Cancer Facts in Bhutan


Key facts

The total number of cancer cases in Bhutan has been steadily increasing over the years and in 2014 there were 639 cases reported across the country. Males had a higher incidence (61%) as compared to females (39%).

– 2015 Bhutan Cancer Report

Top 10 Common cancer in Bhutan

1. Stomach

Gastric (stomach) cancer is a disease in which malignant (cancer) cells form in the lining of the stomach. The stomach is in the upper abdomen and helps digest food. Almost all gastric cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). Other types of gastric cancer are gastrointestinal carcinoid tumors, gastrointestinal stromal tumors, and lymphomas. Infection with bacteria called H. pylori is a common cause of gastric cancer. Gastric cancer is often diagnosed at an advanced stage because there are no early signs or symptoms.

Risk factors for gastric cancer include the presence of precursor conditions such as chronic atrophic gastritis and intestinal metaplasia, pernicious anemia, and gastric adenomatous polyps. Genetic factors include a family history of gastric cancer, Li Fraumeni syndrome, and Type A blood type. Environmental factors that causes gastric cancer  include low consumption of fruits and vegetables; consumption of salted, smoked, or poorly preserved foods; cigarette smoking; and radiation exposure.


2. Cervix

The cervix is located in the pelvis and it is the lower narrow part of the uterus. The cervix connects the uterus to the vagina. Cervical cancer begins in cells on the surface of the cervix. Over time, the cervical cancer can invade more deeply into the cervix and nearby tissues. The cancer cell can travel through lymph vessels to nearby lymph nodes. Also, cancer cells can spread through the blood vessels to the lungs, liver, or bones. Regular cervical screening screening tests and taking the Human Papilloma Virus (HPV) vaccine before a female becomes sexually active is  recommended. 89 cases were reported with cervical cancer in 2014 in Bhutan.


3. CRC/Rectum

Colorectal cancer is cancer that starts in the colon or rectum. The colon and the rectum are parts of the large intestine, which is the lower part of the body’s digestive system. During digestion, food moves through the stomach and small intestine into the colon. The colon absorbs water and nutrients from the food and stores waste matter (stool). Stool moves from the colon into the rectum before it leaves the body.

Most colorectal cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). Colorectal cancer often begins as a growth called a polyp, which may form on the inner wall of the colon or rectum. Some polyps become cancerous over time. Finding and removing polyps can prevent colorectal cancer.

Colorectal cancer is the third most common type of cancer in men and women in the United States. Deaths from colorectal cancer have decreased with the use of colonoscopies and fecal occult blood tests, which check for blood in the stool.


4. Head and Neck/larynx

Head and neck cancers are cancers that start in the tissues and organs of the head and neck. They include cancers of the larynx (voice box), throat, lips, mouth, nose, and salivary glands.Most types of head and neck cancer begin in squamous cells that line the moist surfaces inside the head and neck (for example, the mouth, nose, and throat).

Tobacco use, heavy alcohol use, and infection with the human papillomavirus (HPV) increase the risk of many types of head and neck cancer. To get the right information about treatment and prognosis, you need to know exactly what type of head and neck cancer you have and what stage it is.


5. Oesophagus

Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus. The esophagus is a muscular tube that moves food and liquids from the throat to the stomach.

The most common types of esophageal cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma begins in flat cells lining the esophagus. Adenocarcinoma begins in cells that make and release mucus and other fluids.

Smoking and heavy alcohol use increase the risk of esophageal squamous cell carcinoma. Gastroesophageal reflux disease and Barrett’s esophagus (normal tissue lining the esophagus changes to tissue that resembles the lining of the intestine) may increase the risk of esophageal adenocarcinoma.

Esophageal cancer is often diagnosed at an advanced stage because there are no early signs or symptoms.


6. Liver/GB/Chologio

The liver has many important functions in the body. For example, it cleans toxins from the blood, makes bile that helps digest fat, makes substances that help blood clot, and makes, stores, and releases sugar for energy.

Primary liver cancer is cancer that starts in the liver. The most common type of primary liver cancer is hepatocellular carcinoma, which occurs in the tissue of the liver. When cancer starts in other parts of the body and spreads to the liver, it is called liver metastasis.

