma* Floor of Mouth - SCC 1 0 1

PHARYNX 1 1 0Squamous Cell Carcinoma Nasopharynx - Squamous Cell Ca 1 1 0

EYE 1 1 0Basal Cell Carcinoma Thyroid - Papillary Thyroid Carcinoma 1 1 0

ESOPHAGUS 4 1 3Adenocarcinoma Kidney - Renal Cell Carcinoma, 1 0 1Squamous Cell Carcinoma Stomach - GIST 1 0 1Adenocarcinoma Rectum - Adenocarcinoma 1 1 0Carcinoma Undifferentiated NHL 1 0 1

STOMACH 3 3 0Neuroendocrine Carcinoma Thyroid - Papillary Ca Follicular 1 1 0Signet Ring Cell Carcinoma Esophagus - Sq Cell Carcinoma 1 1 0

2014 (NOS - Not Otherwise Specified) (PREVIOUS OR CONCURRENT)

38

Therapy-Related AML HL - Nodular Sclerosis 1 1 0Refractory Anemia Acute Myeloid Leukemia 1 1 0

SOFT TISSUE 2 1 1Dermatofibrosarcoma* Skin - Basal Cell Carcinoma 1 1 0

Skin- Squamaous Cell Ca 1 0 1Round Cell Liposarcoma Thyroid - Papillary Carcinoma


SKIN 6 3 3Basal Cell Carcinoma Nodular Skin - Basal Cell Carcinoma 1 1 0Basal Cell Carcinoma Skin Lt Temple - Malignant Melanoma 1 0 1Basal Cell Car Nodular*** Skin - Basal Cell Carcinoma 1 0 1

Cheek-Basal Cell CarcinomaSkin Nose - Basal Cell CarcinomaBreast - Malignant phyllodes Tumor

Basal Cell Ca Nodular Skin Scalp/Neck - Basal Cell Carcinoma, 1 0 1Basal Cell Adenocarcinoma** Skin, Lt Nose - Basal Cell Carcinoma 1 1 0

Skin Contra Cheek - Basal Cell CarcinomaSkin: Supraclav Area - Basal Cell Ca

Basal Cell Adenocarcinoma* Skin - Mycosis Fugioides 1 1 0Malignant Lymhpoma Large B-Cell

BRAIN 1 1 0Gliosarcoma Brain - Medulloblastoma 1 1 0

BREAST 48 0 48Lobular Carcinoma Cont Breast - Ductal Ca 1 0 1Intraductal Carcinoma Breast - DCIS 1 0 1Lobular Carcinoma Cont Breast - Lobular Carcinoma 1 0 1Infiltrating Duct Mixed Ca Contra Breast - Infiltrating Ductal Ca 1 0 1Infiltrating Duct Carcinoma Rt Breast - Infiltrating Ductal Ca 1 0 1Lobular Carcinoma Bone Marrow - AML 1 0 1Infiltrating Duct Carcinoma* Tongue - SCC 1 0 1

Cont Breast - Ductal CarcinomaInfiltrating Duct Carcinoma Cont Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Cont Breast - Ductal Carcinoma In Situ 1 0 1Intraductal Carcinoma Noninfilt Cont Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Cont Breast - Infiltrating Ductal Ca 1 0 1Infiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Cont Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Contra Breast - Intraductal Papillary 1 0 1Infiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma* Contra Breast - Ductal Carcinoma

Thyroid - Papillary Thyroid CaInfiltrating Duct Carcinoma Contra Breast - Infiltrating Ductal Ca 1 0 1Infiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Colon - Mucinous Adenocarcinoma 1 0 1Infiltrating Duct Carcinoma Contra Breast - Metaplastic Carcinoma 1 0 1Intraductal Carcinoma Noninfiltrating Contra Breast - DCIS 1 0 1Infiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Contralateral Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Cervix Uteri - Carcinoma In-Situ 1 0 1Lobular Carcinoma In Situ Contra Breast - Lobular Carcinoma 1 0 1Infiltrating Duct Carcinoma Breast - Ductal Carcinoma 1 0 1


Lymphoma Large B-cell Prostate - Adenocarcinoma 1 1 0

SMALL INTESTINE 3 2 1Adenocarcinoma Rectum - Mucinous Adenocarcinoma 1 1 0Adenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Adenocarcinoma Stomach - Adenocarcinoma 1 1 0

COLON 5 4 1Adenocarcinoma Rectum - Adenocarcinoma 1 1 0Neoplasm Malignant Small Instestine - Adenocarcinoma 1 1 0Adenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Adenocarcinoma Rectum - Adenocarcinoma 1 1 0Adenocarcinoma Stomach - Adenocarcinoma 1 1 0


RECTOSIGMOID JUNCTION 9 6 3Adenocarcinoma GI Tract - GIST 1 1 0Adenocarcinoma Breast - Lobular Carcinoma 1 0 1Adenocarcinoma Rectosigmoid - Adenocarcinoma 1 1 0Adenocarcinoma Gum - SCC 1 0 1Adenocarcinoma Colon - Adenocarcinoma 1 1 0Adenocarcinoma Liver - Hepatocellular Carcinoma 1 1 0Adenocarcinoma Colon - Adenocarcinoma 1 1 0Adenocarcinoma Prostate - Prostatic Adenocarcinoma 1 1 0Adenocarcinoma Colon - Adenocarcinoma 1 0 1

ANUS/ANAL CANAL 1 0 1Squamous Cell Carcinoma Thyroid - Follicular Carcinoma 1 0 1

LIVER, INTRAHEPATIC BILE DUCT 3 2 1Hepatocellular Carcinoma Stomach - DLBCL 1 0 1Hepatoblastoma Bone Marrow - AML 1 1 0Hepatocellular Carcinoma Prostate - Adenocarcinoma 1 1 0

PANCREAS / AMPULLA OF VATER 2 1 1Adenocarcinoma Rectum - Adenocarcinoma 1 1 0Carcinoma Vulva - Squamous Cell Carcinoma 1 0 1

LUNG 6 4 2Adenocarcinoma Thyroid - Papillary Adenocarcinoma 1 0 1Squamous Cell Carcinoma Nasopharynx - Carcinoma 1 1 0Adenocarcinoma Colon - Adenocarcinoma 1 1 0Mucinous Adenocarcinoma Cervix uteri - Squamous Cell In Situ 1 0 1Squamous Cell Carcinoma Tongue - SCC 1 1 0Adenocarcinoma Bladder - Papillary Transitional Cell 1 1 0

