Incidence of Colorectal Carcinoma in the Remote Area of Sindh, Pakistan
Abstract
Background: Colorectal carcinoma (CRC) is the third most common cancer in the world that show malignant growth in the colon, rectum, and or appendix. CRC is the second most common malignancy in females and third in males. This study aimed to ascertain the incidence of colorectal carcinoma (CRC) in a population in a remote area of Sindh, Pakistan, and also compared and correlated the sociodemographic characteristics and different parameters such as diagnosis, grade, and histopathology of the CRC cases.
Methods: The study was conducted from February 2012 to 2019 at Pakistan Atomic Energy Cancer Hospital (NORIN) Nawabshah Sindh, Pakistan. All cases were evaluated through a detailed history, clinical examination, radiological examination, and histopathology-proven cases. The sociodemographic parameters, diagnosis grades, and histopathology of the CRC were statistically compared and correlated by SPSS version 21.
Results: Out of a total of 10,848 reported patients, 424 (3.9%) were of CRC. The CRC was further comprised of 63.9% males and 36.1% females. We classified our patients into two age groups, ≤ 40 years (Group-A), and > 40 years (Group B). Group-A comprised 41% of patients, and their mean age was 28±6.98 years, while Group B comprised 59% of patients with a mean age of 43±8.3 years. Histological specimens divulged that most of the common specimens were of adenocarcinoma. Early diagnosis was very strenuous due to no signs and symptoms. Thus, the majority of the patients, approximately 39%, were found to be of grade 2 carcinoma.
Conclusion: Our study unveils an increased number of patients with CDC at an age of <40 belonging to rural areas. Further studies are needed to elucidate the cause of this high incidence with a particular focus on genetic and molecular risk factors.
Keywords: Active lifestyle, Colorectal Carcinoma; Age group; Colorectal Adenocarcinoma
Full Text:
PDFReferences
Gandomani HS, Yousefi SM, Aghajani M, Mohammadian-Hafshejani A, Tarazoj AA, Pouyesh V, Salehiniya H. Colorectal cancer in the world: incidence, mortality and risk factors. BioMed Research International, (2017); 4: 1656.
WHO Cancer. World Health Organization: WHO. Available online: https://www.who.int/news-room/fact-sheets/detail/cancer (accessed on Nov 18, 2022).
Rashid MU, Naeemi H, Muhammad N, Loya A, Lubiński J, Jakubowska A, Yusuf MA. Prevalence and spectrum of MLH1, MSH2, and MSH6 pathogenic germline variants in Pakistani colorectal cancer patients. Hereditary Cancer in Clinical Practice, (2019); 17: 1–16.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, (2021); 71: 209–249.
Anwar N, Badar F, Yusuf MA. Profile of patients with colorectal cancer at a tertiary care cancer hospital in Pakistan. In Proceedings of the Annals of the New York Academy of Sciences; Blackwell Publishing Inc., (2008); 1138: 199–203.
Zahir MN, Azhar EM, Rafiq S, Ghias K, Shabbir-Moosajee M. Clinical Features and Outcome of Sporadic Colorectal Carcinoma in Young Patients: A Cross-Sectional Analysis from a Developing Country. ISRN Oncology, (2014); 2014: 1–8.
Abualkhair WH, Zhou M, Ahnen D, Yu Q, Wu XC, Karlitz JJ. Trends in Incidence of Early-Onset Colorectal Cancer in the United States among Those Approaching Screening Age. JAMA Network Open, (2020); 3: e1920407–e1920407.
Akimoto N, Ugai T, Zhong R, Hamada T, Fujiyoshi K, Giannakis M, Wu K, Cao Y, Ng K, Ogino S. Rising incidence of early-onset colorectal cancer — a call to action. Nature Reviews Clinical Oncology, (2021); 18: 230–243.
Yu EYW, Wesselius A, Mehrkanoon S, Brinkman M, Van Den Brandt P, White E, Weiderpass E, Le Calvez-Kelm F, Gunter M, Huybrechts I, et al. Grain and dietary fiber intake and bladder cancer risk: A pooled analysis of prospective cohort studies. The American Journal of Clinical Nutrition, (2020); 112: 1252–1266.
