A SURVEY ON CANCER IN 17 HOSPITALS IN JAKARTA

  

A SURVEY ON CANCER

  

IN 1 7 H O S P I T A L S I N

J A K A R T A *

Marwoto Partoatmodjo, Reflinar Rosfein and Suriadi Gunawan**

  AB STRAK Telah dilaksanakan suatu survai mengenai catatan penderita kanker yang dirawat di 17 Rumah Sak.it di Jakarta dalmn tahun 1977.

  Sejumlah 2056 kasus kanker berhasil ditemukan, 1183 diantaranya wa nita. Hanya 53% dari kasus ker dianos is nya didasarkan pada pemeriksaan patologi/ sitologi.

  Sepuluh kanker terbanyak p3da pria ial ah kanker di p a ru, hati, nasof aring, kelenjar getah bening, re k tum, leukemia, lambung, u sus b esar, laring dan pancreas. Sepuluh kanker terbanyak pa da w ani t a ia lah kanker le her rahim , payudara, indung telur, paru, hati, nasofaring, rektum , leu k e mia , k elenjar ge tah bening dan usus besar. Kesulitan yang dia lami dal am pen elitian ini ialah k urang len gk ap ny a c atatan medik

rumah sakit , sehingga data sepe rt i suku/ke t u runan, pekerjaan d an

sulit diketahui.

  Upaya registrasi kanker dan penelitian epid emiologi k ank er di Indonesia perlu dit ing - katkan. Tingginya kanker leher ra him pada wani ta serta kanker paru dan hati pada pria

perlu mendapat perhatian. Skrining den g an sitologi vagina (Pap smear), usaha mengurangi

kebiasaan merokok dan vaksinasi h epatitis B (dengan harapan m encegah lrn nk er h ati

perlu pendapat prioritas dalam u s ah a penang gul angan kanker di In donesia.

  INTRODUCTION There is no nationwide cance r r egistry which can provi de accu ra te d ata on ca n ce r in Indones ia. Mos t da ta on c an c er were collected fr om Dep art men ts of Pathology a nd Medical Record D epart m ents of hospitals or hosp i tal depart men ts. On e of them is a survey on canc er p atien ts ad m itted in

  1 7 hospitals in Ja karta , w hich was car ried ou t in 1978.

  The o bjectives were to know t he rela ti ve fre q uency of the 1 most freq uen t c anc er cases by site in t h e f emale and male patient , the basis of diagnosis and some characteristics of the c ancer p atien ts admitted to hos p ita l s in Jak arta.

  Jaka rta is the capit al o f Ind on e sia with a po pulation of abo u t si x m ill ion i n

  19 77.

  Method Th e cancer data were c olle c t ed from the M edic al Record Dep artm ent of each h osp i tal , using a form t h at has bee n prep ar e d for th at pu rpo se1 . The transfer of data was done by a Hospital Record De partment staff mem ber und er the supervisio n of a medical doctor. All cancer patients ad mitted in

  1977 were ThiS pa per wa s present ed a t t he 7-t h Asia Pasific Cancer Con feren ce . J a ka rt a, 1985. _* * Non-Comm u nicable Diseases Resea rc h Ce nter, Ja ka rta .

  18 B u i . Pencl it . K escha t . 16 (l ) 1988

1. Number of Cancer Cases by sex in

  27

  1

  27

  14

  13

  10 Pertamin a

  55

  28

  11

  37 110 9 . Fatma wa t i

  2

  7

  8. Gatot Subroto

  5 53 118

  6

  1 Pelni

  11

  4 76 130

  1

  11

  44

  7 I

  14. Jakar ta

  13

  3

  13 Bu cii Kem uiya an

  2

  1

  2

  14

  7

  Islam

  2 12.

  7. Cilcini

  52f17 incl uded in this survey. The cases were clas.sified according to the ICD ( IX-th revision) and grouped according to sex, age occu pation an d e th nic grou p . The 17 ho spitals treating cancer patients parti- cip a ting in this survey are listed in 'l'able 1. in 1977. A report fr o m the D r . S u t o mo Ho sp ital in Sura ba ya g a ve a percen t age of 2 ,3% -cancer cases ^{2 •} The female to m ale ra t i o w a s a lmost

  3 : 2 (1183 : 873). The sa me ra tio was also reported from Sur a oaya , but it w as

  7

  6

  4

  2

  16. Koja

  11

  4 I

  15. Mi ntoh ar jo

  1

  St. Carolus 117 108 225 _I

  Cipto Man g unkusumo 757 2.

  I Male All C as es 1.

