Sabtu, 02 Juli 2011

Epidemiological Evaluation of Colorectal Cancer at Cipto mangunkusumo Hospital from 2000-2010

Yusak Kristianto, Ibrahim Basir

The incidence of colorectal cancer (CRC) is on the rise, and is the third leading cause of death worldwide. This descriptive study presents the epidemiology of CRC in Cipto Mangunkusumo Hospital, Jakarta, Indonesia in the past decade, from year 2000-2010.

Data is obtained retrospectively from the colorectal database of the Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo Hospital. CRC cases presented to us between the year 2000-2010 were included. The variables analyzed include age, gender, anatomical location of the tumor, presenting symptoms, histopathology type, and staging.

A total of 662 patients with CRC were included in the study. No patient was excluded, the ones with incomplete medical data will be noted. Fifty-two percent of subjects were male, 44,1% were female, giving a ration of 1,2:1. Age were grouped according to Sturgess formula with 7-year interval per group. Most patients belong to the 45-53 years age group (21,8%). Mean age was 50,67 years, the youngest being 18 year-old and the oldest 86 year-old. Fifty-five percent of CRC was located within the rectum. The most common presenting symptoms of CRC located within the colon are changes in bowel habit (83,8%), abdominal pain (65,5%), and palpable abdominal mass (40%). In rectal cancer, patient mostly complain of a change in defecation habit (95,7%), rectal bleeding (85,3%), and mucous faeces (68,2%). Weight loss is found in 33,5% patients. Adenocarcinoma comprises up to 71,6% of cases. Forty-four point four percent of patients were diagnosed at stage III.

We compare our CRC epidemiologic characteristic to those of the United States National CRC and United Kingdom. A striking difference in the incidence of colorectal cancer by age distribution between Indonesia and other countries (Irak, Iran, Egypt, Saudi Arabian, Jordanian) compared to the western countries. In our institution, similar to other Asian countries, CRC seems to occur most frequently within the younger population (under 45 year-old). In the western countries most CRC are found in population older than 65 years. We also find that there’s no difference between male and female about the incidence of rectal cancer, as found in US, where male has a higher incidence. Another notable difference are the stage of disease at time of presentation. Patients usually present in a more advanced stage in our country and the Asian region (stageIII) compared to that of overseas where cases are detected at earlier stage. A later-stage at presentation translates to a decreased chance of resectability and curability. The most likely cause of this phenomena is allegedly due to the lower health awareness among our population, leading to the delay in seeking medical attention, hence later diagnosis. This finding suggest the need of reinforcing a more reliable community screening program to increase the awareness of early signs of CRC, especially in patients with high risk factors.

Keyword: epidemiology, colorectal cancer, Indonesia