Changing Patterns of Colorectal Cancer in Hail Region

Authors: Laila Salah Seada, Ashraf Ibrahim, Fawaz Al Rashid, Ihab Abdo, Hassan Kasim, Waleed Al Mansi, Saud Al Shabli

Abstract:

Background and Objectives: Colorectal carcinoma is increasing among both men and women worldwide. It has a multifactorial etiology including genetic factors, environmental factors and inflammatory conditions of the digestive tract. A clinicopathologic assessment of colorectal carcinoma in Hail region is done, considering any changing patterns in two 5-year periods from 2005-2009 (A) and from 2012 to 2017 (B). All data had been retrieved from histopathology files of King Khalid Hospital, Hail. Results: During period (A), 75 cases were diagnosed as colorectal carcinoma. Male patients comprised 56/75 (74.7%) of the study, with a mean age of 58.4 (36-97), while females were 19/75 (25.3%) with a mean age of 50.3(30-85) and the difference was significant (p = 0.05). M:F ratio was 2.9:1. Most common histological type was adenocarcioma in 68/75 (90.7%) patients mostly well differentiated in 44/68 (64.7%). Mucinous neoplasms comprised only 7/75 (9.3%) of cases and tended to have a higher stage (p = 0.04). During period (B), 115 cases were diagnosed with an increase of 53.3% in number of cases than period (A). Male to female ratio also decreased to 1.35:1, females being 44.83% more affected. Adenocarcinoma remained the prevalent type (93.9%), while mucinous type was still rare (5.2%). No distal metastases found at time of presentation. Localization of tumors was rectosigmoid in group (A) in 41.4%, which increased to 56.6% in group (B), with an increase of 15.2%. Iliocecal location also decreased from 8% to 3.5%, being 56.25% less. Other proximal areas of the colon were decreased by 25.75%, from 53.9% in group (A) to 40% in group (B). Conclusion: Colorectal carcinoma in Hail region has increased by 53.3% in the past 5 years, with more females being diagnosed. Localization has also shifted distally by 15.2%. These findings are different from Western world patterns which experienced a decrease in incidence and proximal shift of the colon cancer localization. This might be due to better diagnostic tools, population awareness of the disease, as well as changing of life style and/or food habits in the region.

Keywords: Colorectal cancer, Hail Region, changing pattern, distal shift.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1314797

References:

