Aim. To demonstrate the possibility of the uniqueness of colorectal cancer (CRC) in the native Nigerian by looking at the different facets of the challenges that management of this disease presents in a tertiary-care hospital in Ibadan, Nigeria. Method. A cohort study starting in 2009 where patients were seen in the out-patient’s clinic. All patients who presented with features suggestive of colon or rectal cancer were studied. Biopsies were performed to confirm CRC (especially rectal cancer); patients were then booked for admission and subsequent operation. Patients were excluded if the histopathology of a resected or biopsied mass turned out to be noncancerous or inflammatory. Demographic data like age and sex were recorded. The type of operation done, findings at surgery, and the histopathology of the resected specimen were all recorded. The time taken for the pathology department to process the biopsy and resected specimens was also recorded. Results. 120 patients with CRC were seen over the study period of 5 years (2009–2013) giving an average of 24 patients per annum. The male？:？female ratio was 1？:？1.14. 86 (71.7%) patients had rectal cancer while the remaining 34 (28.3%) had colon cancer. Most of the colon cancer cases were in the 51–60 age group. The rectum？:？colon ratio was 2.5？:？1.31% of the patients were 40 years and below. 37% of those with rectal cancer were 40 years and below. 50% of resected specimens were Duke’s B and above. 45% of patients had tumors with unfavorable grade or biology (mucinous 21.7%, signet ring 8.3%, and poorly differentiated 15%). Only 24% of patients below 40 years and 41% of those above 40 years with confirmed rectal carcinoma presented for operation. Conclusion. Advanced tumors at presentation may not always be as a result of late presentation. Unusual aggressiveness of the tumors may lead to rapid progression of the disease. Increasing incidence in younger patients makes abdominoperineal excision of the rectum difficult for such patients to accept. 1. Introduction The effective treatment of colorectal cancer (CRC) in sub-Saharan Africa is hampered by the advanced state of the disease when the patients present to hospital. Poverty and ignorance are the two factors indicted. In the past, access to tertiary medical care was the 3rd factor; however in Nigeria where there are 36 federal tertiary hospitals that is no longer a factor. Nigeria has a population of about a little over 160 million people [1]. The crude incidence of colorectal cancer (CRC) in sub-Saharan Africa has been found to be 4.04/100,000 population
References
[1]
World Statistics Pocket Book, Country Profile: Nigeria, 2013, http://unstats.un.org/unsd/default.htm.
[2]
A. Graham, D. Adeloye, L. Grant, E. Theodoratou, and H. Campbell, “The incidence of colorectal cancer in sub-Saharan Africa: a systematic analysis,” Journal of Global Health, vol. 2, Article ID 020404, 2012.
[3]
J. Sack and J. M. Rothman, “Colorectal cancer: natural history and management,” Hospital Physician, vol. 36, pp. 64–73, 2000.
[4]
D. Irabor and O. A. Adedeji, “Colorectal cancer in Nigeria: 40 years on. A review,” European Journal of Cancer Care, vol. 18, no. 2, pp. 110–115, 2009.
[5]
D. O. Irabor, A. Arowolo, and A. A. Afolabi, “Colon and rectal cancer in Ibadan, Nigeria: an update,” Colorectal Disease, vol. 12, no. 7, pp. e43–e49, 2010.
[6]
A. B. M. Wilmink, “Overview of the epidemiology of colorectal cancer,” Diseases of the Colon and Rectum, vol. 40, no. 4, pp. 483–493, 1997.
[7]
M. Moshkowitz and N. Arber, “Differences in incidence and distribution of colorectal cancer among races and ethnic societies: lifestyle, genes or both?” Digestion, vol. 72, no. 4, pp. 219–222, 2005.
[8]
P. Boyle, D. G. Zaridze, and M. Smans, “Descriptive epidemiology of colorectal cancer,” International Journal of Cancer, vol. 36, no. 1, pp. 9–18, 1985.
[9]
O. G. Ajao, “Colon and anorectal neoplasms in a tropical African population,” International Surgery, vol. 64, no. 2, pp. 47–52, 1979.
[10]
O. O. Adekunle and J. A. Lawani, “Clinical aspects and management of carcinoma of the rectum in Nigerians,” East African Medical Journal, vol. 59, no. 3, pp. 206–213, 1982.
[11]
O. S. Ojo, W. O. Odesanmi, and O. O. Akinola, “The surgical pathology of colorectal carcinomas in Nigerians,” Tropical Gastroenterology, vol. 12, no. 4, pp. 180–184, 1991.
[12]
D. O. Akinola and A. O. Arigbabu, “Pattern and presentation of large bowel neoplasms in Nigerians,” Central African Journal of Medicine, vol. 40, no. 4, pp. 98–102, 1994.
[13]
American Cancer Society, Cancer in Africa, American Cancer Society, Atlanta, Ga, USA, 2011.
[14]
K. T. Yawe, A. A. Bakari, U. H. Pindiga, and A. A. Mayun, “Clinicopathological pattern and challenges in the management of colorectal cancer in sub-Saharan Africa,” Journal of the Chinese Medical Association, vol. 2, pp. 688–694, 2007.