BONE 1 0 1Chondroblastic Osteosarcoma Thyroid - Papillary Microcarcinoma 1 0 1

BONE MARROW 6 4 2Acute Myelomonocytic Leukemia Bone marrow - CML 1 1 0Acute Myelomonocytic Leukemia* Thyroid - Medullary Carcinoma 1 0 1Therapy-Related AML** Soft Tissue - Embryonal 1 1 0

Bone - OsteosarcomaAcute Myeloid Leukemia Nos Periph Nerves - Ganglioneuroblastoma 1 0 1























































39





























Intraductal Carcinoma Noninfil Contralateral Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma* Endometrium - Endometrioid Ca 1 0 1

Contral Breast - Ductal CaInfiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Endometrium - Endometrioid 1 0 1Infiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Lobular Carcinoma Endometrium - Endometrioid 1 0 1Infiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Lobular Carcinoma Breast - Lobular Carcinoma 1 0 1Infiltrating Duct Carcinoma Breast - DCIS 1 0 1Infiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Infiltrating Duct And Lobular Contra Breast - Ductal Carcinoma 1 0 1Intraductal Carcinoma Noninfiltrating Ovary - Malignant Teratoma 1 0 1Infiltrating Duct Carcinoma Breast - Ductal Carcinoma Mixed Ca 1 0 1Infiltrating Duct Carcinoma Thyroid - Papillary Microcarcinoma 1 0 1Lobular Carcinoma Contra Breast - Lobular Carcinoma 1 0 1Infiltrating Duct Carcinoma Contra Breast - Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Contra Breast -Ductal Carcinoma 1 0 1Infiltrating Duct Carcinoma Contralateral Breast - Ductal Ca 1 0 1Infiltrating Duct Carcinoma Colon Sigmoid - Colonic Adenocarcinoma 1 0 1


CORPUS UTERI 10 0 10Serous Cystadenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Endometrioid Adenocarcinoma Rt Ovary - Papillary Serous Cystic Tumor 1 0 1Endometrioid Adenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Carcinoma Breast - Ductal Carcinoma 1 0 1Endometrioid Adenocarcinoma Ovary - Adenocarcinoma 1 0 1Squamous Cell Carcinoma Thyroid - Papillary Thyroid Carcinoma 1 0 1Endometrioid Adenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Clear Cell Adenocarcinoma Thyroid - Papillary Carcinoma 1 0 1Adenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Endometrioid Adenocarcinoma Ovary - Endometrioid Carcinoma 1 0 1

OVARY 7 0 7Papillary Cystadenocarcinoma Nos Thyroid - Papillary Adenocarcinoma 1 0 1Mullerian Mixed Tumor Breast - Ductal Carcinoma 1 0 1Clear Cell Adenocarcinoma Contralateral Ovary - Clear Cell Ca 1 0 1Serous Cystadenocarcinoma Contra Ovary - Serous Cyst Adenoca 1 0 1Serous Cystadenocarcinoma Contra Ovary-Serous Cyst Adenoca 1 0 1Serous Cystadenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Serous Cystadenocarcinoma Contra Ovary - Serous Cyst Adenoca 1 0 1

CERVIX UTERI / UTERUS 3 0 3Squamous Cell Carcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Squamous Cell Carcinoma Sigmoid Colon - Adenocarcinoma 1 0 1Leiomyosarcoma Thyroid - Papillary Microcarcinoma 1 0 1

VAGINA 1 0 1Squamous Cell Carcinoma Tongue - Microinvasive SCC 1 0 1

PROSTATE GLAND 4 4 0Adenocarcinoma Pancreas - Adenocarcinoma 1 1 0


40














































Adenocarcinoma Colon - Adenocarcinoma 1 1 0Adenocarcinoma Rectum - Adenocarcinoma 1 1 0

Colon - Mucinous AdenocarcinomaAdenocarcinoma HL - Nodular Sclerosis 1 1 0

Sigmoid Colon - Mucinous Adenoca

TESTIS 1 1 0Hemangiosarcoma Testis - Embryonal Carcinoma 1 1 0

KIDNEY 4 2 2Renal Cell Carcinoma Nos Thyroid - Papillary Ca 1 1 0Papillary Transitional Cell Ca Bladder - Papillary Urothelial Ca 1 0 1Renal Cell Carcinoma Nos Contralateral Kidney - Renal Cell Ca 1 0 1Renal Cell Carcinoma Chromophobe Kidney - Chromophobe Renal Cell Ca 1 1 0

URINARY BLADDER 10 9 1Squamous Cell Carcinoma Pancreas - Adenocarcinoma 1 0 1Papillary Transitional Cell Ca Non Hodgkin's Lymphoma 1 1 0Papillary Transitional Cell Ca Ureteral Orifice - Papillary Urothelial Ca 1 1 0Papillary Transitional Cell Carcinoma Bladder -Urothelial Carcinoma In Situ 1 1 0Papillary Transitional Cell Ca Prostate - Prostatic Adenocarcinoma 1 1 0Papillary Transitional Cell Carcinoma Thyroid - Papillary Thyroid Carcinoma 1 1 0Papillary Transitional Cell Ca Parotid - Warthin Tumor 1 1 0Papillary Transitional Cell Carcinoma Rectum - Adenocarcinoma 1 1 0Papillary Transitional Cell Ca Unknown Primary - Carcinoma 1 1 0Papillary Transitional Cell Carcinoma Bladder - Invasive Carcinoma 1 1 0

ESOPHAGUS 4 1 3Adenocarcinoma Kidney - Renal Cell Carcinoma 1 0 1Squamous Cell Carcinoma Stomach - GIST 1 0 1Adenocarcinoma Rectum - Adenocarcinoma 1 1 0Carcinoma Undifferentiated NHL 1 0 1

LYMPH NODES 7 4 3Non-Hodgkin's Lymphoma Prostate - Adenocarcinoma 1 1 0Non-Hodgkin's Lymphoma HL, Mixed Cellularity 1 1 0Non-Hodgkin's Lymphoma Breast - Ductal Carcinoma 1 0 1Non-Hodgkin's Lymphoma Skin - Kaposi's Sarcoma 1 0 1Non-Hodgkin's Lymphoma Bone Marrow - MDS 1 1 0Non-Hodgkin's Lymphoma Liver - Hepatocellular Carcinoma 1 1 0Non-Hodgkin's Lymphoma Thyroid - Papillary Carcinoma 1 0 1

