Adenocarcinoma of the large bowel in nigerians

Abstract

This paper analyzes 320 cases of colorectal adenocarcinoma at the University College Hospital, Ibadan, Nigeria over a period of 18 years. The sex ratio was 1.5:1 in favor of males; the average age when first seen was 44 years. The symptom complex was weight loss, bloody mucoid stool, altered bowel habit, and abdominal mass. Eighty per cent of rectal cases were in the lower third of the rectum. Most cases were very advanced at the time they were first seen. The association of infective granuloma, notably schistosomiasis and amebiasis, occurred in 11 cases. This probably had diagnostic significance but the etiologic significance is still conjectural. Eighty per cent of the tumors were well-differentiated adenocarcinoma, while 20 per cent were of other histologic variants. In spite of advanced disease, resection was possible in 66 per cent of colonic and 45 per cent of rectal cases. Although the number of cases of colorectal cancers treated yearly in the hospital has increased significantly in the last few years, it is suggested that the hitherto low treatment rate may be attributable to social unacceptability of a permanent colostomy.

Clinicopathological Review Of Colorectal Cancer

“…However, regardless of this relatively higher level of formal education seen in our study, there was no corresponding reflection in the time of presentation as most of our patients (77.1%) presented late (after 6 months of onset of symptoms) with advance cancer (65.7% in stages 3 and 4) which is in keeping with other studies in developing countries 19,20 . This late presentation may be attributed to lack of screening programme and religious/sociocultural beliefs as churches and spiritual homes are usually the first point of call in many cases..…”

“…The relative infrequency in Black Africa has been attributed to the young age of the population, shorter transit time of faeces, high fibre diet and rarity of precancerous conditions such as familial adenomatous polyposis, Crohn's disease and ulcerative colitis 1 . Regardless of the variation in incidence, the molecular characteristics are the same globally 4,5 . In sub Saharan Africa, the incidence of colorectal cancer which was considered low is increasing 6 probably due to the westernization of the diet while in the developed worlds, there is declining incidence with good treatment outcome attributable to early detection and presentation with advances in modalities of diagnosis and treatment 7 .…”

Colorectal Carcinoma: Why Is There a Lower Incidence in Nigerians When Compared to Caucasians?

“…However, studies that have been published from various centres in the country show that the number of patients seen per year with colorectal cancer in each centre ranges from about 6 to 25 [11–18]. Each of these centres is a teaching hospital or tertiary health facility that serves populations of about one million to 1.5 million people.…”

Diet, environmental factors and increasing incidence of colorectal cancer in Nigeria

“…[5,6,42] Ibadan in the core west showed 27 patients per year from 1995 to 2004. [9] Lagos and Sagamu accrued 402 cases over 12 years from five centers giving about 34 cases per year.…”

“…Over the years, several workers in the University College Hospital Ibadan studied this disease and remarked about the increasing rates. [5][6][7] The time trends in common cancers in men from the Ibadan cancer registry in Nigeria show that four decades ago, (1960)(1961)(1962)(1963)(1964)(1965)(1966)(1967)(1968)(1969)) the top five cancers in men did not include CRC. But by the last decade, carcinoma of the colon and rectum moved from the 10 th to the 4 th position.…”