Advertisement

Indian Journal of Surgical Oncology

, Volume 8, Issue 4, pp 484–490 | Cite as

Colorectal Cancer in India: An Audit from a Tertiary Center in a Low Prevalence Area

  • Prachi S. PatilEmail author
  • Avanish Saklani
  • Pravir Gambhire
  • Shaesta Mehta
  • Reena Engineer
  • Ashwin De’Souza
  • Supriya Chopra
  • Munita Bal
Original Article

Abstract

Colorectal cancer (CRC) is a common cancer worldwide with a low reported incidence in India. There is significant geographical variation in the incidence rates, and the presentation may also vary. There are few studies evaluating the clinical profile of CRC in Indian patients. We analyzed a prospective database maintained at the Tata Memorial Hospital, a referral cancer center in Mumbai, of consecutive patients with CRC between August 2013 and August 2014. We captured details regarding the demography, symptoms, pathology, stage, and treatment plan. The aim was to assess the demographic and clinical details of patients with CRC in India and compare it with those of the reported literature. Eight hundred new patients with CRC were seen in the colorectal clinic in one year. The mean age was 47.2 years. Sixty-five percent were males. Patients were symptomatic for an average period of 4 months prior to presentation. The commonest symptoms were rectal bleeding (57%), pain (44%), and altered bowel habits (26%). Thirteen percent of the patients had signet ring tumors. The median CEA (carcinoembryonic antigen) level was 5.8 ng/mL. Most patients had localized or locally advanced disease. Twenty-eight percent of the patients had metastatic disease with liver being the commonest site of metastases (14%) followed by peritoneum and lung. More than half of the patients received treatment with a curative intent. Colorectal cancer in India differs from that described in the Western countries. We had more young patients, higher proportion of signet ring carcinomas, and more patients presenting with an advanced stage. Inadequate access to healthcare and socioeconomic factors may play a role in some of these differences.