THYROID 10 2 8Papillary Adenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Follicular Carcinoma Thyroid - Papillary Microcarcinoma 1 0 1Papillary Adenocarcinoma Colon - Mucinous Adenocarcinoma 1 0 1Papillary Microcarcinoma Kidney - Renal Cell Carcinoma 1 1 0Follicular Adenocarcinoma Skin - Basal Cell Carcinoma 1 1 0Papillary Carcinoma Encapsulated Thyroid - Marginal Zone B-Cell Lymphoma 1 0 1Papillary Carcinoma Endometrium - Endometrioid 1 0 1Papillary Adenocarcinoma Maxillary Bone - Osteosarcoma 1 0 1Papillary Adenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Oxyphilic Adenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1

UNKNOWN PRIMARY 2 0 2Adenocarcinoma Liver - Hepatocellular Carcinoma 1 0 1Adenocarcinoma Liver - Hepatocellular Carcinoma 1 0 1

41














Adenocarcinoma Colon - Adenocarcinoma 1 1 0Adenocarcinoma Rectum - Adenocarcinoma 1 1 0

Colon - Mucinous AdenocarcinomaAdenocarcinoma HL - Nodular Sclerosis 1 1 0

Sigmoid Colon - Mucinous Adenoca

TESTIS 1 1 0Hemangiosarcoma Testis - Embryonal Carcinoma 1 1 0

KIDNEY 4 2 2Renal Cell Carcinoma Nos Thyroid - Papillary Ca 1 1 0Papillary Transitional Cell Ca Bladder - Papillary Urothelial Ca 1 0 1Renal Cell Carcinoma Nos Contralateral Kidney - Renal Cell Ca 1 0 1Renal Cell Carcinoma Chromophobe Kidney - Chromophobe Renal Cell Ca 1 1 0

URINARY BLADDER 10 9 1Squamous Cell Carcinoma Pancreas - Adenocarcinoma 1 0 1Papillary Transitional Cell Ca Non Hodgkin's Lymphoma 1 1 0Papillary Transitional Cell Ca Ureteral Orifice - Papillary Urothelial Ca 1 1 0Papillary Transitional Cell Carcinoma Bladder -Urothelial Carcinoma In Situ 1 1 0Papillary Transitional Cell Ca Prostate - Prostatic Adenocarcinoma 1 1 0Papillary Transitional Cell Carcinoma Thyroid - Papillary Thyroid Carcinoma 1 1 0Papillary Transitional Cell Ca Parotid - Warthin Tumor 1 1 0Papillary Transitional Cell Carcinoma Rectum - Adenocarcinoma 1 1 0Papillary Transitional Cell Ca Unknown Primary - Carcinoma 1 1 0Papillary Transitional Cell Carcinoma Bladder - Invasive Carcinoma 1 1 0

ESOPHAGUS 4 1 3Adenocarcinoma Kidney - Renal Cell Carcinoma 1 0 1Squamous Cell Carcinoma Stomach - GIST 1 0 1Adenocarcinoma Rectum - Adenocarcinoma 1 1 0Carcinoma Undifferentiated NHL 1 0 1

LYMPH NODES 7 4 3Non-Hodgkin's Lymphoma Prostate - Adenocarcinoma 1 1 0Non-Hodgkin's Lymphoma HL, Mixed Cellularity 1 1 0Non-Hodgkin's Lymphoma Breast - Ductal Carcinoma 1 0 1Non-Hodgkin's Lymphoma Skin - Kaposi's Sarcoma 1 0 1Non-Hodgkin's Lymphoma Bone Marrow - MDS 1 1 0Non-Hodgkin's Lymphoma Liver - Hepatocellular Carcinoma 1 1 0Non-Hodgkin's Lymphoma Thyroid - Papillary Carcinoma 1 0 1

THYROID 10 2 8Papillary Adenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Follicular Carcinoma Thyroid - Papillary Microcarcinoma 1 0 1Papillary Adenocarcinoma Colon - Mucinous Adenocarcinoma 1 0 1Papillary Microcarcinoma Kidney - Renal Cell Carcinoma 1 1 0Follicular Adenocarcinoma Skin - Basal Cell Carcinoma 1 1 0Papillary Carcinoma Encapsulated Thyroid - Marginal Zone B-Cell Lymphoma 1 0 1Papillary Carcinoma Endometrium - Endometrioid 1 0 1Papillary Adenocarcinoma Maxillary Bone - Osteosarcoma 1 0 1Papillary Adenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1Oxyphilic Adenocarcinoma Breast - Infiltrating Ductal Carcinoma 1 0 1

UNKNOWN PRIMARY 2 0 2Adenocarcinoma Liver - Hepatocellular Carcinoma 1 0 1Adenocarcinoma Liver - Hepatocellular Carcinoma 1 0 1

* Patient has three primary malignancies** Patient has four primary malignancies*** Patient has five primary malignancies

4242

STAGE OF DISEASE AT DIAGNOSIS Stage in any malignant process may be defined as the particular step, phase, or extent in a tumor's development, which is one of the predictors for outcome and treatment selection assigned at the time of initial diagnosis. The microscopic appearance, extent, and biological behavior of a tumor, as well as host factors, play a part in prognosis and are therefore important in staging. The SEER (Surveillance, Epidemiology and End Results) Summary Staging Guide was utilized for all stage-able cases. This system summarizes the disease categories into four general staging groups (i.e., in situ, localized, regional and distant). Stage categories are based on a combination of clinical observations and operative-pathological evaluation. Summary Staging Definitions: IN SITU : Intraepithelial, noninvasive, non-infiltrating LOCALIZED : Within organ a. Invasive cancer confined to the organ of origin b. Intraluminal extension where specified REGIONAL : Beyond the organ of origin a. By direct extension to adjacent organs/tissues b. To regional lymph nodes c. Both (a) and (b) DISTANT : Direct extension or metastasis a. Direct continuity to organs other than above b. Discontinuous metastasis c. To distant lymph nodes Systemic diseases, i.e., leukemia and multiple myeloma and cases of unstageable unknown primary were disregarded in graphically illustrating the stages for all analytic cases seen at KFSH&RC in 2014 (Figure 13). The 37 cases unstageable at diagnosis were those patients who refused further diagnostic workup, or further workup was not possible due to the patients' state of health, e.g., terminal cases or those with co-morbid conditions, or those with not enough information from the referring hospitals to stage the disease. Please refer also to Table 5 for the distribution of the 2014 analytic cases by site and stage at diagnosis. In addition to the SEER Summary Staging, the cases were also staged according to the American Joint Committee on Cancer (AJCC) TNM system. This scheme is based on the premise that cancers of similar histology or site of origin share similar patterns of growth and extension. This system is based on the assessment of three components: T: Extent of the primary tumor N: Absence or presence and extent of regional lymph node involvement M: Absence or presence of distant metastasis Analytic cases of six major sites, i.e., breast, lung, nasopharynx, stomach, colorectal, and hodgkin’s lymphoma are presented in Table 12 with their clinical group stages and yearly comparative figures from 2009 to 2014.

