PATTERN AND STAGE AT PRESENTATION OF COLORECTAL CANCER IN SAINT PAUL’S HOSPITAL MILLENEUM MEDICAL COLLAGE /ADDIS ABABA /ETHIOPIA

Abstract

ABSTRACT Background: Colorectal Cancer is the third most common cause of admission and death in the West; and till recently it was thought to be an uncommon disease in Africa and Asia. A recent report from Global cancer statistics center shows an increasing incidence in the sub-Saharan Africa. The magnitude of EOCRC incidence in Ethiopia increased, contributing to significant morbidity and mortality. This may be related to economic transition and westernization. A recent study at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia showed that an overall mortality rate was 67.46% with 1-year overall survival rate was 63.16% . Poor survivals of CRC patients in Ethiopia is largely due to advanced stage of the disease and lack of timely treatment, and highlight the urgent need for improved access to cancer treatment in the region Objective: The main objective of this study was to assess the pattern and Stage at presentation of colorectal cancer in SPHMMC from Jan 1/2019-Dec 31/ 2022 Methods Institution based cross sectional study was conducted. All patients operated from referral clinic and emergency OPD with a diagnosis of biopsy proven colorectal cancer on the study period, which fulfilled the inclusion criteria was included in the study. And data was collected from patient record and pathologic result using structured questionnaire by principal investigator and residents. After checking the completeness of data, it was analyzed using SPSS to answer the research question. Result: The mean age of the study subjects was 54 years, ranging between 22 and 84 years. A fourth (23.8%) was below the age of 40 years, 51.7 % were men, and 73.5% presented as an elective. The most common symptom was rectal bleeding 5 5.6% followed by abdominal pain (51.1%), change in bowel habit (44.0%). The study revealed mass on Digital Rectal Examination in 33.1%, signs of obstruction in 30%. The common sites of cancer were the rectum in 26.5% of cases followed by sigmoid colon (19.9%), caecum (13.9%). 39.7 % of the study subjects presented in late stage disease. More than 78 % of the patients had histologically proven adenocarcinoma. Out of 151 operated pts around 51 % LN harvested were <12 LN with average LN was 10. And tumor margin positive were 7.3 % which all were radial margin mean while the Lymph-vascular and perineural invasion was found to be 11.2% and 3.9%. Conclusion: 56% of the patients presented with a complain of rectal bleeding and 33% of them had palpable rectal mass on Digital Rectal Examination signifying the importance of a thorough physical examination. Around 40 %of the study subjects had advanced cancer (stage III and IV) which shows a big gap on early diagnosis and referral; both at community and facility level. In more than half of operated patients the number of lymph node harvested were less than 12 lymph nodes which are inadequate for pathological staging and it has a negative impact on proper management. Around 7.3% of operated patients were positive for surgical margins that are at risk for local recurrence and distal metastasis Recommendations: Colorectal Cancer is a problem of significant magnitude and as the outcome of treatment depends largely on the early detection of cases a detailed research should be done to see the factors which hamper early detection and referral of cases to the tertiary health facilities where multidisciplinary management is available.. Adequate lymph node harvesting is paramount essential for staging and subsequent managing of patients with CRC. So Operating surgeons should give a great focus on it Attaining of margin positive surgery to the level of zero should be a target for quality improvement through the identification of best practices among general and CRC surgeons