title: Clinicopathological patterns and challenges of management of colorectal cancer in a resource-limited setting: a Tanzanian experience.
abstract: BACKGROUND
  Colorectal cancer is one of the most common cancers worldwide and its incidence is reported to be increasing in resource-limited countries, probably due to the acquisition of a western lifestyle. However, information regarding colorectal cancer in Tanzania and the study area in particular is limited. This study was conducted in our local setting to describe the clinicopathological pattern of colorectal cancer and highlight the challenging problem in the management of this disease.
  
  
  METHODS
  This was a retrospective study of histologically confirmed cases of colorectal cancer seen at Bugando Medical Center between July 2006 and June 2011. Data were retrieved from patients' files and analyzed using SPSS computer software version 17.0.
  
  
  RESULTS
  A total of 332 colorectal cancer patients were enrolled in the study, representing 4.7% of all malignancies. Males outnumbered females by a ratio of 1.6:1. The median age of patients at presentation was 46 years. The majority of patients (96.7%) presented late with advanced stages. Lymph node and distant metastasis at the time of diagnosis was recorded in 30.4% and 24.7% of cases, respectively. The rectosigmoid region was the most frequent anatomical site (54.8%) involved and adenocarcinoma (98.8%) was the most common histopathological type. The majority of adenocarcinomas (56.4%) were moderately differentiated. Mucinous and signet ring carcinomas accounted for 38 (11.6%)and 15 (4.6%) patients, respectively. Three hundred and twenty-six (98.2%) patients underwent surgical procedures for colorectal cancer. Only 54 out of 321 (16.8%) patients received adjuvant treatment. Postoperative complication and mortality rates were 26.2% and 10.5%, respectively. The overall median duration of hospital stay was 12 days. Only nine out of 297 survivors (3.0%) were available for follow-up at the end of 5 years. Cancer recurrence was reported in 56 of 297 survivors (18.9%). Data on long-term survival were not available as the majority of patients were lost to follow-up.
  
  
  CONCLUSIONS
  Colorectal cancer is not uncommon in our environment and shows a trend towards a relative young age at diagnosis and the majority of patients present late with advanced stage. There is a need for screening of high-risk populations, early diagnosis and effective cost-effective treatment and follow-up to improve outcome of these patients.
authors.affiliation: Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. drphillipoleo@yahoo.com
authors.forename: Phillipo L
authors.initials: PL
authors.lastname: Chalya
authors.forename: Mabula D
authors.initials: MD
authors.lastname: McHembe
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Mabula
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rambau
authors.forename: Hyasinta
authors.initials: H
authors.lastname: Jaka
authors.forename: Mheta
authors.initials: M
authors.lastname: Koy
authors.forename: Eliasa
authors.initials: E
authors.lastname: Mkongo
authors.forename: Nestory
authors.initials: N
authors.lastname: Masalu
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013636:Tanzania; D055815:Young Adult