  I I um ber of Patients No. ¹ Name of Hospital Fema l e

  17 Ho s pit a ls in J a karta

  Tabl e

  17. Atmajaya

  3

  6 . Husa d a

  4. Su m ber Waras

  54 100 154 '

  5. P ersaha a tan

  1 ^!

  9

  1

  82 109

  I

  4 T o t a l 1.183 873 2.056 RESULTS AND DISCU S SIONS The to tal n u m b e r of c ancer cases reported was 2056, t his was only 1,2% of the total patients ad mitted ( for all cases)

  72 201

  3. Kanker 129

  19

  T h e dis t ri b ution of c an c er c ases by age is s ho wn i n F igure 1.

  8 the reverse in Singapore and is was 1 : 1 ·n som e p r ef e c tures in Japan.3,4

  Bu i. P n c lit . K ese hat. 1 6 ( I ) 198

  5

  _I A survey on canc e r ........ . .. .. . . ..... .. . Marwot o P a rto a tm o djo e t al . r

  Num be 500 450 400

  350

• 300 250 200
• 150 _,...-- 100

  .--------

  50 n n

  40- 60- 80+ Age 0- 10- 20- 30- 50- 70- Note : In 10 cases the age was not specified

Figure The distribution of cancer cases by age.

  1.: population.

  The age ranged from several weeks to over 80 years, with a preponderance These 2056 cases were then classified of cases between 30 to 59 years and into 45 different groups by site, according a peak at 45 to 50 years. A 5 year study to the ICD (IX th revision) in 3 digits. in the Dr. Sutomo Hospital in Surabaya Not all cases diagnosed has been showed almost the same result i.e. a peak verified by laboratory methods. Onl y at 45 to 54 years. These peak ages were 1096 cases (53 % ) were confirmed , namely m uch younger compared to those in the 747 by histopathological, 202 by cytolo- more developed countries. gical and 147 by hematolo g ical exa- This difference in age is probably, partly, mination. d ue to " the difference in the demographic The 10 most freq uent sites for both composition and life expectancy of the sexes are listed in Table 2.

  Bui. P e neLit . Kes c h at. 16 ( l) J 988

  20

• 10 109 136 105 56
• · .
• 6

• 7
• ·-
• 4
• 432
• 9
• ) Bre a st Cancer Cases in Male : 2

  m or e th e 3 / 4, (

  C a nc er in these 10 site s re pr esent

  8 1577

  I 14 37 90 310 419 282 220 75 22

  50 T o t a

  67

  76

  77

  84

  222 214 182 173

  2

  10 11 6

  5

  7

  · - -

  1

  1

  6

  10 9 18 15

  7

  . -

  1

  5

  77 / 2056) o f all c ancer cas e s r e ported ( d i vi ded in t o 4 5 ro ups ).

  The 10 most freq uent cancer cases in the female is presen ted in Table 3. _{(I )} Th e total n u mb e r of c a ses in t h e

  Ta ble 4 presen t the

  t h e m ost freq u en t c an c er in the female bu t is wa s on l y in th e 7th place in U.S.A ( C o nn ), ir . the 4th place in Canad a ( Alberta ) an d in th e 3rd place in Birmingh am, En g land (1968-1972 , skin cancer not included )5.

  co u ntr i e s l i k e Ch ina ( Sh a n ghai) and Ind ia (Bom bay ), cer v ix canc e r was also

  e) . I n other d e ve l oping

  11 81) of all cases in th e f em ale . Cer vix cancer w h i ch wa s st ill h ig h in this s u rv e y t e n d t o decr e a se in ot h e r m o re d evel o pe d cou ntri es , b ut b reast ca nc er is increasin g (Japan , Sing a por

  fre q ue n t cases re p re s en t 4 / 5 ( 979-

  10 most

  in to 39 gro ups by s ite . The

  f e m a l e was 1181, whic h wa s d evid e

  the second in U.K. (Birmingham ) in 196 8- 1972 (skin cancer not incl uded )5.

  C anc er of the cer v ix wa s st i ll th e most fr e q u en t malignan t tu m or , follo wed by cancer of the lu ng . In Su ra bay a ( Dr.

  6 6-197 ) . Br e a st c an c er was th e m o st freq uent c a n c er in U.S.A . ( C onn ) and Canada ( Alberta ) and it was

  9

  7 7 ) . T h is was al so true in Fi n l a n d (1

  19

  6 8-

  9

  1

  In S in g apor e , lung ca n c er was in the first place, :' ollowed by stomach cancer (in

  Sutom o hospital ) ._ a n cer of t he c ervix w a s foll o wed by c ancer of the li ver.