43

SURG&RAD&CHEMO30(1.2%)

RADIATION395(15.5%)

SURGERY409(16.1%)

FIGURE14

DISTRIBUTIONOFANALYTICCASESBYFIRSTCOURSEOFTREATMENTMODALITY

2014(TOTALCASES=2,543)

RAD&CHEMO591(23.2%)

SURG&CHEMO6(10.2%)

NOTREATMENT141(5%)

CHEMOTHERAPY427(16.8%)

SURG&RAD591(23.2%)

INSITU48(2.1%)

DISTANT*632(27.5%)

FIGURE13

DISTRIBUTIONOFANALYTICCASESBYSTAGE(SEER)ATDIAGNOSIS2014(TOTALCASES=2,301)

*ExcludesHematopoie2cPrimaries(220cases)**ExcludesUnstageableUnknownPrimaries(1case)

UNSTAGEABLE**37(1.6%)

LOCALIZED777(33.8%)

REGIONAL 807(35.1%)

FIGURE 14

DISTRIBUTION OF ANALYTIC CASES BYFIRST COURSE OF TREATMENT MODALITY

2014 (TOTAL CASES = 2,543)

FIGURE 13

DISTRIBUTION OF ANALYTIC CASESBY STAGE (SEER) AT DIAGNOSIS

2014 (TOTAL CASES = 2,301)

REGIONAL 807 (35.1%)

DISTANT* 632 (27.5 %)

CHEMOTHERAPY 427 (16.8%)

SURGERY 409 (16.1%)

NO TREATMENT 141 (5%)

RAD & CHEMO 591 (23.2%) SURG & CHEMO 6 (10.2%)

SURG & RAD 591 (23.2%)

RADIATION 395 (15.5%)

SURG & RAD & CHEMO 30 (1.2%)

UNSTAGEABLE** 37 (1.6%)

LOCALIZED 777 (33.8%)

IN SITU 48 (2.1 %)

*Excludes Hematopoietic Primaries (220 cases) **Excludes Unstageable Unknown Primaries (1 case)

44

BREASTStage 2010 2011 2012 2013 2014 T O T A L

No % No % No % No % No % No %

0 6 1.7 12 3.1 13 3.7 13 3.3 14 3.2 58 3.11 - - - - - - 6 1.5 33 7.5 40 2.21A 37 10.6 39 10.2 37 10.5 26 6.5 9 2.1 139 7.71B 0 0.0 0 0.0 0 0.0 2 0.5 0 0.0 2 0.12A 61 17.5 66 17.2 71 20.0 81 20.3 69 15.8 348 18.02B 51 14.7 60 15.6 33 9.3 60 15.0 81 18.5 285 13.83A 16 4.6 30 7.8 31 8.7 45 11.3 49 11.2 171 7.73B 34 9.8 44 11.4 39 11.0 50 12.5 61 14.0 228 11.33C 5 1.4 3 0.8 8 2.3 1 0.3 9 2.1 26 1.24 71 20.4 64 16.7 63 17.8 64 16.0 92 21.1 354 18.5Unstageable 67 19.3 66 17.2 59 16.7 51 12.8 20 4.5 263 16.4

Total 348 100.0 384 100.0 354 100.0 399 100.0 437 100.0 1,922 100.0

LUNGStage 2010 2011 2012 2013 2014 T O T A L


0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.01A 4 6.7 4 5.9 5 7.6 3 4.2 2 2.4 18 6.01B 0 0.0 4 5.9 2 3.0 3 4.2 1 1.2 10 4.72A 0 0.0 2 2.9 3 4.5 3 4.2 0 0 8 2.52B 3 5.0 0 0.0 0 0.0 2 2.8 1 1.2 6 2.23A 7 11.7 5 7.4 5 7.6 5 7.0 8 10 30 7.83B 3 5.0 7 10.3 5 7.6 7 9.9 3 3.7 25 9.74 43 71.7 41 60.2 39 59.1 43 60.7 26 31.7 192 60.8Unstageable 0 0.0 5 7.4 7 10.6 5 7.0 41 50 58 6.3

Total 60 100.0 68 100.0 66 100.0 71 100.0 82 100.0 347 100.0

NASOPHARYNXStage 2010 2011 2012 2013 2014 T O T A L


0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.01 2 2.8 4 6.3 2 3.6 4 6.2 1 1.9 13 4.22 6 8.5 8 12.7 5 9.1 1 1.5 4 7.4 20 6.52A - - - - - - - - - - 1 0.32B - - - - - - - - - - 2 0.63 19 26.8 13 20.6 9 16.4 10 15.4 8 14.8 72 23.34A 13 18.3 12 19.0 17 30.9 15 23.1 14 25.9 66 21.44B 21 29.6 18 28.6 17 30.9 24 36.9 13 24.1 93 30.14C 9 12.7 8 12.7 4 7.3 11 16.9 3 5.6 39 12.6Unstageable 1 1.4 0 0.0 1 1.8 0 0.0 11 20.4 3 1.0

Total 71 100.0 63 100.0 55 100.0 65 100.0 54 100.0 309 100.0

* Excludes Lymphoma Cases 44

TABLE 12

AJCC CLINICAL TNM GROUP STAGE OF ANALYTIC CASES OF MAJOR SITES* BY YEAR 2009 - 2014

BREAST Stage 2010 2011 2012 2013 2014 T O T A L


0 6 1.7 12 3.1 13 3.7 13 3.3 14 3.2 58 3.1 1 - - - - - - 6 1.5 33 7.5 40 2.2 1A 37 10.6 39 10.2 37 10.5 26 6.5 9 2.1 139 7.7 1B 0 0.0 0 0.0 0 0.0 2 0.5 0 0.0 2 0.1 2A 61 17.5 66 17.2 71 20.0 81 20.3 69 15.8 348 18.0 2B 51 14.7 60 15.6 33 9.3 60 15.0 81 18.5 285 13.8 3A 16 4.6 30 7.8 31 8.7 45 11.3 49 11.2 171 7.7 3B 34 9.8 44 11.4 39 11.0 50 12.5 61 14.0 228 11.3 3C 5 1.4 3 0.8 8 2.3 1 0.3 9 2.1 26 1.2 4 71 20.4 64 16.7 63 17.8 64 16.0 92 21.1 354 18.5 Unstageable 67 19.3 66 17.2 59 16.7 51 12.8 20 4.5 263 16.4 Total 348 100.0 384 100.0 354 100.0 399 100.0 437 100.0 1,922 100.0

