Fazal Ahmad  ( Khyber Medical College, Peshawar. )
Mohammad Iqbal Khadim  ( Institute of Radiotherapy and Nuclear Medicine (Irnum) Peshawar. )
Gui Rehman  ( Institute of Radiotherapy and Nuclear Medicine (Irnum) Peshawar. )
A. Qayum  ( Department of Phaimacy, University of Peshawar. )

The report is based on 4428 biopsy specimens examined in 3 laboratories of Peshawar during 1982. These laboratories receive their material from all over the North Western Region (NWFP) and adjoining Tribal areas of Pakistan. In this study 803 specimens were obtained from malignant lesions. The distribution of these tumours has been shown according to sex, age, organs/systems and anatomical sites using the oncology section of the International Classification of Diseases (ICD-O). In males malignant lesions of skin and in females breast cancer were most common neoplastic lesions (JPMA 35:49, 1985).

The Faisal Clinical Laboratory, the Pathology Section of the Institute of Radiotherapy and Nuclear Medicine (IRNUM) and the Department of Dentistry, Khyber Medical College, Peshawar, receive biopsies from almost all the divisions of the North West Frontier Province and adjoining tribal areas, having a population of approximately 15 million. The present paper deals with a survey of the histologically proven malignant tumours examined in these laboratories in the year 1982.

The report is based on 4428 biopsy specimens received by the following laboratories during 1982.
i. Faisal Clinical Laboratory, Peshawar.
ii. Institute of Radiotherapy and Nuclear Medicine (IRNUM) Peshawar.
iii. Department of Dentistry, Khyber Medical College, Peshawar.
In 808 cases, a diagnosis of a malignant tumour was made and they form the basis of this paper.
The cases with malignant tumours have been distributed according to (1) Sex (ii) Age and (iii) Anatomical site, using the oncology section of the International Classification of Diseases (ICD-O)¹ (WHO-I 976).
In order to prevent duplication, inforniation about submission of the sample to another laboratory was obtained from the concerned patient or the individual who brought the biopsy. for examination.

Amongst the males the five commonest primary malignant tumours were as follows:-
1. Skin(16.8%)
2. Lymph Node (14.5%)
3. Oral Cavity (6.8%)
4. Larynx (6.3%)
5. Esophagus (6.1%)
The five commonest in females were:-
1. Breast (18.8%)
2. Skin (12.8%)
3. Esophagus (7.43)
4. Lymph Nodes(6.7%)
5. Oral Cavity (5.4%)
Malignant tumours in children (lO-l4yrs) formed 4.7% of all the tumours in both males and females.     The commonest tumour seen in childhood in both the sexes was of the lymph node.
The largest number of tumours in males were seen in the age group 5 5-64 yrs with skin being the commonest. In females the maximum number of cases were seen in the age group 35-44 yrs and breast was the commonest tumour.

The paper presents the frequency distri­bution of histologically proven malignant tumours seen in three laboratories of Peshawar which do the bulk of histopathology in the province of NWFP.
The number of cases reported here are only a small sample of the total number of new cases of malignant disease that must be occurring in such a large population. However, these are the only cases for which histologically proven diagnosis is available, as histopathology services are not available in the rest of province.
It is also fully realised that these figures are subject to many selection and other biases, but they are being reported to document the present situation and to serve as a point of reference for future research.
Despite the limitations stated above this report brings out a few points of interest for future research. Unlike other provinces of Pakistan skin tumours are common in NWFP, a pattern similar to that of Iran and Afghanistan. Tumours of the Bronchus is being reported from Karachi and Hyderabad as the commonest tumours in males². In the present sample they constitute only 2% of all tumours. It is noteworthy that NWFP is the principal tobacco growing area of Pakistan with many cigarette manufacturing units. A possible explanation is that traditionally the local population uses tobacco which is chewed. The relatively high frequency of laryngeal tumours in males and Esophageal in both males and females also needs attention.

1. WHO ICD-O International classification of diseases for oncology. Geneva, WHO, 1976.
2. Pakistan Medical Research Council Malignant tumours; a report of multi centre study 1977-1980. Karachi PMRC, 1983.