K. Chu1, P. Naidu1, A. Amer2, E. Coetzee2, A. Boutall2 1Stellenbosch University, Centre For Global Surgery, Cape Town, WESTERN CAPE, South Africa 2University of Cape Town, General Surgery, Cape Town, WESTERN CAPE, South Africa 3Ceza District Hospital, Ceza, KZN, South Africa
Introduction:
Colorectal adenocarcinoma (CRC-AC) is estimated to be the 5th most common cancer in sub-Saharan Africa (SSA). CRC-AC characteristics, including anatomic location, are not well described in SSA. The anatomical distribution of CRC-AC or “sidedness” can help predict prognosis, treatment and guide screening modalities. In South Africa, an upper-middle income country, screening colonoscopy is not readily available due to a lack of gastroenterologists and surgeons. Flexible sigmoidoscopy, which is used to detect left colonic and rectal AC, could potentially be used as a screening tool, particularly because the procedure does not require sedation and could be performed by trained non-specialists. The objective of this study was was describe patient characteristics and anatomic location of colorectal adenocarcinoma (CRC-AC) in South Africa.
Methods:
This was a retrospective study of all pathology-confirmed CRC-AC in the South African National Cancer Registry from 2006-2011. CRC-AC were classified by anatomical site/topography using the International Classification of Diseases – Oncology, Version 3. Variables extracted included age, gender, province, race, ICD.10 code, and the full pathology report. Univariate and multivariate analysis were performed to determine associations with location. Variables with a p-value ≤ 0.10 were included in the multivariate analysis.
Results: 6146 patients with CRC were identified of which 5498(89%) had CRC-AC. The median age was 60 (interquartile range, 49-70) years. 1372 (25%) of patients were < 50 years and 2870 (52%) were male. Right colonic tumours were found in 1277 (26%), 1214 (25%) were left colonic lesions, and 2404 (49%) lesions were located in the rectum. Patients ≥ 50 years (OR=1.29. p<0.001) were more likely to have left colonic and rectal AC on multivariate analysis. Patients < 50 years were more likely to be black (OR=1.67. p<0.001) and have right sided tumours (OR=1.25. p<0.007).
Conclusion: CRC-AC in South Africa presents at an earlier age than in high income countries, such as the US. The majority of colorectal cancer were left-sided and rectal; thus screening flexible sigmoidoscopy should be considered. Further studies on the age-specific incidence and the genetics and epigenetics of CRC-AC in South Africa are needed.