Correlation of clinical data, anatomical site and disease stage in colorectal cancer
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OBJECTIVE: To evaluate the colorectal cancer clinical data with respect to the anatomical location and stage of disease. DESIGN: Retrospective observational study. SETTING: Kenyatta National Hospital (KNH), Nairobi, Kenya. SUBJECTS: Two hundred and fifty three tumours were categorised as right colonic (RCC), left colonic (LCC) and rectal (RC) lesions. The distribution of symptoms (rectal bleeding, tenesmus, change in bowel habits, abdominal pain, intestinal obstruction, rectal mass), anaemia, transfusion requirement, and the Dukes' stages were compared for right colon, left colon and rectal tumours. RESULTS: There were 54 RCC, 59 LCC, 140 RC lesions. Patient delay from onset of symptom(s) to presentation was a mean of 26.6 +/- 43, 20 +/- 25 and 33.7 +/- 42 weeks for right, left and rectal lesions respectively (p = 0.092). The proportion of patients presenting with rectal bleeding was 21%, 44% and 79% for RCC, LCC and RC lesions, respectively. The prevalence of intestinal obstruction was 14.8%, 27.1% and 43.6% in right, left and rectal lesions, respectively. The haemoglobin levels were significantly lower for right sided lesions (p = 0.05 for right colon/rectum pair; p = 0.059 for right colon/left colon pair). The sites of the lesions had no relationship to the stage of disease at presentation. CONCLUSION: In patients with colorectal cancer, the duration of symptoms was prolonged irrespective of the anatomical sub-sites. Symptoms were evenly distributed across the anatomical regions except for bleeding and obstruction which predominated in rectal and left colon cancers respectively. This underlines the need for early investigations in patients with rectal bleeding, change of bowel habit, intestinal obstruction and anaemia.