[15]
I. S. Abdulraheem, “Health needs assessment and determinants of health-seeking behaviour among elderly Nigerians: a house-hold survey,” Annals of African Medicine, vol. 6, no. 2, pp. 58–63, 2007.
[16]
G. B. S. Iyalomhe and S. I. Iyalomhe, “Health-seeking behaviour of rural dwellers in southern Nigeria: implications for healthcare professionals,” International Journal of Tropical Disease & Health, vol. 2, pp. 62–71, 2012.
[17]
M. A. Tanimola and J. O. Owoyemi, “Healthcare-seeking behaviour in Anyigba, North Central, Nigeria,” Research Journal of Medical Sciences, vol. 3, no. 2, pp. 47–51, 2009.
[18]
I. A. Oreagba, K. A. Oshikoya, and M. Amachree, “Herbal medicine use among urban residents in Lagos, Nigeria,” BMC Complementary and Alternative Medicine, vol. 11, article 117, 2011.
[19]
I. S. Akande, O. A. Adewoyin, U. F. Njoku, and S. O. Awosika, “Biochemical evaluation of some locally prepared herbal remedies (Agbo) currently on high demand in Lagos metropolis, Nigeria,” Journal of Drug Metabolism & Toxicology, vol. 3, p. 118, 2012.
[20]
E. R. Ezeome and A. N. Anarado, “Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria,” BMC Complementary and Alternative Medicine, vol. 7, article 28, 2007.
[21]
O. G. Ajao, M. O. Adenuga, and J. K. Ladipo, “Colorectal carcinoma in patients under the age of 30 years: a review of 11 cases,” Journal of the Royal College of Surgeons of Edinburgh, vol. 33, no. 5, pp. 277–279, 1988.
[22]
A. Z. Sule and B. M. Mandong, “Malignant colorectal tumours in patients 30 years and below: a review of 35 cases,” Central African Journal of Medicine, vol. 45, no. 8, pp. 209–212, 1999.
[23]
O. O. Adekunle and G. O. Ajao, “Colorectal cancer in adolescent Nigerians,” Scandinavian Journal of Gastroenterology, Supplement, vol. 21, no. 124, pp. 183–186, 1986.
[24]
L. Xie, P. J. Villeneuve, and A. Shaw, “Survival of patients diagnosed with either colorectal mucinous or non-mucinous adenocarcinoma: a population-based study in Canada,” International Journal of Oncology, vol. 34, no. 4, pp. 1109–1115, 2009.
[25]
M. Numata, M. Shiozawa, T. Watanabe, et al., “The clinicopathological features of colorectal mucinous adenocarcinoma and a therapeutic strategy for the disease,” World Journal of Surgical Oncology, vol. 10, article 109, 2012.
[26]
S. T. Edino, A. Z. Mohammed, and O. Ochicha, “Characteristics of colorectal carcinoma in Kano, Nigeria: an analysis of 50 cases,” Nigerian Journal of Medicine, vol. 14, no. 2, pp. 161–166, 2005.
[27]
J. O. Obafunwa, “Pattern of alimentary tract tumours in Plateau State: a middle belt area of Nigeria,” Journal of Tropical Medicine and Hygiene, vol. 93, no. 5, pp. 351–354, 1990.
[28]
P. L. Chalya, M. D. Mchembe, J. B. Mabula et al., “Clinicopathological patterns and challenges of management of colorectal cancer in a resource-limited setting: a Tanzanian experience,” World Journal of Surgical Oncology, vol. 11, article 88, 2013.
[29]
O. G. Ajao, I. A. Grillo, T. Malatani, and M. Y. al Shehri, “Colo-rectal carcinoma in a tropical African population: an overview report,” East African Medical Journal, vol. 71, no. 10, pp. 640–643, 1994.
[30]
Y. Iliyasu, J. K. Ladipo, E. E. U. Akang, C. A. Adebamowo, O. G. Ajao, and P. U. Aghadiuno, “A twenty-year review of malignant colorectal neoplasms at University College Hospital, Ibadan, Nigeria,” Diseases of the Colon and Rectum, vol. 39, no. 5, pp. 536–540, 1996.
[31]
A. N. Ani, “Anorectal diseases in Western Nigerian adults. A field survey,” Diseases of the Colon and Rectum, vol. 26, no. 6, pp. 381–385, 1983.
[32]
D. C. Nwafo and J. O. Ojukwu, “Malignant disease of the colon, rectum, and anus in Nigerian Igbos,” Annals of the Royal College of Surgeons of England, vol. 62, no. 2, pp. 133–135, 1980.
[33]
I. Segal, “Rarity of colorectal adenomas in the African black population,” European Journal of Cancer Prevention, vol. 7, no. 5, pp. 387–391, 1998.
[34]
K. Jaskiewicz, E. Lancaster, L. Banach, and A. Karmolinski, “Proliferative ability of normal and neoplastic colonic mucosa in population groups with high and low risk for colorectal cancer,” Anticancer Research, vol. 18, pp. 4641–4644, 1998.
