Colorectal cancer burden and trends in a South Asian cohort: experience from a regional tertiary care center in Sri Lanka

Abstract

ObjectiveColorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-economic landscape and population demographics. There is a lack of robust high quality data from this region in order to evaluate the disease pattern and comparison. Using generalized linear models assuming Poisson distribution and model fitting, authors describe the variation in the landscape of CRC burden along time since 1997 at a regional tertiary care center in Sri Lanka.ResultsAnalyzing 679 patients, it is observed that both colon and rectal cancers have significantly increased over time (pre 2000—61, 2000 to 2004—178, 2005 to 2009—190, 2010 to 2014–250; P < 0.05). Majority of the cancers were left sided (82%) while 77% were rectosigmoid. Over 25% of all CRC were diagnosed in patients less than 50 years and the median age at diagnosis is < 62 years. Increasing trend is seen in the stage at presentation while 33% of the rectal cancers received neoadjuvant chemoradiation. Left sided preponderance, younger age at presentation and advanced stage at presentation was observed. CRC disease pattern in the South Asian population may vary from that observed in the western population which has implications on disease surveillance and treatment.

Basics in molecular evolution of colorectal cancer and their implications for the surgeon: is it a 'big-bang' or a 'survival of the toughest'?

“…The incidence of the disease has increased with countries achieving a higher developmental index. A similar pattern has been observed in Sri Lanka over the past few decades where the incidence has increased from 3.8 in year 2000 to 5.6 in year 2010 per 100,000 population (2,3) .…”

“…In the recent past this has been challenged with regard to colorectal cancer (CRC) evolution, where by, scientists suggest that the genomic heterogeneity seen within the tumour existed from the point of origin; hence the term 'big bang model' (10). In this review we discuss the details of the available theories on 1,2,3 Pramodh C Chandrasinghe colorectal cancer evolution and the evidence that support them.…”

It’s contrary – comorbidity does not affect survival of South Africans with colorectal cancer: An analysis from the Colorectal Cancer in South Africa cohort

“…When compared with HICs, a possible explanation for the lower prevalence of comorbid disease in our study and other studies from SSA may be the younger mean ages at presentation (53 -56 years). [27][28][29][30][31][32][33] Aside from SSA, younger mean ages (45 -67 years) have been observed in South Asia, China and Brazil. [34,35] Collectively, these findings from LMICs contrast with those from HICs, where median ages are ~10 -15 years older, and comorbidity is twice as high and adversely affects…”

Radiological staging of rectal cancer in a resource limited setting

“…Colorectal cancer (CRC) is the third most common cancer in the world [1]. It's incidence is increasing in the South Asian region [2,3,4]. Rectal cancer (RC) comprises roughly one third of CRC [5].…”