CLINICOPATHOLOGIC PATTERN AND TREATMENT OUTCOME OF COLORECTAL CANCER AT AYDER COMPREHENSIVE SPECALIZED HOSPITAL FROM 2017 to 2024.

Abstract

Background - Colorectal cancer (CRC) is a broad term and a major public health problem which includes tumors arising from colonic, rectum and anus. CRC is the most common cancer representing 13% of all malignant tumors in the gastrointestinal tract. In Ethiopia, colorectal cancer is among the leading causes of cancer morbidity and mortality in both sexes. Adenocarcinoma is the commonest histologic type with relatively better prognosis. Commonest presentation is abdominal pain and rectal bleeding. In CRC, the primary treatment options are surgery, chemotherapy (CT), targeted agents, and radiotherapy (RT). The predictors of mortality in CRC patients are Age, marital status, CEA level, cancer stage and comorbidities. Objective: The purpose of this study is to assess the clinicopathologic patterns and treatment outcomes of colorectal cancer patients at Ayder Comprehensive Specialized Hospital from 2017 to 2024. Methods: A retrospective institution-based cross-sectional study was done on total of 304 CRC patient who visited ACSH from 2017 to 2024.Trained physicians/residents using an ODK tool collected secondary data from patient charts that was retrieved from archive. Data entered to SPSS, Patient demographics, clinical features, tumor characteristics, treatment modalities, and outcomes were analyzed. Descriptive statistics, cumulative incidence, incidence density, median survival time, and adjusted hazard ratio were calculated to describe variables. Result: A total of 304 patients were recorded in this study. The mean age of presentation was 51.1years (SD=15). The most common chief complaint was rectal bleeding (33.9%), followed by abdominal pain (23%). Metastatic symptoms were detected in 41(13.5%) of patients at presentation. The most common being back pain (6.3%), cough, vaginal bleeding (2%).112(36.8%) of patients had anemia .73.4% (47) had low albumin. CEA> 5 ng/ml value was seen in 44(48.9%) of patient.211 (69.4%) had pre op colonoscope and 145(68.7%) had ulcerative lesion. The most Common site was lower rectum found to be 95(46.6%) and lowest incidence was at transverse colon 7(3.4%) both with imaging US/CT and colonoscope. from the preoperative biopsy result adenocarcinoma 192(76.5%) and 14(5.6%) were poorly differentiated. 56 (35.2%) presented advanced. stage 4, 33(20.8%) stage 3C. 87 patients (28.6%) received neoadjuvant chemotherapy. With FOLFOX 53 (60.9%), CAPOX 14(16.1%). mean number of chemo cycle provided was 6(SD=4). nineteen (21.8%) had radiological, clinical, CEA response. out of 364 patients 168(55.3%) were operated, subsequently 98(32.2%) received adjuvant chemotherapy, 2 (0.7%) received radiotherapy and 74(24.3%) did not receive any treatment due financial, personal and social reasons. Of the total patients XI 23(7.6%) died at discharge. Of the 168 patients operated 199 procedures done 67.3% were done on elective basis. Of which 44.8% Ro resections were done. Of all most common procedure done was colostomy 76(38.2%), followed by segmental resection 36(18.1%), APR (14.1%), right hemicolectomy (11.1%). Total of 18(9%) intraoperative accidents were recorded. The most common intraoperative complication was adjacent organ injury (61.1%) followed by tumor rupture and fecal spillage (16.7%). There was 1 intraoperative death recorded. There were 61 (30.7%) post operative complications, SSI was the most common complication (32.8%), anastomotic leak (13.1%). for which 15(7.5%) required surgical intervention /reoperations.30 days post operative mortality was 6%. At the 5yr follow up 70 out of 304 were deceased. Out of 168 operated 44 were deceased. Conclusion: The clinical presentation of the CRC patients was similar to other studies conducted in Ethiopia and other LMICs with rectal bleeding being the most common chief complaint. Rectal cancer is more common than colon cancer. Most patients present at advanced stages, often from rural areas outside Mekelle, indicating limited access to early diagnostic services. One-fifth of the patients were younger. The most common histological type is well-differentiated adenocarcinoma, aligning with global CRC pathology trends. Assessing the clinic pathology pattern and treatment of study area is important to understand and initiate early detection, screening and treatment for better outcome