Wactawski-Wende J, Kotchen JM, Anderson GL, Assaf AR, Brunner RL, O’Sullivan MJ, Margolis KL, Ockene JK, Phillips L, Pottern L, et al. Calcium plus Vitamin D Supplementation and the Risk of Colorectal Cancer. The New England Journal of Medicine, (2006); 354: 684–696.
Meyerhardt JA, Heseltine D, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ, Thomas J, Nelson H, Whittom R, Hantel A, et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: Findings from CALGB 89803. Journal of Clinical Oncology, (2006); 24: 3535–3541.
Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Hu FB, Mayer RJ, Nelson H, Whittom R, Hantel A, Thomas J, et al. Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. Obstetrical & Gynecological Survey, (2008); 63: 94–96.
Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ, Nelson H, Whittom R, Hantel A, Thomas J, Fuchs CS. Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: Findings from cancer and leukemia group B 89803. Journal of Clinical Oncology, (2008); 26: 4109–4115.
Flossmann E, Rothwell PM. Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies. Lancet, 2007; 369: 1603–1613.
Koehne CH, Dubois RN. COX-2 inhibition and colorectal cancer. Seminars in Oncology, (2004); 31: 12–21.
Strickler JH, Yoshino T, Graham RP, Siena S, Bekaii-Saab T. Diagnosis and Treatment of ERBB2-Positive Metastatic Colorectal Cancer: A Review. JAMA Oncology, (2022); 325: 669–685.
Idrees R, Fatima S, Abdul-Ghafar J, Raheem A, Ahmad Z. Cancer prevalence in Pakistan: Meta-analysis of various published studies to determine variation in cancer figures resulting from marked population heterogeneity in different parts of the country. World Journal of Surgical Oncology, (2018); 16: 1–11.
Masood K, Masood A, Zafar J, Shahid A, Kamran M, Murad S, Masood M, Alluddin Z, Riaz M, Akhter N, et al. Trends and Analysis of Cancer Incidence for Common Male and Female Cancers in the Population of Punjab Province of Pakistan during 1984 to
Asian Pacific Journal of Cancer Prevention, (2015); 16: 5297–5304.
Ahmad Z, Idrees R, Fatima S, Uddin N, Ahmed A, Minhas K, Memon A, Fatima SS, Arif M, Hasan S, et al. Commonest cancers in Pakistan – findings and histopathological perspective from a premier surgical pathology center in Pakistan. Asian Pacific Journal of Cancer Prevention, (2016); 17: 1061–1075.
Bhurgri AA, Khatti SN, Danish AA, Shaikh M, Seerani NL, Memon AS, Shaikh MK, Raza S, Shah SZA. Frequency of Rectal Cancer among Young and Older patients. Pakistan Journal of Medical & Health Sciences, (2022); 16: 28–29.
Ahmed RN, Rai L, Samo KA, Saeed S, Salam A, Khan H, Memon AS. Factors affecting delay in diagnosis of colorectal cancer: A cross-sectional study from a tertiary care hospital of Karachi, Pakistan. International Journal of Clinical Practice, (2021); 75: e14529.
Alexander DD, Weed DL, Mink PJ, Mitchell ME. A weight-of-evidence review of colorectal cancer in pesticide applicators: The agricultural health study and other epidemiologic studies. International Archives of Occupational and Environmental Health, (2012); 85: 715–745.
Sohaib M, Shafiq A. PAEC’s Annual Cancer Registry Report 2015-2017.
Sohaib, M.; Shafiq, A. PAEC Cancer Registry Report 2018 and 2019.
Badar F, Mahmood S. Hospital-based cancer profile at the Shaukat Khanum memorial cancer hospital and research centre, Lahore, Pakistan. Journal of College of Physicians and Surgeons Pakistan, (2015); 25: 259–263.
Ahmed MZ, Shahzad H, Rao T, Ali A, Samad N. Seroprevalence of Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) In District Vehari, Pakistan. Journal of College of Physicians and Surgeons Pakistan, (2020); 30: 550–551.