  1

  20 18 3 6

  17

  4

  3

  Cen ix Uter i Lu ng etc. Liver etc. Breast * ) Nasopha rynx Rect um etc. Leucaemia Ly m phoid etc. Ovar y etc . Colon

  174 147 154 208 200 183 153

  180 162 155

  10.

  8 9 .

  7

  6

  5

  3

  2

  2

  1

  70- 80+ N.S

  Total 0- 10- 20- 30- 40- 50- 60-

  IX I S i t e A g e

  ·

  I 1c o

  Table 2. The 10 Most Frequent Cancer Cases by Site and Age, Both Sexes No.

  A survey on cancer ........ ...... ... ...... Marw ot o Parto a tmodjo et al.

  1

  1

  6

  5 47 56 45 18 6

  11 16 8 18 8 5 4

  2

  19 17 5

  17

  18

  60 44 11 4

  4

  3

  2 . .. 5 13

  2

  8

  3

  2

  39 55 36 16

  46

  6 4 10

  5 15 50 66 57 19

  4

  3

  8

  10 most freq uent cancer cases in the male.

3. The 10 M ost F r e qu e nt C ancer Ca s es in t he Female b y Sit e

  O f Cases

  48 7 154

  Nasopharynx

  57 6 . 147

  Bile Duct (Intrahepatal )

  Liver &

  5 155

  I C D

  IX s l t e Num ber

  1 180 Cervix Ute r i

  

An us

  A su rvey on can c er . .. . . . . . .. .. . . . . .. .. .... Marwoto Partoatmodjo et al.

  43

  2 2 174

  B reast 180

  3 183 Ov a rium & Adnexa

  6

  4

  16

  Retu rn , Rectosygmoid &

  40

  64

  8 208

  Ta ble

  1

  5

3 I

  Total cases m females

  1181, in

  T abl e 4. Th e

  24 T o t a l

  10 Col on

  30

  Reticulu m Ce! Sarcoma

  00 Lymp h osarc oma &

  2

  9

  37

  Leu ca e m ia Not Sp e cified

  2 Tra ch ea , Bronchus & Pulmon um

39 Grou p s by sit e .

1 Most Fr eq uen t Can cer Cases in The Mal e By Site No.

  22 1.iu l. ;•l'nc!i t K esc h a t. l ti ^{(! )} 1988 N o.

  40 7 154 Gaster

  I CD

  IX s l t e

  N um b er Of Cas e s

  1.

  162 Trachea, Bronch us, Pulm on um

  158 2 155 Liver , Bile Duct, ( ln tra hepa tal ) 157 3 147 Naso pharynx

  125 4 200 Lym phosarcoma & Reticulum Ce! Sarcoma 46 5. 154 Rectum

  & Rectosigmoid & An us

  44 6 208 Leucaemia Not Specified

  35

  35 Groups B y Site.

  8 153 Colon

  26

  9 161 Larynx

  20 10 157 Pancreas

  19

  r 0 t a 1

  6

  70 Total Cases in Males : 873,

  In

  23

  77 8. Lym phosarcoma etc.

  26

  9 39 173 6. Rectu m etc.

  26

  3

  15

  6

  34

  84

  7. Leucaemia

  28

  6

  15

  7

  21

  24

  81

  67 10. Colon etc.

  Bui. Pen e lit . K ese h a t. 16 (I) 1988

  73 454 1.577 .

  50 _{>--- -} Total 641 111 298

  14

  3

  6

  12

  8

  2

  45

  76 9. Ovarium etc .

  33

  6

  5

  18

  5. Nasopharynx

  p, su rvey o n ca ncer ..... .. . . . ... . .. Ma rwoto Pa r toa t mod JO et a l

  Site

  The total num ber of cases in the male was 873 ( in 53 groups by site). These 670 cases (in 10 groups) repregented almost 3 / 4 of all cancer cases reported in the male.

  In Jakarta, lung cancer was the most

  frequent cancer in the male, which was also true in most other countries.

  Some difficulties has been encountered in completing the q uestionaire, because some of the medical records were missing at that time, and most of the records do not include in- formation about ethnic origins and occu pation of patient.

  It

  was also not possible to lmow the stage of the cancer. The 10 most frequent cancer cases by ethnic origin is presented in Table 5.

  The eth nic origins were not spe- cif ied

  in

  448 cases ( 28%). In this table, we can still see the relatively high fre- quency of cancer cases in people of Chinese ethnic origin, and these ethnic groups are only a small part of the popu - lation in Jakarta (about 10% ). This high freq uenc y in the Chinese fits with reports from Singapore.

  Table 6 shows the 10 most freq uent cancer cases by occupation.