Keywords

Colorectal cancer Demography India 

Notes

Compliance with Ethical Standards

Conflict of Interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA a cancer J Clin 65(2):87–108CrossRefGoogle Scholar
  2. 2.
    Center MM, Jemal A, Smith RA, Ward E (2010) Worldwide variations in colorectal cancer. Dis Colon rectum 53(7):1099CrossRefGoogle Scholar
  3. 3.
    “Fact Sheets by Population-CRC India ASRs.” [Online]. Available: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx
  4. 4.
    Allemani C et al. (2015) Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 385:977–1010Google Scholar
  5. 5.
    “Three year report of the population based cancer registries: 2009–2011.” [Online]. Available: http://www.ncrpindia.org/ALL_NCRP_REPORTS/PBCR_REPORT_2009_2011/ALL_CONTENT/PDF_Printed_Version/Preliminary_Pages_Printed.pdf
  6. 6.
    Goggins WB, Wong G (2009) Cancer among Asian Indians/Pakistanis living in the United States: low incidence and generally above average survival. Cancer Causes Control 20(5):635–643CrossRefPubMedGoogle Scholar
  7. 7.
    (2015) Singapore Cancer Registry Interim Annual Report Trends in Cancer Incidence in Singapore 2010-2014. https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/cancertrends-2010-2014_interim-annual-report_final-(public).pdf Accessed 31 Jan 2017
  8. 8.
    Edwards BK et al (2014) Annual report to the nation on the status of cancer, 1975–2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 120(9):1290–1314CrossRefPubMedGoogle Scholar
  9. 9.
    Davis DM, Marcet JE, Frattini JC, Prather AD, Mateka JJL, Nfonsam VN (2011) Is it time to lower the recommended screening age for colorectal cancer? J Am Coll Surg 213(3):352–361CrossRefPubMedGoogle Scholar
  10. 10.
    Siegel R, Desantis C, Jemal A (2014) Colorectal cancer statistics, 2014. CA Cancer J Clin 64(2):104–117CrossRefPubMedGoogle Scholar
  11. 11.
    Nooyi SC, Murthy NS, Shivananjaiah S, Sreekantaiah P, Mathew A (2011) Trends in rectal cancer incidence—Indian scenario. Asian Pac J Cancer Prev 12(8):2001–2006PubMedGoogle Scholar
  12. 12.
    Badwe RA, Dikshit R, Laversanne M, Bray F (2014) Cancer incidence trends in India. Jpn J Clin Oncol 44(5):401–407CrossRefPubMedGoogle Scholar
  13. 13.
    Sarkar S, Mukherjee R, Paira SK, Roy B, Banerjee S, Mukherjee SK (Dec. 2012) Profile of colorectal cancer in Eastern India. J Indian Med Assoc 110(12):901–903PubMedGoogle Scholar
  14. 14.
    Peedikayil MC et al (2009) Colorectal cancer distribution in 220 Indian patients undergoing colonoscopy. Indian J Gastroenterol 28(6):212–215CrossRefPubMedGoogle Scholar
  15. 15.
    Hussain N, Gahine R, Mourya J, Sudarshan V (2013) Colorectal cancer in young adults in a tertiary care hospital in Chhattisgarh, Raipur. Indian J Cancer 50(4):337CrossRefPubMedGoogle Scholar
  16. 16.
    Laskar RS, Talukdar FR, Mondal R, Kannan R, Ghosh SK (2014) High frequency of young age rectal cancer in a tertiary care centre of southern Assam, North East India. Indian J Med Res 139(2):314–318PubMedPubMedCentralGoogle Scholar
  17. 17.
    Nath J, Wigley C, Keighley MRB, Perakath B (2009) Rectal cancer in young adults: a series of 102 patients at a tertiary care centre in India. Color Dis 11(5):475–479CrossRefGoogle Scholar
  18. 18.
    “SRS: chapter—2 population composition.” [Online]. Available: http://www.censusindia.gov.in/vital_statistics/srs_report/9chap2-2011.pdf. [Accessed: 25-Oct-2016]
  19. 19.
    IRIS Knowledge Foundation, “State of the urban youth, India 2012". [Online]. Available: http://www.esocialsciences.org/general/a201341118517_19.pdf [Accessed: 24-March-2017]
  20. 20.
    Jessup JM, McGinnis LS, Steele GD, Menck HR, Winchester DP (1996) The National Cancer Data Base. Report on colon cancer. Cancer 78(4):918–926CrossRefPubMedGoogle Scholar
  21. 21.
    Thörn M, Bergström R, Kressner U, Sparén P, Zack M, Ekbom A (1998) Trends in colorectal cancer incidence in Sweden 1959–93 by gender, localization, time period, and birth cohort. Cancer Causes Control 9(2):145–152CrossRefPubMedGoogle Scholar
  22. 22.
    Hirai HW et al (2016) Systematic review with meta-analysis: faecal occult blood tests show lower colorectal cancer detection rates in the proximal colon in colonoscopy-verified diagnostic studies. Aliment Pharmacol Ther 43(7):755–764CrossRefPubMedGoogle Scholar
  23. 23.
    Suryadevara S, Veerendra KKV, Pampanagouda SKM, Arjun R, Deshmani V (2014) Colorectal cancer profile in a tertiary care centre, Bangalore, India. Online J Heal allied Sci 13(1):1–4Google Scholar
  24. 24.
    Mohandas KM, Desai DC (1999) Epidemiology of digestive tract cancers in India. V. Large and small bowel. Indian J Gastroenterol 18(3):118–121PubMedGoogle Scholar
  25. 25.
    Majumdar SR, Fletcher RH, Evans AT (1999) How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol 94(10):3039–3045CrossRefPubMedGoogle Scholar
  26. 26.
    Sinha R et al (2015) Lifestyle and sporadic colorectal cancer in India. Asian Pac J Cancer Prev 16(17):7683–7688CrossRefPubMedGoogle Scholar
  27. 27.
    Locker GY et al (2006) ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol 24(33):5313–5327CrossRefPubMedGoogle Scholar
  28. 28.
    Liu Z et al. (2014) A systematic review and meta-analysis of diagnostic and prognostic serum biomarkers of colorectal cancer. PLoS One 9(8)Google Scholar
  29. 29.
    Nitsche U et al (2013) Mucinous and signet-ring cell colorectal cancers differ from classical adenocarcinomas in tumor biology and prognosis. Ann Surg 258(5):775–782Google Scholar
  30. 30.
    Hyngstrom JR et al (2012) Clinicopathology and outcomes for mucinous and signet ring colorectal adenocarcinoma: analysis from the National Cancer Data Base. Ann Surg Oncol 19(9):2814–2821CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Siegel RL, Miller KD, Jemal A (2016) Cancer statistics. CA Cancer J Clin 66(1):7–30CrossRefPubMedGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2017

Authors and Affiliations

  • Prachi S. Patil
    • 1
    Email author
  • Avanish Saklani
    • 2
  • Pravir Gambhire
    • 1
  • Shaesta Mehta
    • 1
  • Reena Engineer
    • 3
  • Ashwin De’Souza
    • 2
  • Supriya Chopra
    • 3
  • Munita Bal
    • 4
  1. 1.Department of Digestive Diseases and Clinical NutritionTata Memorial HospitalMumbaiIndia
  2. 2.Department of Surgical OncologyTata Memorial HospitalMumbaiIndia
  3. 3.Department of Radiation OncologyTata Memorial HospitalMumbaiIndia
  4. 4.Department of PathologyTata Memorial HospitalMumbaiIndia

Personalised recommendations