Elalouf A, Edelman A, Sever D, Cohen S, Ovadia R, Agami O, Shayhet Y. Students’ Perception and Performance Regarding Structured Query Language Through Online and Face-to-Face Learning. Frontiers in Education, (2022); 7: 935997.
Elalouf A, Moran R, Yaron B, Oman M. Pediatric Dental Emergency Visits and Treatment during Lockdown in the COVID-19 Pandemic: A Retrospective Study. International Journal of Environmental Research and Public Health, (2022); 19: 3774.
Quach DT, Nguyen OT. Clinical, endoscopic and pathogical characteristics of early- onset colorectal cancer in Vietnamese. Asian Pacific Journal of Cancer Prevention, (2012); 13: 1767–1770.
Chan KK, Dassanayake B, Deen R, Wickramarachchi RE, Kumarage SK, Samita S, Deen KI. Young patients with colorectal cancer have poor survival in the first twenty months after operation and predictable survival in the medium and long-term: Analysis of survival and prognostic markers. World Journal of Surgical Oncology, (2010); 8: 1–11.
Campos FG. Colorectal cancer in young adults: A Difficult challenge. World Journal of Gastroenterology, (2017); 23: 5041–5044.
Akbar A, Bhatti ABH, Khattak S, Syed AA, Kazmi AS, Jamshed A. Outcome of rectal cancer in patients aged 30 years or less in the Pakistani population. Asian Pacific Journal of Cancer Prevention, (2014); 15: 6339–6342.
Amini AQ, Samo KA, Memon AS. Colorectal cancer in younger population: Our experience. Journal Of Pakistan Medical Association, (2013); 63: 1275–1277.
Sarwar MR, Saqib A. Cancer prevalence, incidence and mortality rates in Pakistan in 2012. Cogent Medicine, (2017); 4: 1288773.
Patil PS, Saklani A, Gambhire P, Mehta S, Engineer R, De’Souza A, Chopra S, Bal M. Colorectal Cancer in India: An Audit from a Tertiary Center in a Low Prevalence Area. Indian Journal of Surgical Oncology, (2017); 8: 484–490.
Soliman AS, Bondy ML, El-Badawy SA, Mokhtar N, Eissa S, Bayoumy S, Seifeldin IA, Houlihan PS, Lukish JR, Watanabe T, et al. Contrasting molecular pathology of colorectal carcinoma in Egyptian and Western patients. British Journal of Cancer, (2001); 85: 1037–1046.
Pirzada MT, Ahmed MJ, Muzzafar A, Nasir I. ul I, Shah MF, Khattak S, Syed AA. Rectal Carcinoma: Demographics and Clinicopathological Features from Pakistani Population Perspective. Cureus, (2017); 9.
Bhurgri Y, Khan T, Kayani N, Ahmad R, Usman A, Bhurgri A, Bashir I, Hasan SH, Zaidi SMH. Incidence and current trends of colorectal malignancies in an unscreened, low risk population. Asian Pacific Journal of Cancer Prevention, (2011); 12: 703–708.
Parkin DM, Bray F, Ferlay J, Pisani P. Global Cancer Statistics, 2002. CA: A Cancer Journal for Clinicians, (2005); 55: 74–108.
Thanikachalam K, Khan G. Colorectal cancer and nutrition. Nutrients, (2019); 11: 164..
Song M, Chan AT. Environmental factors, gut microbiota, and colorectal cancer prevention. Clinical Gastroenterology and Hepatology, (2019);17(2): 275-289.
Oddone E, Modonesi C, Gatta G. Occupational exposures and colorectal cancers: A quantitative overview of epidemiological evidence. World Journal of Gastroenterology, (2014); 20: 12431–12444.
Rawla P. Epidemiology of prostate cancer. World journal of oncology, (2019); 10(2): 63.
Chen H, Zheng X, Zong X, Li Z, Li N, Hur J, Fritz CDL, Chapman W, Nickel KB, Tipping A, et al. Metabolic syndrome, metabolic comorbid conditions and risk of early-onset colorectal cancer. Gut, (2021); 70: 1147–1154.
Refbacks
- There are currently no refbacks.