Rare malignancies in Eastern India, socio-economic impact

Abstract

The etiology of cancer is multifactorial. Various factors, including physical carcinogens, chemicals and viral carcinogens affect patients with known predisposing factors who subsequently develop malignancies. Here is a retrospective study of 18 patients who developed rare malignancies in clinical situations like xeroderma pigmentosum, tuberous sclerosis, neurofibromatosis, hereditary multiple exostosis, second malignancies due to radiotherapy and chronic irritation. The predisposing factors like chronic infection in leprosy, filariasis, poverty and ignorance leading to the chronicity of the lesion, lack of available health care facilities and socio-cultural background, i.e. consanguinity marriage in some community are responsible for the development of these rare malignancies. They were treated at A.H Regional Cancer Centre, Cuttack, Odisha, which is located at Eastern part of India for various malignancies, between January 1989 and January 2008. Malignancies that developed in patients with the above predisposing factors are being reported here due to their rarity and to highlight the impact of socio cultural background in developing these malignancies. Patients with above clinical situations should be kept under close observation for early detection of malignancy so their chances of survival can be improved. In addition, those oncogenic stimuli that initiated or propagated the malignancies, due to socio-economic factors, should be addressed promptly to prevent their eventual development. (HME) are more prone to develop malignancies which are otherwise rare in incidence. With the advent of multidisciplinary approaches and newer developments in the treatment of cancer, the survival rate of such patients has improved. However, the incidence of secondary malignancies due to treatment is becoming increasingly recognized. Secondary malignant neoplasms arise due to chemotherapy, radiotherapy, or both. These are distinct entities having a definite picture of malignancy; they are histologically different from, and lack metastatic deposits from, the primary neoplasm. 1,2 The incidence of treatment related malignancies, though rare, is being reported with greater frequency of late. Here, we present a retrospective study on 18 patients having uncommon malignancies that developed in XP, TS. NF I and II, HME, cancer related treatment, and chronic infection who subsequently developed malignancies. Exposure to sunlight, consanguineous marriage, infection with leprosy, filariasis, lack of knowledge of development of such malignancies on above genetic disorders, poor access to health care facilities in remote village areas and poverty are the various factors to develop these malignancies in rare situations. These cases merit reporting and documentation for their rarity.