Liver cancer is rare in children and teenagers, but there are two types of liver cancer that can form in children. Hepatoblastoma occurs in younger children, and hepatocellular carcinoma occurs in older children and teenagers.

The bile ducts are tubes that carry bile between the liver and gallbladder and the intestine. Bile duct cancer is also called cholangiocarcinoma. When it begins in the bile ducts inside the liver, it is called intrahepatic cholangiocarcinoma. When it begins in the bile ducts outside the liver, it is called extrahepatic cholangiocarcinoma. Extrahepatic cholangiocarcinoma is much more common than intrahepatic cholangiocarcinoma.


7. Ovary

According to the 2015 Bhutan Cancer Report, ovarian cancer accounts for 9% of cancers among bhutanese women. The ovaries and fallopian tubes are part of the female reproductive system. There is one ovary and one fallopian tube on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). The ovaries store eggs and make female hormones. Eggs pass from the ovaries, through the fallopian tubes, to the uterus.

Most of the ovarian cancer begins in the tissue that covers the ovaries (ovarian epithelial cancer), it can also sometime begin at the end of the fallopian tube near the ovary and spread to the ovary or  begin in the peritoneum and spread to the ovary. Few ovarian cancer (ovarian germ cell tumor) begin in the germ (egg) cells in the ovary . Ovarian low malignant potential tumor (OLMPT) is a type of ovarian disease in which abnormal cells form in the tissue that covers the ovaries. OLMPT rarely becomes cancer.

The risk factors for ovarian cancers include; family history of ovarian cancer, obesity, nulliparity, and use of postmenopausal hormone therapy. Factors that helps decrease risk of ovarian cancer include use of oral contraceptives, multiple pregnancies, breast-feeding, and tubal ligation.


8. Skin

Skin cancer is the most common type of cancer. There are several types of skin cancer depending on the type of skin cell. Cancer arising from the squamous cells and basal cells are called nonmelanoma skin cancer and usually treatment is effective while the melanoma skin cancer, although rare, is more aggressive and spreads towards other regions of the body. 20 cases were reported in 2014 with skin cancer.


9. KUB/Penis

The penis is the male sex organ that passes sperm and urine from the body. The glans (head of the penis) is covered with loose skin called the foreskin.

The most common type of penile cancer is squamous cell carcinoma (cancer that begins in flat cells in the top layer of the skin). It usually forms on or under the foreskin. Signs of penile cancer include sores or other skin changes, discharge, and bleeding.

Infection with certain types of human papillomavirus (HPV) causes about one-third of penile cancer cases. Circumcision (removal of the foreskin) may help prevent infection with HPV and decrease the risk of penile cancer. When found early, penile cancer can usually be cured.


10. Breast

The breast is made up of glands called lobules that can produce milk and thin tubes that carry the milk from the lobules to the nipples. Breast tissues are also made up to fat, blood vessels and connective tissues.

Although breast cancer may start from any area of the breast, the most common is ductal carcinoma which begins at the cells of the ducts. Breast cancer can also begin in the lobules and other tissues. It can occur to both women and men but cases of men are very rare. In 2008-2014, 6% of the total women population in Bhutan were reported for breast cancer. If a family member of the woman has been diagnosed with breast cancer before, there is an increased risk of her getting breast cancer since breast cancer has been known to be hereditary.


Identifying cancer

Risk factors

  1.   Tobacco use
  2.   Alcohol use
  3.   Unhealthy diet
  4.   Physical inactivity
  5.   Infections
  6.   Occupational hazard
  7.   Pollution of air, water and soil
  8.   Radiations: ionizing, ultraviolet and electromagnetic


At least one-third of all cancer cases are preventable. It is not possible to prevent all cancers  with the current knowledge, however substantial number of cancer cases can be prevented by practicing the following:

  1. Healthy lifestyle : avoid tobacco, alcohol and unhealthy diet
  2. Physical exercise
  3. Vaccinate against Human Papilloma Virus (HPV) and Hepatitis B virus  (HBV)
  4. Control occupational hazards
  5. Reduce exposure to non-ionizing radiation by sunlight
  6. Reduce exposure to ionizing radiations


All these treatments are used depending on the stage of diagnosis of the disease and the patient’s performance status.

  • Surgery
  • Chemotherapy
  • Radiation
  • Hormonal therapy
  • Immunological therapy