A Narrative Review on Colorectal Adenocarcinoma in East Africa
The fourth leading cause of death from cancer in the world is colorectal cancer. It is the world’s third most widely diagnosed malignancy and is responsible for 1.4 million new infections in 2012 and about 700,000 deaths. This paper is a study of research conducted in East Africa on colorectal adenocarcinoma showing regional distribution, age and sex ratios, clinical appearance, management, and prevalent histopathology. A gradually growing incidence of CRC is currently being recorded in East African countries, but this is correlated with higher morbidity and mortality associated with CRC. Although the male: female ratio ranges from 1.2:1 to 1.88:1, patients younger than 40 years are diagnosed with up to 38 percent of CRC, compared to just 1.9 percent of CRC patients in Western developed countries such as the USA. Generally, rectal carcinoma is more prevalent than colon carcinoma, and up to 54% to 71% of abdominal perineal resections are usually performed due to the advanced stage of rectal tumor presentation in East Africa. A higher morbidity in CRC patients may result from late stage presentation and delayed successful care in East Africa. Interestingly, there is a large occurrence of sub-groups of mucinous adenocarcinoma relative to developed Western countries with a poor prognosis. A large proportion of CRC patients have been shown to have histological and demographic characteristics that show that younger patients are more common with MSI-tumors and these tumors. Only a few scientists, however, have investigated the probability of mismatch repair mutations in the genetic aetiopathogenesis of East African colorectal adenocarcinoma. In East Africa, colorectal cancer needs further unravelling, especially in aetiopathogenesis, and immunohisto-chemical staining and MSI testing is therefore recommended to determine the molecular subtypes and therefore the prevalence of colorectal carcinoma of Hereditary Non-Polyposis (HNPCC). This will explain the hereditary aetiopathogenesis of the East African area of colorectal adenocarcinoma.
Author (s) Details
Dr. Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
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