NASOPHARYNX Stage 2010 2011 2012 2013 2014 T O T A L

No % No % No % No % No % No % 0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 2 2.8 4 6.3 2 3.6 4 6.2 1 1.9 13 4.2 2 6 8.5 8 12.7 5 9.1 1 1.5 4 7.4 20 6.5 2A - - - - - - - - - - 1 0.3 2B - - - - - - - - - - 2 0.6 3 19 26.8 13 20.6 9 16.4 10 15.4 8 14.8 72 23.3 4A 13 18.3 12 19.0 17 30.9 15 23.1 14 25.9 66 21.4 4B 21 29.6 18 28.6 17 30.9 24 36.9 13 24.1 93 30.1 4C 9 12.7 8 12.7 4 7.3 11 16.9 3 5.6 39 12.6 Unstageable 1 1.4 0 0.0 1 1.8 0 0.0 11 20.4 3 1.0 Total 71 100.0 63 100.0 55 100.0 65 100.0 54 100.0 309 100.0

LUNG Stage 2010 2011 2012 2013 2014 T O T A L No % No % No % No % No % No % 0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1A 4 6.7 4 5.9 5 7.6 3 4.2 2 2.4 18 6.0 1B 0 0.0 4 5.9 2 3.0 3 4.2 1 1.2 10 4.7 2A 0 0.0 2 2.9 3 4.5 3 4.2 0 0 8 2.5 2B 3 5.0 0 0.0 0 0.0 2 2.8 1 1.2 6 2.2 3A 7 11.7 5 7.4 5 7.6 5 7.0 8 10 30 7.8 3B 3 5.0 7 10.3 5 7.6 7 9.9 3 3.7 25 9.7 4 43 71.7 41 60.2 39 59.1 43 60.7 26 31.7 192 60.8 Unstageable 0 0.0 5 7.4 7 10.6 5 7.0 41 50 58 6.3 Total 60 100.0 68 100.0 66 100.0 71 100.0 82 100.0 347 100.0

45

AJCC CLINICAL TNM GROUP STAGE OF ANALYTIC* CASES OF MAJOR SITES BY YEAR2009 - 2014

HODGKIN'S LYMPHOMAStage 2010 2011 2012 2013 2014 T O T A L


1A 4 4.8 3 4.3 8 9.2 7 8.2 13 10.6 35 6.11B 1 1.2 0 0.0 0 0.0 1 1.2 1 0.8 3 1.02A 22 26.5 17 24.3 19 21.8 14 16.5 28 21.9 100 22.42B 10 12.0 5 7.1 8 9.2 10 11.8 14 10.9 47 10.03A 8 9.6 10 14.3 15 17.2 16 18.8 19 14.8 68 16.53B 11 13.3 12 17.1 6 6.9 11 12.9 12 9.4 52 11.74A 2 2.4 5 7.1 9 10.3 7 8.2 7 5.5 30 7.94B 24 29.0 18 25.7 21 24.1 19 22.3 26 20.3 108 23.7Unstageable 1 1.2 0 0.0 1 1.1 0 0.0 8 6.3 10 0.7

Total 83 100.0 70 100.0 87 100.0 85 100.0 128 100.0 453 100.0

STOMACHStage 2010 2011 2012 2013 2014 T O T A L


0 0 0.0 0 0.0 0 0.0 2 3.5 0 0.0 2 0.71A 0 0.0 1 1.9 0 0.0 1 1.8 2 1.8 4 0.71B 4 7.1 2 3.7 0 0.0 0 0.0 1 1.9 7 3.22 - - - - - - - - - - 5 1.82A 2 3.6 2 3.7 1 1.9 0 0.0 1 1.9 5 1.82B 1 1.8 2 3.7 2 3.7 0 0.0 0 0.0 5 1.83A 3 5.4 1 1.8 1 1.9 1 1.8 0 0.0 6 2.53B 5 8.9 2 3.7 1 1.9 1 1.8 1 1.8 10 4.73C 3 5 5 9.3 0 0.0 0 0.0 0 0.0 8 2.94 5 8.9 2 3.7 2 3.7 2 3.5 9 3.5 20 6.8Unstageable 33 58.9 37 68.5 47 87.0 50 87.7 46 87.7 213 73.1

Total 56 100.0 54 100.0 54 100.0 57 100.0 60 100.0 285 100.0

COLON, RECTUMStage 2010 2011 2012 2013 2014 T O T A L


0 0 0.0 0 0.0 1 0.6 0 0.0 0 0.0 1 0.11 6 4.1 10 5.8 7 4.2 6 3.4 2 2.2 31 4.72A 12 8.2 16 9.3 10 5.9 24 13.5 2 2.2 64 9.72B 1 0.7 0 0.0 1 0.6 4 2.3 0 0.0 6 0.82C 2 1.4 0 0.0 1 0.6 0 0.0 0 0.0 3 0.43A 2 1.4 3 1.7 2 1.2 1 0.6 1 1.1 9 1.23B 7 4.8 17 9.9 20 12.0 12 6.8 3 3.3 59 8.53C 4 2.7 2 1.2 4 2.4 9 5.0 2 2.2 21 2.84 - - - - 1 0.6 0 0.0 0 0.0 18 2.24A 10 6.8 8 4.7 6 3.6 15 8.5 5 5.4 40 4.84B 12 8.2 7 4.1 6 3.6 7 4.0 1 1.1 32 3.94C 0 0.0 0 0.0 2 1.2 0 0.0 1 1.1 2 0.2Unstageable 90 61.6 109 63.3 106 63.5 99 55.9 75 81.5 479 60.7

