scholarly journals Colorectal Cancers in Low- and Middle-Income Countries—Demographic Pattern and Clinical Profile of 970 Patients Treated at a Tertiary Care Cancer Center in India

2021 ◽  
pp. 1110-1115
Author(s):  
S. V. S. Deo ◽  
Sunil Kumar ◽  
Sandeep Bhoriwal ◽  
N. K. Shukla ◽  
Atul Sharma ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Advanced Stage ◽  
Middle Income ◽  
Female Ratio ◽  
Histologic Subtype ◽  
Middle Income Countries ◽  
Rectal Cancers ◽  
Low And Middle Income

PURPOSE Globally, colorectal cancer (CRC) ranks third in terms of incidence and second in terms of mortality. A relatively low burden of CRC has been reported from low- and middle-income countries (LMIC), and there is a paucity of publications related to CRC from LMIC. PATIENTS AND METHODS A computerized comprehensive structured CRC clinical database was developed. All the patients with histopathologically proven CRC undergoing either curative and palliative multimodality management or surgical interventions between 2000 and 2019 were included in the study. A descriptive analysis of the demographic profile and clinical spectrum was performed. RESULTS A total of 970 patients of CRC were treated between 2000 and 2019. Of these, 401 patients (41.3%) had colon cancer and 569 (58.7%) had rectal cancer. The male-to-female ratio was 1.79:1. The mean age at presentation was 47.7 years. A total of 337 (34.7%) patients qualified as young CRC (≤ 40 years of age at diagnosis). The commonest symptom among patients with colon cancer was abdominal pain; 55.6% of patients had a right-sided primary tumor as compared with 42.2% with left-sided tumors. The commonest symptom among patients with rectal cancer was bleeding per rectum. The predominant location of the tumor was in the lower rectum (58%). Majority of patients with CRC presented with locally advanced stage II and III disease. The most common histologic subtype encountered for both colon and rectal cancers was adenocarcinoma (84.8% and 81.2%, respectively). CONCLUSION This study has revealed certain important findings related to CRC in LMIC including a higher burden of young colorectal cancer, a relatively higher proportion of rectal cancers in comparison with colon cancer, a high percentage of patients with low-rectal cancer, and advanced stage at presentation.

Genetic epidemiology of colorectal cancer and associated cancers

Mutagenesis ◽  
2019 ◽  
Vol 35 (3) ◽  
pp. 207-219
Author(s):  
Hongyao Yu ◽  
Kari Hemminki
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Familial Risk ◽  
Shared Environment ◽  
Relative Risks ◽  
Swedish Family ◽  
Rectal Cancers ◽  
Common Risk Factors ◽  
Double Primary Cancers

Abstract We review here data on familial risk in colorectal cancer (CRC) generated from the Swedish Family-Cancer Database, the largest resource of its kind in the world. Although the concordant familial risk for CRC (i.e. CRC risk in families of CRC patients) has been reasonably well established, the studies on discordant familial risks (i.e. CRC risk in families with any other cancers) are rare. Because different cancers could be caused by shared genetic susceptibility or shared environment, data of associations of discordant cancers may provide useful information for identifying common risk factors. In analyses between any of 33 discordant cancers relative risks (RRs) for discordant cancers were estimated in families with increasing numbers of probands with CRC; in the reverse analyses, RRs for CRC were estimated in families with increasing numbers of probands with discordant cancers. In separate analyses, hereditary non-polyposis colorectal cancer (HNPCC) families were excluded from the study, based on HNPCC related double primary cancers, to assess the residual familial RRs. We further reviewed familial risks of colon and rectal cancers separately in search for distinct discordant associations. The reviewed data suggested that colon cancer was associated with a higher familial risk for CRC compared to rectal cancer. The previous data had reported associations of CRC with melanoma, thyroid and eye cancers. Nervous system cancer was only associated with colon cancer, and lung cancer only associated with rectal cancer. The reviewed data on discordant association may provide guidance to gene identification and may help genetic counseling.

scholarly journals The implementation of colorectal cancer screening interventions in low-and middle-income countries: a scoping review

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Désirée Schliemann ◽  
Kogila Ramanathan ◽  
Nicholas Matovu ◽  
Ciaran O’Neill ◽  
Frank Kee ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Scoping Review ◽  
Small Scale ◽  
Screening Methods ◽  
Recruitment Strategies ◽  
Middle Income ◽  
Crc Screening ◽  
Middle Income Countries ◽  
Screening Cost ◽  
Low And Middle Income

