Clinicopathological patterns and challenges of management of colorectal cancer in a resource-limited setting: a Tanzanian experience

Abstract

BackgroundColorectal cancer is one of the most common cancers worldwide and its incidence is reported to be increasing in resource-limited countries, probably due to the acquisition of a western lifestyle. However, information regarding colorectal cancer in Tanzania and the study area in particular is limited. This study was conducted in our local setting to describe the clinicopathological pattern of colorectal cancer and highlight the challenging problem in the management of this disease.MethodsThis was a retrospective study of histologically confirmed cases of colorectal cancer seen at Bugando Medical Center between July 2006 and June 2011. Data were retrieved from patients’ files and analyzed using SPSS computer software version 17.0.ResultsA total of 332 colorectal cancer patients were enrolled in the study, representing 4.7% of all malignancies. Males outnumbered females by a ratio of 1.6:1. The median age of patients at presentation was 46 years. The majority of patients (96.7%) presented late with advanced stages. Lymph node and distant metastasis at the time of diagnosis was recorded in 30.4% and 24.7% of cases, respectively. The rectosigmoid region was the most frequent anatomical site (54.8%) involved and adenocarcinoma (98.8%) was the most common histopathological type. The majority of adenocarcinomas (56.4%) were moderately differentiated. Mucinous and signet ring carcinomas accounted for 38 (11.6%)and 15 (4.6%) patients, respectively. Three hundred and twenty-six (98.2%) patients underwent surgical procedures for colorectal cancer. Only 54 out of 321 (16.8%) patients received adjuvant treatment. Postoperative complication and mortality rates were 26.2% and 10.5%, respectively. The overall median duration of hospital stay was 12 days. Only nine out of 297 survivors (3.0%) were available for follow-up at the end of 5 years. Cancer recurrence was reported in 56 of 297 survivors (18.9%). Data on long-term survival were not available as the majority of patients were lost to follow-up.ConclusionsColorectal cancer is not uncommon in our environment and shows a trend towards a relative young age at diagnosis and the majority of patients present late with advanced stage. There is a need for screening of high-risk populations, early diagnosis and effective cost-effective treatment and follow-up to improve outcome of these patients.

Clinicopathological Review Of Colorectal Cancer

“…This was similar to the findings of Abdulkareemet al 24 and Chalya et al The predominant histological type was adenocarcinoma which was seen in 80% of cases and well differentiated in 51.4%. This finding concurs with that of other studies 17,22 where similar histological patterns were reported. Sphincter saving procedures were not possible because the …”

“…Most of our patients (54.3%) came from the rural areas located within the Niger Delta sub region but 62.9% of the patients had secondary education and above as opposed to some other studies 17,18 where over 60% had either primary or no formal education. 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 .…”

Prognostic and predictive roles of microRNA-383 in colorectal cancer

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Diagnostic and Prognostic Value of miR-1287 in Colorectal Cancer

“…Colorectal cancer (CRC) is the fourth most common cancer type in men and the third most common cancer type in women worldwide [1]. Accounting for approximately one million new types of cancers and one-half million deaths, CRC represents 10 % of cancer deaths [2].…”