Total 146 100.0 172 100.0 167 100.0 177 100.0 92 100.1 765 100.044

TABLE 12

AJCC CLINICAL TNM GROUP STAGE OF ANALYTIC CASES OF MAJOR SITES* BY YEAR 2009 - 2014

BREAST Stage 2010 2011 2012 2013 2014 T O T A L


0 6 1.7 12 3.1 13 3.7 13 3.3 14 3.2 58 3.1 1 - - - - - - 6 1.5 33 7.5 40 2.2 1A 37 10.6 39 10.2 37 10.5 26 6.5 9 2.1 139 7.7 1B 0 0.0 0 0.0 0 0.0 2 0.5 0 0.0 2 0.1 2A 61 17.5 66 17.2 71 20.0 81 20.3 69 15.8 348 18.0 2B 51 14.7 60 15.6 33 9.3 60 15.0 81 18.5 285 13.8 3A 16 4.6 30 7.8 31 8.7 45 11.3 49 11.2 171 7.7 3B 34 9.8 44 11.4 39 11.0 50 12.5 61 14.0 228 11.3 3C 5 1.4 3 0.8 8 2.3 1 0.3 9 2.1 26 1.2 4 71 20.4 64 16.7 63 17.8 64 16.0 92 21.1 354 18.5 Unstageable 67 19.3 66 17.2 59 16.7 51 12.8 20 4.5 263 16.4 Total 348 100.0 384 100.0 354 100.0 399 100.0 437 100.0 1,922 100.0

NASOPHARYNX Stage 2010 2011 2012 2013 2014 T O T A L

No % No % No % No % No % No % 0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 2 2.8 4 6.3 2 3.6 4 6.2 1 1.9 13 4.2 2 6 8.5 8 12.7 5 9.1 1 1.5 4 7.4 20 6.5 2A - - - - - - - - - - 1 0.3 2B - - - - - - - - - - 2 0.6 3 19 26.8 13 20.6 9 16.4 10 15.4 8 14.8 72 23.3 4A 13 18.3 12 19.0 17 30.9 15 23.1 14 25.9 66 21.4 4B 21 29.6 18 28.6 17 30.9 24 36.9 13 24.1 93 30.1 4C 9 12.7 8 12.7 4 7.3 11 16.9 3 5.6 39 12.6 Unstageable 1 1.4 0 0.0 1 1.8 0 0.0 11 20.4 3 1.0 Total 71 100.0 63 100.0 55 100.0 65 100.0 54 100.0 309 100.0

LUNG Stage 2010 2011 2012 2013 2014 T O T A L No % No % No % No % No % No % 0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1A 4 6.7 4 5.9 5 7.6 3 4.2 2 2.4 18 6.0 1B 0 0.0 4 5.9 2 3.0 3 4.2 1 1.2 10 4.7 2A 0 0.0 2 2.9 3 4.5 3 4.2 0 0 8 2.5 2B 3 5.0 0 0.0 0 0.0 2 2.8 1 1.2 6 2.2 3A 7 11.7 5 7.4 5 7.6 5 7.0 8 10 30 7.8 3B 3 5.0 7 10.3 5 7.6 7 9.9 3 3.7 25 9.7 4 43 71.7 41 60.2 39 59.1 43 60.7 26 31.7 192 60.8 Unstageable 0 0.0 5 7.4 7 10.6 5 7.0 41 50 58 6.3 Total 60 100.0 68 100.0 66 100.0 71 100.0 82 100.0 347 100.0

46

IV. SPECIAL STUDY

RENAL CARCINOMA; KING FAISAL SPECIALIST HOSPITAL & RESEARCH CENTER EXPERIENCE

Fazal Hussain, MD, Shouki Bazarbashi, MD, Naeem Chaudhri, MD

Renal carcinoma is the 10th most common cancer among men and 14th most common cancer among women at KFSH&RC. During the year 2014, an ascending trend with 95 new cases of renal carcinoma was reported at KFSHRC as compared to 77 cases in 2013. Out of these new cases, 80 cases were analytical; 48 males and 32 females. KFSH&RC is the tertiary care referral center and have seen a steady increase in the numbers of renal carcinoma cases since 1975 (Figure 1). It’s primarily due to significant expansion of cancer services, including screening and early detection, in the Kingdom and partly due to incidental diagnoses during abdominal imaging. A total of 1,970 renal cancer cases have been registered at KFSH&RC out of a total of 80,978 cancer cases by the end of 2014. Renal cancers accounts for 2.4% of all cancers seen at KFSH&RC; 4.6% of all male and 2.1% of all female malignant cases with a male to female ratio of 2.2:1. Men are twice as likely as women to be diagnosed with renal cancer.

FIGURE 1 DISTRIBUTION OF RENAL CANCER CASES (1975-2014)

Relative frequencies of major cancers seen at KFSH&RC although reflect the national trends as evidenced by Saudi Cancer Registry data, are very different from the Western countries. For instance, renal carcinomas including renal pelvis accounts for 2.4% of all cancer cases at our center, 2.6% in Saudi Cancer Registry, and 4% of all cancers in the United States. Majority (32%) of our renal cancer patients are referred from the Central Region (Riyadh). Although our center receives patients from all parts of the Kingdom; Hail, Qassim, Asir, and Eastern Province are the major referring areas for renal cancers to KFSH&RC (Figure 2). Table 1. Distribution of renal cancer by stage during 2014.

TNM Cl Stage I II III IV Unk Number of cases 12 9 2 10 62

050

100150200250300350400450

1975-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2004 2005-2009 2010-2014

MALE FEMALE

47

Table 2. Distribution of renal cancer by grade during 2014.

Grade I II III Undifferentiated Unk Number of cases 1 26 10 10 48

FIGURE 2 DISTRIBUTION OF 2014 RENAL CANCER ANALYTIC CASES BY REGION

(BASED ON GIVEN ADDRESS AT THE TIME OF DIAGNOSIS)

Majority of these renal cancer patients present in 50-69 years of age group. However, the age distribution is bimodal with majority presenting in <20 years of age group and during the 5th-6th decades of life (Figure 3).

FIGURE 3

DISTRIBUTION OF 2014 RENAL CANCER ANALYTIC CASES BY AGE VS. SEX

RIYADH32%

HAIL13%QASSIM

13%

ASIR11%

EP9%

MAKKAH5%

JOUF4%

MADINAH4%

NP4%

JAZAN1%

NP1%

OT1%

SP1%

TABUK1%

0

2

4

6

8

10

12

14

16

18

20

<20 20-29 30-39 40-49 50-59 60-69 70-79 79+

Female

Male

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Histo-pathologically, majority of renal cancers seen at KFSH&RC were Renal Cell Carcinomas (RCC) and Clear Cell Carcinoma (TCC, also known as Urothelial Cell Carcinoma) of the renal pelvis, followed by Transitional Cell Carcinoma. During 2014, 41.3% of all renal cancers seen at our institution were RCC, 26.2% were Clear Cell Carcinoma and 6.2% were TCC. Only 3.8% were Adenocarcinomas (Figure 4).