Abstract Background Low- and middle-income countries (LMICs) experienced increasing rates of colorectal cancer (CRC) incidence in the last decade and lower 5-year survival rates compared to high-income countries (HICs) where the implementation of screening and treatment services have advanced. This review scoped and mapped the literature regarding the content, implementation and uptake of CRC screening interventions as well as opportunities and challenges for the implementation of CRC screening interventions in LMICs. Methods We systematically followed a five-step scoping review framework to identify and review relevant literature about CRC screening in LMICs, written in the English language before February 2020. We searched Medline, Embase, Web of Science and Google Scholar for studies targeting the general, asymptomatic, at-risk adult population. The TIDieR tool and an implementation checklist were used to extract data from empirical studies; and we extracted data-informed insights from policy reviews and commentaries. Results CRC screening interventions (n = 24 studies) were implemented in nine middle-income countries. Population-based screening programmes (n = 11) as well as small-scale screening interventions (n = 13) utilised various recruitment strategies. Interventions that recruited participants face-to-face (alone or in combination with other recruitment strategies) (10/15), opportunistic clinic-based screening interventions (5/6) and educational interventions combined with screening (3/4), seemed to be the strategies that consistently achieved an uptake of > 65% in LMICs. FOBT/FIT and colonoscopy uptake ranged between 14 and 100%. The most commonly reported implementation indicator was ‘uptake/reach’. There was an absence of detail regarding implementation indicators and there is a need to improve reporting practice in order to disseminate learning about how to implement programmes. Conclusion Opportunities and challenges for the implementation of CRC screening programmes were related to the reporting of CRC cases and screening, cost-effective screening methods, knowledge about CRC and screening, staff resources and training, infrastructure of the health care system, financial resources, public health campaigns, policy commitment from governments, patient navigation, planning of screening programmes and quality assurance.

Disparities in stage at presentation and treatment of colorectal cancer among Hispanic and non-Hispanic white patients.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 433-433 ◽  
Author(s):  
Rodrigo Rodriguez ◽  
Melissa Gonzalez ◽  
Bridget N. Fahy ◽  
Anita Kinney ◽  
Ashwani Rajput
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Locally Advanced ◽  
Incidence Rates ◽  
Cancer Center ◽  
Advanced Stage ◽  
Stage Of Disease ◽  
Nccn Guidelines ◽  
Significant Difference

433 Background: Although incidence rates for colorectal cancer (CRC) for Hispanics are similar to non-Hispanic whites (NHW) in New Mexico, the cause-specific mortality is higher among the Hispanic population. Hispanics have also been shown to be less likely to be current with colorectal cancer screening guidelines as compared to NHW. The purpose of this study was to determine if there was a difference between Hispanics and NHW in stage at presentation and if the care provided was concordant with NCCN guidelines at our NCI designated cancer center. Methods: A prospective data base of all patients who presented with colorectal cancer between June 2009 and July 2013 was queried. A total of 197 patients were identified. Data was extracted that included: demographics, stage of CRC at first diagnosis, treatments given, and pathology results. Frequencies of stage at presentation and NCCN guideline concordance (meeting the 12 lymph node metric, receipt of adjuvant therapy for stage III disease and radiation therapy for locally advanced rectal cancer) were recorded. Results: The Table shows the results. There were 107 (55%) males. There was not a statistical difference in the stage of presentation for Hispanics and NHW for patients with colon cancer. Hispanic patients with rectal cancer, however, presented with more advanced stage of disease as compared to NHW (p<0.05). There was no statistically significant difference in concordance with NCCN guidelines for the three metrics analyzed. Conclusions: Hispanics and NHW with colon cancer presented with similar stage of disease and were concordant with NCCN guideline metrics. Hispanics with rectal cancer, however, presented at a more advanced stage of disease as compare to NHW patients. The reason for this disparity remains to be elucidated. Future studies to include outreach, education, screening and molecular profiling of these disparate populations are planned. [Table: see text]

Prognostic significance of mesenteric tumor nodules in patients with stage III colorectal cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 3566-3566
Author(s):  
D. S. Lo ◽  
A. Pollett ◽  
S. Gallinger ◽  
L. L. Siu ◽  
R. L. Burkes
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Cancer Patients ◽  
Prognostic Significance ◽  
Tnm Staging ◽  
Stage Iii ◽  
Stage Iiic ◽  
Female Ratio ◽  
Mesenteric Tumor

