Colorectal Carcinoma: An Update of Current Trends in Accra

Abstract

BACKGROUND Clinical experience and earlier studies indicate that the number of colorectal cancer cases seen annually in the Accra metropolis is increasing. OBJECTIVE This study was aimed at providing a current update on colorectal cancer in Accra, Ghana. METHODS A prospective study of confirmed cases of colorectal cancer diagnosed from January 1997- December 2007. RESULTS Three hundred and fifty-nine colorectal cancer cases were studied. Males were 192(53.5%) and females 167(46.5%) with an annual incidence of 32.6 new cases. The crude incidence rates were 12.53, 9.87 and 11.18 per 100,000 population for males, females and overall respectively. Rectal bleeding 185(51.1%), abdominal mass 76(21.1%), intestinal obstruction 62(17.3%), intestinal perforation nine (2.5%) and iron deficiency anaemia nine (2.5%) cases were the main presentations. There were 168 (46.8%) rectal and 191(53.2%) colon tumours. Two hundred and thirty-one patients had laparotomy with 225 resections, and 128 patients for various reasons did not undergo surgery. The Astler Coller stages of the tumours at diagnosis were C2 84(36.7%), C1 53(22.1%), B2 49(21.4%), D 17(7.4%), B1 14(6.1%) and A 12(5.1%) cases. Adenocarcinoma was the commonest histological type 321(89.4%), with the majority either well-differentiated (62.5%) or moderately well-differentiated (25.6) carcinomas. Poorly differentiated carcinomas accounted for 28 cases (7.8%). Post-operative mortality was 6.1%. Long term survival could not be assessed as the majority of patients were lost to follow up. CONCLUSION The incidence of colorectal cancer has increased over the last four decades in tandem with an aging population of Accra with adenocarcinoma as the predominant histological type.