FIGURE 4 DISTRIBUTION OF 2014 RENAL CANCER ANALYTIC CASES BY HISTO-PATHOLOGICAL TYPE

As per Saudi Cancer Registry (SCR) 2014 published report, annual incidence rate of Kidney cancer (including renal pelvis) for the Kingdom of Saudi Arabia was 2.6% of all newly diagnosed cases in 2014; A total of 407 cases (268 males and 139 females). It ranked as the 10th most common cancer among males and 13th among females with a M:F ratio of 1.9:1.0. The median age at diagnosis was 56 years among males and 49 years among females in Saudi population. Renal cancer was ranked as the 5th most common cancer among Saudi male pediatric patients and the 4th most common cancer among Saudi female pediatric patients, during 2014, as reported by SCR (Figures 5). Most of the early stage renal cancers presented with no symptoms. With disease advancing stage and disease progression, symptoms included hematuria, pain or mass in lower back or abdomen, fatigue, weight loss, fever, and lower extremity edema.

0

5

10

15

20

25

30

35

49

Figure 5 with permission from Saudi Cancer Registry (SCR) Annual Report, 2014

FIGURE 5 DISTRIBUTION OF PEDIATRIC CANCER CASES (0-14 YEARS) AMONG SAUDI NATIONALS BY

GENDER AND AGE GROUPS, 2014

In the GCC States, renal cancer is the 7th most common cancer among males below 15 years of age and 5th most common cancer among females in this age group between 1998-2009. The overall ASR was 2.5 and 1.6 per 100,000 populations for males and females, respectively. There has been a gradual increase in ASR among males and females from 1998-2009 (Table 3). Renal cancer incidence is significantly higher among males compared to females in all GCC States. The highest incidence of renal cancers is among Kuwaiti men with ASR of 5.3 followed by Bahrain with ASR 0f 4.6. Renal cancer incidence continues to incline over the twelve-year period (1998-2009) in all GCC States. The total number of newly diagnosed renal cancers increased exponentially over the twelve-year period, with significant increase in the ASR trend among males during the same period. Cigarette smoking, obesity, and hypertension are well established as risk factors for RCC and there is some evidence implicating physical inactivity and dietary factors. Recent changes in lifestyle in the Middle East and, to a lesser extent, in North Africa, may have an impact on the incidence of RCC in the future. Increasing obesity rates associated with Westernization of the diet and reduced physical activity are particularly relevant. Table 3. Distribution of renal cancer and Age Standardized Rate (ASR) per 100,000 population All GCC by gender during 1998-2001, 2002-2005, and 2006-2009.

Year Males Females 1998-2001 1.9 1.4 2002-2005 2.3 1.5 2006-2009 2.8 1.6

Figure 5 with permission from Saudi Cancer Registry (SCR) Annual Report, 2014

FIGURE 5 DISTRIBUTION OF PEDIATRIC CANCER CASES (0-14 YEARS) AMONG SAUDI NATIONALS BY

GENDER AND AGE GROUPS, 2014

In the GCC States, renal cancer is the 7th most common cancer among males below 15 years of age and 5th most common cancer among females in this age group between 1998-2009. The overall ASR was 2.5 and 1.6 per 100,000 populations for males and females, respectively. There has been a gradual increase in ASR among males and females from 1998-2009 (Table 3). Renal cancer incidence is significantly higher among males compared to females in all GCC States. The highest incidence of renal cancers is among Kuwaiti men with ASR of 5.3 followed by Bahrain with ASR 0f 4.6. Renal cancer incidence continues to incline over the twelve-year period (1998-2009) in all GCC States. The total number of newly diagnosed renal cancers increased exponentially over the twelve-year period, with significant increase in the ASR trend among males during the same period. Cigarette smoking, obesity, and hypertension are well established as risk factors for RCC and there is some evidence implicating physical inactivity and dietary factors. Recent changes in lifestyle in the Middle East and, to a lesser extent, in North Africa, may have an impact on the incidence of RCC in the future. Increasing obesity rates associated with Westernization of the diet and reduced physical activity are particularly relevant. Table 3. Distribution of renal cancer and Age Standardized Rate (ASR) per 100,000 population All GCC by gender during 1998-2001, 2002-2005, and 2006-2009.

Year Males Females 1998-2001 1.9 1.4 2002-2005 2.3 1.5 2006-2009 2.8 1.6

50

An estimated 337,860 new renal cancer cases occurred worldwide in 2012 and there were 143,406 deaths as a result of it. It is the 9th most common cancer in men (213,924 cases, 2.9% of the total) and the 14th in women (123,936 cases, 1.9%). Men are twice as likely as women to be diagnosed with renal cancer. An estimated 63,990 new renal cancer cases will be diagnosed in the USA and 14,400 deaths will result from it in 2017. In North America and other Western countries, obesity and tobacco smoking are strong risk factors for renal cancers. Hypertension, chronic renal failure, occupational hazards (trichloroethylene), radiation exposure, genetic disorders (von Hippel-Lindau disease, hereditary papillary renal cell carcinoma) are additional risk factors. The overall 5-yr relative survival rate for renal cancer has been reported as 74%. About 66% of the renal malignancies are diagnosed at early (loco-regional) stage with a 5-yr relative survival rate of 93%. Renal cancers at KFSH&RC are managed by multidisciplinary approach by all the oncology services, urology, pathology, radiology, family medicine department and oncology nursing, as appropriate. Surgery is the primary treatment for most of the localized renal cancers. Patient who are not eligible for surgery are considered for local ablative therapy. Adjuvant therapy have only shown benefit with Sunitinib in patients with high risk features. Other TKI’s have failed to show any improvement with adjuvant therapy. Several other trials using other targeted therapies and immunotherapy are ongoing. For metastatic cancers, targeted therapies and immunotherapy using checkpoint inhibitors are the gold standard sometime with cytoreductive nephrectomy at KFSH&RC. In summary, renal cancers remain one of the leading cancers in the Kingdom of Saudi Arabia and form a significant proportion of new patients referred to King Faisal Specialist Hospital & Research Center. Management of renal cancers continues to evolve with significant improvements in therapeutic strategies and prognosis over the course of last two decades. At our center, management follows established evidence based guidelines which are updated as soon as new evidence becomes available. The center is also a tertiary referral center for relapsed and refractory renal cancers treatment. KFSH&RC is the largest transplant center in the Middle East. We are members of Southwest Oncology Group (SWOG) and Radiation Therapy Oncology Group (RTOG) in an effort to provide cutting edge treatment to our patients and to promote research and training in this vital area. REFERENCES:

1. Saudi Cancer Registry Annual Report, 2014. 2. KFSH&RC, Tumor Registry Annual Report, 2013. 3. Globocan 2012: http://globocan.iarc.fr/, Accessed Dec 21, 2017. 4. American Cancer Society (ACS). Cancer Facts & Figures 2017. Atlanta, GA, USA:

https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf.