3566 Background: Tumor nodules are occasionally found in adjacent mesentery of colorectal cancer specimens, but their prognostic significance is unclear. According to the TNM staging system, mesenteric nodules are classified as part of T or N categories, but clinically they are regarded to reflect a worse prognosis, more like M1. We investigated the clinical significance of mesenteric tumor nodules. Methods: We reviewed 786 patients with stage III colorectal cancer referred between 1995 and 1999. We standardized TNM staging by assigning N status based on number of definite lymph nodes. Mesenteric nodules were considered separately and not assigned to T or N categories. Survival analyses were performed. Results: Mesenteric tumor nodules were found in 116 patients (14.8%); 48 with colon cancer (41.4%) and 68 rectal cancer (58.6%). Mean age at surgery was 62.8±1.0 yrs (SE), and the male: female ratio was 1.2. All tumors were adenocarcinomas with an average size of 4.3±0.1 cm, and the majority were moderately differentiated. Resection margins were clear except in 7 cases. With respect to high risk features, 6 cases (5.2%) had bowel perforation, 12 (10.3%) obstructive symptoms, 41 (35.3%) lymphovascular invasion, and 11 (9.5%) were T4 lesions. Adjuvant chemotherapy was given to 84.8% of colon cancer patients. Two (2.9%) rectal cancer patients received neoadjuvant chemo-radiation, and 63 (92.6%) received adjuvant therapy; chemotherapy, radiation or both. In the cohort with mesenteric nodules, the median time to progression was 23.1 months; the median 5-yr disease free survival was 35%; and the median overall survival (OS) was 47.9 months, with 44% OS at 5 yrs. After TNM standardization, 19 (16.4%) patients were down-staged to either stage I or II, and their 5-yr OS was 60% (SEER Stage II 5 yr survival 82.5%). In the remaining cohort-patients with stage III disease after standardization, the 5-yr OS was 40% (SEER 5yr survival Stage IIIc 44.3%; Stage IV 8.1%). Conclusions: In comparison to SEER survival data, the presence of mesenteric nodules appears to worsen prognosis of any T/N0 disease to that of overall stage III disease. Patients with mesenteric nodules in the setting of any T/N1+ disease had prognosis similar to that of stage IIIC disease, but their prognosis was better than M1 disease. No significant financial relationships to disclose.

scholarly journals Colorectal Cancer in Ukraine: Regional Disparities and National Trends in Incidence, Management, and Mortality

2018 ◽  
pp. 1-8 ◽  
Author(s):  
Nelya Melnitchouk ◽  
Galyna Shabat ◽  
Pamela Lu ◽  
Heather Lyu ◽  
Rebecca Scully ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Screening Program ◽  
Specific Treatment ◽  
Specific Therapy ◽  
Annual Percent Change ◽  
Middle Income ◽  
Middle Income Countries ◽  
National Trends ◽  
Improve Access

Purpose The incidence of colorectal cancer (CRC) is increasing worldwide, and the greatest increase is in low- to middle-income countries, such as Ukraine. Better knowledge of epidemiology of CRC in Ukraine is needed to understand how best to decrease the burden of disease. Methods The National Cancer Registry of Ukraine (NCRU) was queried for CRC incidence, mortality, stage, and treatment in Ukraine and assessed for regional variation from 1999 to 2015. Joinpoint analysis was used to analyze the trends. Results The incidence of colon cancer increased from 10.6 to 13.3 occurrences per 100,000, which provided an average annual percent change (AAPC) of 1.48 (95% CI, 1.3 to 1.7; P < .05). The incidence of rectal and anal cancers also increased from 9.9 to 11.5 occurrences per 100,000, which provided an AAPC of 1.0 (95% CI, 0.8 to 1.3; P < .05). Mortality remained the same (AAPC, 0.1; 95% CI, −0.3 to 0.2; P = .4). The proportion of patients who received cancer-specific treatment increased from 54.6% to 68.5% for colon cancer and from 61% to 74.4% for rectal and anal cancers. Overall, 34.5% of patients with colon cancer and 27.5% of patients with rectal cancer died within a year of diagnosis in 2015. Great regional variations in 1-year mortality and treatment received were identified. Conclusion The incidence of CRC in Ukraine is increasing. Despite stable mortality rates, many do not receive cancer-specific treatment, and a large proportion of patients die within a year of diagnosis. These findings illustrate the need to promote establishment of a screening program and to improve access to cancer-specific therapy in Ukraine.

Some Conditions for Task Shifting in Low and Middle-Income Countries

2012 ◽  
Author(s):  
Joop de Jong ◽  
Mark Jordans ◽  
Ivan Komproe ◽  
Robert Macy ◽  
Aline & Herman Ndayisaba ◽  
...  
Keyword(s):  
Task Shifting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income
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