  The occupation of patients were not specif ied in 930 cases (59%), while the occupations mentioned were not specif ic and distinct . The available data on occu- pation is not suitable for an epidemiolo- gical analysis.

  Tabel 5 : The 10 Most Frequent Cancer Cases By

  Ethnic Origin

(3 Most Frequent)

  No.

  ICD IX Java- nese

  18 4 103 182

  97

  8

  49

  4. Breast

  8 58 214

  33

  18

  10 40 222 3. Liver etc.

  Sumat- trans Chi- nese

  50

  23

  99

  91 432 2. Lung etc .

  23

  Others NS* Total 1. Cervix Uteri 186 22 110

• 8
• 27
• 454 Cases Ethnic Origin Not Specified (29%)

  

A survey on cancer . . ............ .. .. . . . . . Marwoto Partoatmodjo et a I.

  Table 6 : The 10 Most Frequent Cancer Cases By Occupation House Office Pri- La- Sebo- Far- Med. 0- Total N.S.*

  I Site No. hour: Wif e Work- vate lar mer Doctor then

  ICD IX er Work- er

  14

• Cervix Uteri 162

  21 19 216 432 1.

• 2. Lu ng etc.

  33

  28 6 139 222

  16

  13

  

7

• 3. Liver etc.

  22 134

  38 214

  17

  11

• 18

  10 126 182 Breast

• 4.
• ·-

  20

  21

  21

  34 77 173

5. Nasopharynx

  8

  7

  

2

• 6. Rectum etc.

  2

  65

  84

• -

  - 7.

  Leucaemia

  8

  9

  9

  6

  45

  77

• 8. Lymphoid

  11

  8

  2

  2

  53

  76

  23

  3

  3

• 9. Ovarium etc.

  2

  36

  67

• -

  2
• 10. Colon

  2 .3

  4

  39

  50 152 Total 205 123

  

15

  11

  21 3 117 930 1.577 930 (59%).

  Cases : Occupation Not Specified * SUMMAR Y stomach , colon and pancreas.

  Ef forts to improve cancer registration A survey of med ical records of cancer and initiate epidemiological research

  17 patients in hospitals in Jakarta has should be continued . been carried out in 1977. A total of Priorities for cancer control programs 2056 cases has been reported which was in Indonesia, should include routine

  1.2% of all patient ad mitted . The ratio Pap smear examination in high risk

  3:2. of male to female patients was women, smoking control and vaccination

  53% Only of the cases has been verif ied against hepatitis B (to prevent liver by pathological examination. The age cancer ) d istribution ranged from several weeks

  80

  45 to over years, with a peak at years.

  The most frequent cancers in the female are located in the cervix breasts ' '

  ACKNOWLEDGEMENTS ovaries, lu ngs liver, nasopharynx, rectum , leucemia , lymph glands and colon, while

  The authors thank Dr. Soekojo in the male, the most frequent cancers Saleh who initiated this project, and the are located in the lungs, liver, naso- d irectors and staffs of the 17 hospitals p hary nx, lym ph glands, rectum, leukemia , for participation in the study, the Head

  24 _{(J )} I3ul. Pcnelit . Kesehat. 1 6 1988

  A survey on cancer ........................ Marwoto Partoatmodjo et al.

  3. Shanmugaratnam et.al. Ed. (1984). of the National Institute of Health Ca ncer Indicence in Singapore 1968- Research & Development and the Head 1977. IARC Scientif ic Publication no. of the Research Center for Non Commu- nicable Diseases for funds and permission 47, Lyon. to pu blish.

  4. Tominaga , S. et.al. (1982). Cancer Mortality and Morbidity statistics in In

  REFERENCES Japan. Kunio . Aoki et.al. (Ed ): Cancer Prevention in Developing

  1. WHO Handbook for Standard ised Countries. University of Nagoya Press, Cancer Registries (1971) Who Offset Nagoya. Pu blication no.25, Geneva.

  5. N, Triaspolitica. "Mengenal Penyakit

  2. Sukardja IDG. (1982) Cancer Sta- Kanker, Jenis, Gejala, Penyebab Berikut tistics at Dr. Sutomo Hospital, Sura- Pengobatan Kanker." Mau Nanya Dong baya. In Kunio Aoki et.al.( Ed ). Can- Dok. N.p, 20 June 2017. Web. 28 June cer Prevention in DevelopingCou ntries.

  2017. <https:// University of Nagoya Press, Nagoya. nanyadongdok.blogspot.com/2017/06/ mengenal-penyakit-kangker-jenis- gejala.html>.

• * * * * * *

_(I)

  25 Bui. Penelit . Kesehal. 16 1988