The characteristics of advanced colorectal cancer in patients presenting to the academic centers of the Witwatersrand University in Johannesburg, South Africa

Nyatsambo, Chido
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Background: Colorectal cancer (CRC) is one of the most common cancers in South Africa. The characteristics of CRC differ in terms of anatomical location, histology and metastatic spread. The aim of this study was to assess the characteristics of the primary tumour in advanced colorectal cancer. Objectives: The objectives were to profile the metastatic spread in patients with T3/T4 lesions according to the characteristics of the primary lesion; to assess the percentage of synchronous metastases in patients with T3/T4 colorectal cancer; and to compare the relationship of the primary in CRC patients presenting with T3/T4 against those presenting with T1/T2 in terms of demographics, socioeconomics, risk profile, disease specific and outcome variables. Methods: The MRC Prospective Colorectal Cancer database (M1050446) was used. A retrospective review of 494 patients diagnosed with CRC between 2016 and October 2018 was done. Data was collected from the database and a descriptive analysis was done looking at the tumour stage, tumour site and histology. Results: A total of 494 patients were included 48.5% female and 51.5% male. 41.5% of the sample were older than 60 years. The rectum/anus had the highest number of tumours 231, followed by the left colon 106, and right colon 84. T3 tumours were most common in the left colon 55.7%. T4 tumours were predominantly in the right colon 46.5%. 247 out of 285 had adenocarcinoma, 38 patients had mucinous adenocarcinoma. 29.4% of the sample had synchronous metastases. There was a total of 79 liver metastases and 36 lung metastases. Conclusion: The rectum is the most common site for CRC. Advanced tumours are seen more in the proximal colon, compared to the distal colon. The most common histology type is adenocarcinoma. Almost 1/3 of the patients had metastases and the most common site was the liver followed by the lung.
A research report submitted in fulfilment of the requirements for the degree of Master of Medicine in Surgery to the faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2021