[1] Tamas K, Walenkamp AM, de Vries EG, van Vugt MA, Beets-Tan RG, van Etten B, de Groot DJ, Hospers GA: Rectal and colon cancer: Not just a different anatomic site. Cancer Treat Rev. 2015 Sep;41(8):671-9.
[2] Kim HS: Site-specific colorectal cancer; how is it different? Korean J Gastroenterol. 2013 Feb;61 (2):63-70.
[3] Nakagawa H, Ito H, Hosono S, Oze I, Mikami H, Hattori M, Nishino Y, Sugiyama H, Nakata K, Tanaka H: Changes in trends in colorectal cancer incidence rate by anatomic site between 1978 and 2004 in Japan. Eur J Cancer Prev. 2017 Jul;26 (4):269-276.
[4] Li FY, Lai MD: Colorectal cancer, one entity or three. J Zhejiang Univ Sci B. 2009 Mar;10(3):219-29.
[5] Hamilton SR, Aaltonen LA: World Health Organization classification of tumors. Pathology and genetics. IARC, Lyon (2000).
[6] Román R, Verdú M, Calvo M, Vidal A, Xavier Mireya S Jimeno, Antonio Salas, Josefina Autonell Isabel, Xavier Puig: Microsatellite instability of the colorectal carcinoma can be predicted in the conventional pathologic examination. A prospective multicentric study and the statistical analysis of 615 cases consolidate our previously proposed logistic regression model. Virchows Archiv. May 2010, Volume 456, Issue 5, pp 533–541(2010).
[7] Seydaoğlu G1, Özer B, Arpacı N, Parsak CK, Eray IC: Trends in colorectal cancer by subsite, age, and gender over a 15-year period in Adana, Turkey: 1993-2008. Turk J Gastroenterol. 2013;24(6):521-31.
[8] Hjartåker A, Aagnes B, Robsahm TE, Langseth H, Bray F, Larsen IK: Subsite-specific dietary risk factors for colorectal cancer: a review of cohort studies. J Oncol. 2013;2013:703854.
[9] Parente F1, Bargiggia S, Boemo C, Vailati C, Bonoldi E, Ardizzoia A, Ilardo A, Tortorella F, Gallus S: Anatomic distribution of cancers and colorectal adenomas according to age and sex and relationship between proximal and distal neoplasms in an i-FOBT-positive average-risk Italian screening cohort. Int J Colorectal Dis. 2014 Jan;29 (1):57-64.
[10] Omranipour R, Doroudian R, Mahmoodzadeh H: Anatomical distribution of colorectal carcinoma in Iran: a retrospective 15-yr study to evaluate rightward shift. Asian Pac J Cancer Prev. 2012; 13 (1):279-82.
[11] Larsen IK, Bray F: Trends in colorectal cancer incidence in Norway 1962-2006: an interpretation of the temporal patterns by anatomic subsite. Int J Cancer. Feb 1;126 (3):721-32 (2010).
[12] Brozek W, Kriwanek S, Bonner E, Peterlik M, Cross H: Mutual Associations between Malignancy, Age, Gender, and Subsite Incidence of Colorectal Cancer. Anticancer Research 29: 3721-3726 (2009).
[13] Caldarella A, Crocetti E, Messerini L, Paci E: Trends in colorectal incidence by anatomic subsite from 1985 to 2005: a population-based study. Int J Colorectal Dis. 2013 May;28(5):637-41(2013).
[14] Howarth AE, Pihl E: High-fat diet promotes and causes distal shift of experimental rat colonic cancer--beer and alcohol do not. Nutr Cancer. 1984;6(4):229-35(1984).
[15] Seada L, Al Rashid F, Negm A: A Four-Year Study of Thyroid Carcinoma in Hail Region: Increased Incidence. International Journal of Medical, Health, Biomedical, Bioengineering and Pharmaceutical Engineering Vol:10 No: 12, 201(2016).
[16] Ezzeldin M Ibrahim, Ahmed A Zeeneldin, Tawfik R El-Khodary, Aboelkhair M Al-Gahmi, Bakr M Bin Sadiq: Past, present and future of colorectal cancer in the Kingdom of Saudi Arabia. The Saudi J Gastroenterology: Volume: 14: 4, 178-182 (2008).
[17] Azzeh FS1, Alshammari EM2, Alazzeh AY2, Jazar AS3, Dabbour IR4, El-Taani HA5, Obeidat AA6, Kattan FA7, Tashtoush SH: Healthy dietary patterns decrease the risk of colorectal cancer in the Mecca Region, Saudi Arabia: a case-control study. BMC Public Health. 2017 Jun 29;17(1):607(2017).
[18] Mosli, Mahmoud H.; Al-Ahwal, Mahmoud S: Colorectal Cancer in the Kingdom of Saudi Arabia: Need for Screening. Asian Pacific Organization for Cancer Prevention. Volume 13, Issue 8, 2012, pp.3809-3813 (2012).
[19] Gadelkarim AH, Alawad GM, Alharbi SH: Histopathological Pattern of Colorectal Cancer in Relation to Age and Gender in Northern Saudi Arabia. Journal of Cancer Prevention & Current Research. Volume 8 Issue 3 (2017).
[20] McKeown-Eyssen G. Epidemiology of colorectal cancer revisited: Are serum triglycerides and/or plasma glucose associated with risk? Cancer Epidemiol Biomarkers Prev 1994;3:687-95.
[21] Armstrong B, Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer 1975;15:617-31.
[22] Gunter MJ, Leitzmann MF. Obesity and colorectal cancer: Epidemiology, mechanisms and candidate genes. J Nutr Biochem 2006;17:145-56.
[23] Giovannucci E. Modifiable risk factors for colon cancer. Gastroenterol Clin North Am 2002;31:925-43.
[24] Ahsan H, Neugut AI, Garbowski GC, et al. Family history of colorectal adenomatous polyps and increased risk for colorectal cancer. Ann Intern Med 1998;128:900-5.
[25] Gado A, Ebeid B, Abdelmohsen A, Axon A: Colorectal cancer in Egypt is commoner in young people: Is this cause for alarm? Alexandria Journal of Medicine. Volume 50, Issue 3, September 2014, Pages 197-201(2014).
[26] Gerharz CD, Gabbert H, Krummel F: Age-dependent shift-to-the-right in the localization of colorectal adenomas. Virchows Archiv November 1987, Volume 411, Issue 6, pp 591–598 (1987).
[27] Petros C. Papagiorgis, Ioannis Oikonomakis, Dionysios Delaportas, Despoina Myoteri, Elissavet Arkoumani, Nikolaos Thalassinos, Adamantia Zizi-Sermpetzoglou: Proximal shift of colorectal cancer. A persistent phenomenon with multiple causes, patterns and clinical implications. JBUON 2014; 19(3): 605-617 (2014).
[28] Y. Kazushige, Kawai Nelson, H. Tsuno, Soichiro Ishihara, Hironori Yamaguchi, Eiji Sunami, J Kitayama, T Watanabe: Proximal Shift of Colorectal Cancer along with Aging. Clinical Colorectal Cancer. Volume 13, Issue 4, December 2014, Pages 213-218 (2014).
[29] Fenoglio L, Castagna E, Comino A, Luchino C, Senore, Migliore E, Capucci F, Panzone S, Silvestri A, Ghezzo L, Ferrigno D: A shift from distal to proximal neoplasia in the colon: a decade of polyps and CRC in Italy. BMC Gastroenterology 2010, 10:139 (2010).
[30] Jass JR, O’Brien MJ, Riddell RH, Snover DC: Recommendations for the reporting of surgically resected specimens of colorectal carcinoma. Virchows Archive January 2007, Volume 450, Issue 1, pp 1–13 (2007).
[31] Ming Li, Jin Gu, Ming Li Jin Gu: Changing patterns of colorectal cancer in China over a period of 20 years. World J Gastroenterol; 11(30):4685-4688 (2005).
[32] Cady B, Persson AV, Monson DO, Maunz DL: Changing patterns of colorectal carcinoma. Cancer. 1974 Feb; 33(2):422-6.