[35]
I. Segal, S. A. R. Cooke, D. G. Hamilton, and L. Ou Tim, “Polyps and colorectal cancer in South African Blacks,” Gut, vol. 22, no. 8, pp. 653–657, 1981.
[36]
A. van't Hof, K. Gilissen, R. J. Cohen et al., “Colonic cell proliferation in two different ethnic groups with contrasting incidence of colon cancer: is there a difference in carcinogenesis?” Gut, vol. 36, no. 5, pp. 691–695, 1995.
[37]
C. A. Adebamowo, O. Adeyi, R. Pyatt, T. W. Prior, R. B. Chadwick, and A. de la Chapelle, “Case report on hereditary non-polyposis colon cancer (HNPCC) in Nigeria,” African Journal of Medicine and Medical Sciences, vol. 29, no. 1, pp. 71–73, 2000.
[38]
W. F. Anderson, A. Umar, and O. W. Brawley, “Colorectal carcinoma in black and white race,” Cancer and Metastasis Reviews, vol. 22, no. 1, pp. 67–82, 2003.
[39]
L. Cronje, P. J. Becker, A. C. Paterson, and M. Ramsay, “Hereditary non-polyposis colorectal cancer is predicted to contribute towards colorectal cancer in young South African blacks,” South African Journal of Science, vol. 105, no. 1-2, pp. 68–72, 2009.
[40]
R. Makkar, R. K. Pai, and C. A. Burke, “Sessile serrated polyps: cancer risk and appropriate surveillance,” Cleveland Clinic Journal of Medicine, vol. 79, no. 12, pp. 865–871, 2012.
[41]
D. C. Snover, “Update on the serrated pathway to colorectal carcinoma,” Human Pathology, vol. 42, no. 1, pp. 1–10, 2011.
[42]
O. W. Brawley, “Toward a better understanding of race and cancer,” Clinical Cancer Research, vol. 16, no. 24, pp. 5920–5922, 2010.
[43]
P. Kheirandish and F. Chinegwundoh, “Ethnic differences in prostate cancer,” British Journal of Cancer, vol. 105, no. 4, pp. 481–485, 2011.
[44]
A. Ribe, T. Ribalta, R. Lledó, G. Torras, M. A. Asenjo, and A. Cardesa, “Evaluation of turnaround times as a component of quality assurance in surgical pathology,” International Journal for Quality in Health Care, vol. 10, no. 3, pp. 241–245, 1998.
[45]
F. B. Abdulkareem, L. A. Sanni, S. D. Richman, and P. Chambers, “KRAS and BRAF mutations in Nigerian colorectal cancers,” West African Journal of Medicine, vol. 31, pp. 198–203, 2012.
[46]
G. Safaee Ardekani, S. M. Jafarnejad, L. Tan, A. Saeedi, and G. Li, “The prognostic value of BRAF mutation in colorectal cancer and melanoma: a systematic review and meta-analysis,” PLoS ONE, vol. 7, no. 10, Article ID e47054, 2012.
[47]
L. Raskin, J. C. Dakubo, N. Palaski, J. K. Greenson, and S. B. Gruber, “Distinct molecular features of colorectal cancer in Ghana,” Cancer Epidemiology, vol. 37, pp. 556–561, 2013.
[48]
H. Ashktorab, D. T. Smoot, J. M. Carethers et al., “High incidence of microsatellite instability in colorectal cancer from African Americans,” Clinical Cancer Research, vol. 9, no. 3, pp. 1112–1117, 2003.
[49]
P. Benatti, R. Gafa, D. Barana, and M. Marino, “Microsatellite instability and colorectal cancer prognosis,” Clinical Cancer Research, vol. 11, pp. 8332–8340, 2005.
[50]
W. H. Ling and S. C. Lee, “Inter-ethnic differences-how important is it in cancer treatment?” Annals of the Academy of Medicine Singapore, vol. 40, no. 8, pp. 356–361, 2011.
[51]
P. H. O'Donnell and M. E. Dolan, “Cancer pharmacoethnicity: ethnic differences in susceptibility to the effects of chemotherapy,” Clinical Cancer Research, vol. 15, no. 15, pp. 4806–4814, 2009.
[52]
M. A. Aghaji and O. M. Obiekwe, “Sexual function in males following abdomino-perineal resection in Nigeria,” Central African Journal of Medicine, vol. 37, no. 9, pp. 301–303, 1991.
[53]
M. J. Traa, J. de Vries, J. A. Roukema, and B. L. den Oudsten, “Sexual (dys) function and the quality of sexual life in patients with colorectal cancer: a systematic review,” Annals of Oncology, vol. 23, no. 1, pp. 19–27, 2012.
[54]
L. M. D. Yusufu, S. Y. Sabo, and V. I. Odigie, “Anorectal cancer involving the female genital tract: the morbidity and implications for sexual function,” Nigerian Journal of Surgical Research, vol. 5, pp. 38–42, 2003.
