Evaluating clinicopathological pattern and management of colorectal cancer for adult patients presenting at Queen Elizabeth Central Hospital: a 10-year retrospective review

Abstract

Colorectal cancer (CRC) is the second leading cause of cancer mortality and the third prevalent cancer globally. In Sub-Saharan Africa (SSA), the incidence is increasing. This retrospective cross-sectional study evaluated clinicopathological pattern and management of CRC for adult patients presenting at Queen Elizabeth Central Hospital (QECH), Malawi. The review of oncology and surgical register books identified patients diagnosed with CRC who presented between 2012 and 2022. The variables assessed were age, sex, HIV status, symptoms, family history, diagnostic approach, tumour site, histological diagnosis, treatment modality, and length of hospital stay (LOHS). There were 192 patients identified with CRC. The median age was 45 years [interquartile range (IQR) = 43.5–60], with slight male predominance at 100 (52.08%). There were 23 (11.98%) patients with HIV infection and all were on treatment. Abdominal pain and rectal bleeding were the predominant symptoms occuring in 100 (52.08%) and 78 (40.63%) respectively. The mean duration of signs and symptoms was 7.6 months (SD = 4.6). Over half of the patients, 113 (58.85%) were in clinical stage IV. The majority were diagnosed at laparotomy 116 (60.42%), followed by colonoscopy 19 (9.90%). Out of the 192 participants, 110 (57.29%) had histology reports confirming CRC, while 82 (42.71%) had no histology reports. All the available histology reports showed adenocarcinoma. Surgery was the main treatment for 155 (80.73%) patients while chemotherapy was offered to 81 (42.19%) patients. CRC at QECH is predominantly diagnosed in young patients at advanced stages. Screening younger age groups could improve with early diagnosis and management.