Patterns and presentations of colorectal cancer at Komfo-Anokye teaching hospital Kumasi, Ghana

Abstract

IntroductionColorectal cancer is a major cause of morbidity and mortality globally and its incidence is increasing in developing countries. This study determined the incidence, clinical features and the histopathological patterns of colorectal cancer at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana.MethodsA retrospective review of all colorectal cancer cases over a six year period from (2009-2015) presented to the Surgical and Oncological Department of KATH. Patients' records were retrieved and information on their demographics, clinical and pathological presentations recorded.ResultsIn all, 221 cases of colorectal cancer were identified over the study period. The mean age was 54 ± 16.8 and ranged from 16 to 90 years. Sixteen (7.24%) had family history of cancer and the prevalence of comorbidities was (24.89%). The commonest clinical symptoms presented were weight loss (44.80%), bleeding per rectum (39.82%) and abdominal pain (38.91%) Majority of the patients presented with rectal cancers (48.87%). Microscopically, adenocarcinoma (68.33%) was the most common histopathological type. According to Tumour Node Metastasis (TNM) staging of cancer, majority of the patients 89(40.27%) were identified as being in late stage (TNM Stage III). The overall crude annual incidence was 4.62 per 100000 populations. The age specific standardized incidence rate was 7.93 per 100,000 populationConclusionThis study has clearly showed a high incidence in colorectal cancer at KATH, with similar trends in clinico-pathological patterns comparable to that of most African countries. These include predominance of rectal cancers, high incidence among younger people and delayed presentation of the disease at advanced stage.

Colorectal Cancer Screening in Ghana: Physicians’ Practices and Perceived Barriers

“…Colorectal cancer is the second and the third most common cancer among men and women worldwide, respectively [ 1 ]. Ghana has seen a rise in the incidence of colorectal cancer over the past decade [ 2 – 4 ]. Specifically, the number of new cases has increased by 8-fold from an average of 4.1 new cases per 100,000 per year in 1960s to an average of 32.6 new cases per 100,000 per year in 2017 with a noted high incidence in younger people and delayed presentation of the disease [ 4 ].…”

“…Ghana has seen a rise in the incidence of colorectal cancer over the past decade [ 2 – 4 ]. Specifically, the number of new cases has increased by 8-fold from an average of 4.1 new cases per 100,000 per year in 1960s to an average of 32.6 new cases per 100,000 per year in 2017 with a noted high incidence in younger people and delayed presentation of the disease [ 4 ]. This, in part, has been attributed to the increased adoption of Western lifestyles including diet, physical inactivity, improved life expectancy (from 57 years in 2000 to 63 years in 2016) [ 4 ] and establishment of screening guidelines.…”

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…”

“…disease at presentation. [20,29,30,33,[35][36][37] However, distant disease at time of presentation is not unique to LMIC settings, and has been extensively described in HICs, albeit in older persons. [8,9,12,14,18] The trend of younger people presenting with advanced disease in our setting may be attributed to a number of contextual factors.…”

“…This finding was analogous with findings in the abovementioned studies from LMICs, where approximately half of the participants had rectal cancer, and differed from HIC studies, where less than a third had rectal cancer. [29,30,33,[35][36][37]…”