5. ACS Global Cancer Facts and Figures. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/global-cancer-facts-and-figures/global-cancer-facts-and-figures-3rd-edition.pdf

6. Alkhateeb SS, Alkhateeb JM, Alrashidi EA. Increasing trends in kidney cancer over the last 2 decades in Saudi Arabia. Saudi Med J. 36(6):698-703, 2015.

7. Ghosn M, Jaloudi M, Larbaoui B, et al. Insights into the epidemiology of renal cell carcinoma in North Africa and the Middle East. Pan Arab Journal of Oncology. 8(2):38-43, 2015.

8. Lipworth L, Tarone RE, Lund L, et al: Epidemiologic characteristics and risk factors for renal cell cancer. Clin Epidemiol 1:33-43, 2009.

9. Chow WH, Dong LM, Devesa SS. Epidemiology and risk factors for kidney cancer. Nat Rev Urol 7:245-257, 2010.

10. Abomelha MS. Trends of genitourinary cancer among Saudis. Arab J Urol. 9(3): 199-202, 2011. 11. Al-Shabanah MO, Jenkin DR, Khafaga YO, et al. Renal cell carcinoma in children. Prognostic

factors. 25(11): 1583-6, 2004. 12. Abomelha MS. Genito-urinary cancer in Saudi Arabia. Saudi Med J. 25(5): 552-6, 2004. 13. Alshaibani K, Raza S, Alfurayh O. The kidney transplant program at King Faisal Specialist Hospital

and Research Center: results of the last 10 years. Transplant Proc. 30(7): 3103-5, 1998.

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V. APPENDIX

REQUESTS FOR TUMOR REGISTRY DATA 2014

MOH 2013 Statistics Ministry of Health

All patient population diagnosed as Desmoid Tumor Dr. A. Suhaibani

or Fibromatosis in KFSH&RC from 2001-2014

Malignant thymoma cases at KFSH&RC from 1978-2014 Dr. E. Devol

Adult Ewing Sarcoma cases in KFSH&RC from 1997-2014 Dr. A. Memon

Giant cell tumor cases from 2002-2014 at KFSH&RC Dr. M. Elshenawy

Acute promyelocytic leukemia from 1975-2014 at KFSH&RC Dr. A. Hanbali

Hodgkin’s lymphoma cases at KFSH&RC Dr. M. Rauf

Lymphoma cases from 1975-2014 at KFSH&RC Dr. I. Maghfoor

Multiple myeloma cases from 1984-2014 at KFSH&RC Dr. F. Alsharif

Cardiac sarcoma KFSH&RC patients from 1990-2014 Dr. N. Jastaniyah

DLBCL/NHL cases with gastric involvement Dr. S. Akhtar

Giant cell tumor patients on chemotherapy from 2003-2014 Dr. M. Elshenawy

Metastatic colorectal carcinoma treatment data from 2005-2014 Dr. A. Alzahrani

Metaplastic breast carcinoma cases from 2000-2014 Dr. M. Elshenawy

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Colorectal Cancer Cases with metastectomy 2005-2013 Dr. A. AlZahrani

All lymphoma patient population NHL,HL, NOS with Dr. S. Akhtar

any type of second cancers 1975-2013

List of All NHL, HL seen and their diagnosis 1975-2013 Dr. S. Akhtar

Epithelial Ovarian Cancer (Age < or= 50) from 2008-2013 Dr. H. AlHusaini

All Metastatic Nasopharyngeal Cancers from 1975-2013 Dr. A. Memon

Micropapillary Thyroid Cancers from 2002-2013 Dr. A. AlZahrani

Pancreatic Adenocarcinoma from 2005-2014 Dr. M. AlSebayel

Follicular Lymphoma with or without extranodal involvement Dr. S. Akhtar

and < 30 years of age (1975-2013)

5353

VI. GLOSSARY OF TERMS Accessioned: Cases are entered into the Tumor Registry by the year in which they were first seen at KFSH&RC for each primary cancer. Age of Patient: Recorded in completed years at the time of diagnosis. Analytic Cases: Cases which were first diagnosed and/or received all or part of their first course of treatment at KFSH&RC. Non-Analytic Cases: Cases diagnosed elsewhere and received all of their first course of treatment elsewhere. Case: A diagnosis or finished abstract. A patient who has more than one primary is reported as multiple cases. Crude Relative Frequency: The proportion of a given cancer in relation to all cases in a clinical or pathological series. First Course of Treatment: The initial tumor-directed treatment or series of treatments, usually initiated within four months after diagnosis. Stage of Disease: Extent of disease process determined at first course of treatment. SEER (Surveillance, Epidemiology and End Results) Summary Staging:

In Situ: Tumor meets all microscopic criteria for malignancy except invasion.

Local: Tumor is confined to organ of origin.

Regional: Tumor has spread by direct extension to immediately adjacent organs and/or lymph nodes and appears to have spread no further.

Distant: Tumor has spread beyond immediately adjacent organs or tissues by direct extension and/or has either developed secondary or metastatic tumors, metastasized to distant lymph nodes or has been determined to be systemic in origin.

AJCC (American Joint Committee on Cancer) TNM Staging: A classification scheme based on the premise that cancers of similar histology or site or origin share similar patterns of growth and extension. T+N+M = Stage T: Extent of primary tumor N: Extent of regional lymph node involvement M: Distant Metastasis

Clinical Stage: Classification based on the evidence acquired before treatment. Such evidence arises from physical examination, imaging, endoscopy, biopsy, surgical exploration and other relevant findings. Pathologic Stage: Classification based on the evidence acquired before treatment, supplemented or modified by the additional evidence acquired from surgery and from pathologic examination of the resected specimen.

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