The ‘Kashmir fire pot’ and Kangri Cancer?
The ‘Kashmir fire pot’ and Kangri Cancer?
Kangri (Locally known as Kanger) is an earthen pot woven around with wicker filled with hot embers used by Kashmiris beneath their traditional clothing pheran to keep them warm. It is normally kept inside the Pheran, the Kashmiri cloak, or inside a blanket.
It is generally believed that Kashmiris learned the use of the kangri from the Italians who were in the retinue of the Mughal emperors, because in Italy, a somewhat similar device was made, called scaldino. Though this assumption contradicts the historical data, but it is well known that it was used in the time of the Mughal Empire.
Kangri cancer is a heat-induced skin carcinoma associated with the use of the Kangri. A 5-year study (From 2003 to 2008) was conducted during which 17 patients who were documented with a Kangri cancer were treated. Sixteen patients had cancer on a thigh and 1 had cancer on the abdominal wall. All had an excision of the neoplasm. Histopathology documented squamous cell carcinoma in all patients.
Kangri cancer still occurs in patients who live in remote areas of Kashmir where there is a chilling cold in winter months and have no modern and alternative cheap means of warming other than the Kangri.
This is seen mostly among the “not well-to-do classes” who have no other means of fighting the extreme cold during the winter. The ulcers are the result of continuous constant contact of Kangris.
A study conducted by Suryanarayan, Col C R studied a number of cases in all age groups during his stay in the valley, and noticed that the precancerous condition of pigmentation and rough skin in the users of this “Kangri pot” has certain manifestations. In due course, by further irritation by heat, the ulcer breaks down with secondary infection and malignant transformation.
The squamous type of carcinoma of the skin at the site of the constant heat application exists at times without involving the adjacent lymph glands. The prognosis of the disease is worse when the infiltration of cancer involves the lumph glands.
He observed that this type of cancer is entirely due to the environmental causes, which could be prevented. The victims, in addition, are anemic due to worm infestations in their system (round and hookworms). The secondary infection of ulcer and glands is accentuated by the poor hygience which also increases the morbidity and mortality of these cases.
The treatment of this condition has to be done first to combat the anemia due to worms by deworming the patients, combating the secondary infection by antibiotics, and, finally, by certain herbs, chemotherapeutic drugs, and radioactive isotopes. The surface application of radioactive isotopes in early ulcers is useful. Deep x-ray therapy also has been tried. The intra-lymphatic perfusion of radioactive isotopes combined with cehmotherapeutic drugs for those cases involving the lymph glands have shown good results.
Some medical surveys conducted in 20 villages revealed how the burning brazier affected carriers. Stomach complaints, scorched thighs and bellies, pus-filled boils are common. Worst of all is the malignant growth that develops in the part of the body constantly under the exposure of the heat radiated by the Kangri.
Signs and symptoms
Most cases (80%) of squamous cell carcinoma attributed to ultraviolet radiation present in areas of the skin that are usually more exposed to sunlight (e.g., head, face, neck). Although a particular form of squamous cell carcinoma, Kangri cancer is more often associated with the abdomen, thigh, and leg regions due to the usage and positioning of kangri pots, which come in close contact with these anatomical features
Over time, the use of kangri pots to keep warm results in erythema ab igne, a precancerous keratotic growth that “take the shape of superficial, serpegenous, reticular blackish brown colored lesions.” Eventually, the cells at the lesion site become more irregular in shape and form; the lesions ulcerate and may become itchy and bloody. The resulting irregular growth is the presentation of kangri cancer.
Use of the kangri pot is the principal cause of kangri cancer. Elements that are believed to contribute to the development of kangri cancer are heat, burning wood particles, smoke, soot, and tar of burnt chinar leaves.
In one study, researchers found that kangri cancer patients had a history of using a kangri for 5-6 hours a day, 3-4 months a year.
In the treatment of kangri cancer, surgery is, most often, the first-line course of action to remove the primary tumor
1. The first case of kangri cancer was reportedly recognized in 1819.
2. The risk of kangri cancer is higher for those over age 50.
3. There is no definitive predominance of kangri cancer in either males or females. Some studies may point to higher prevalence in males while others observed higher prevalence in females.
4. In scientific literature, kangri cancer has only been attributed to the Kashmir region due to the traditional use of kangri pots. Kangri cancer is limited to this population, and thus, relatively little is known still, and there is much to be studied about the condition.
5. In 2017, a local Kashmir media outlet, The Kashmir Reader, reported that researchers and health care providers are optimistic about the reduced incidence of kangri cancer, citing the rise of thermal clothing and electric heating sources that are now used in place of kangri pots to keep warm.
Source: Wikipedia, Mosby, Inc, India Today,