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Introduction: The prevalence and survival of colorectal cancer in Sri Lankans has not been previously reported. We did a retrospective and a prospective survey, in the region of North Colombo, Sri Lanka between 1992 and 2004. The aim was to study cancer burden, sites of colorectal cancer and survival after surgery., Patients and Methods: The records of 175 patients with colorectal cancer between 1992 and 1997 in the selected region of were analysed retrospectively. A prospective study was performed in 220 new patients with colorectal cancer between 1996 and 2004. Data evaluated were demographics, tumour stage and survival., Results: Between 1992 and 1997 the crude annual incidence of colorectal cancer was 1.9 per 100,000, which increased over the years. The current national crude annual incidence is 3.2 per 100,000 in women and 4.9 in men. Median age at presentation was 60 years with similar prevalence of cancer in men and women. In the entire group, 28% of cancers were in those less than 50 years old. Survival at 2 and 5 years was 69% and 52%. The majority of cancer related deaths were within the first 2 years after surgery., Conclusion: The burden of colorectal cancer in Sri Lanka is on the rise. Up to a third of cancers occur in those under 50 years, and the majority of cancers are in the rectum or rectosigmoid region. Flexible sigmoidoscopy offers a useful screening tool.

Purpose: The impact of neoadjuvant therapy (NAT) for rectal cancer on lymph node yield is not well known. This study evaluates the impact of NAT on tumor regression and lymph node harvest., Methods: The subjects were 40 patients with rectal cancer; 20 receiving high-dose, long-course neoadjuvant therapy, and 20 age- and sex-matched controls who did not receive neoadjuvant therapy. Tumor regression (TRG) was graded from 1 to 5 as: TRG1, no residual tumor cells; TRG2, occasional residual tumor cells with marked fibrosis; TRG3, marked fibrosis with scattered tumor cells or groups; TRG4, abundant cancer cells with little fibrosis; TRG5, no tumor regression. We also evaluated the number of lymph nodes retrieved from excised specimens, the size of the largest node, and the extent of lymph node involvement by the tumor., Result: Tumor regression was seen in all patients; as TRG1 in 6 (30%), TRG2 in 2 (10%), TRG3 in 3 (15%), and TRG4 in 9 (45%). The median nodal harvest was 4 (range (0-12) in the NAT group vs 9 (range 1-19) in the control (P = 0.001). The median size of the largest lymph node was 5 mm (range 2-12 mm) in the NAT group vs 9 mm (range 4-15 mm) in the control group (P = 0.004). Tumor-positive nodes were identified in 4 of 17 of the NAT group patients and in 9 of the 20 controls (P = 0.308)., Conclusion: Although NAT down-stages rectal cancer, it results in a significantly low yield of lymph nodes, which are also significantly smaller than those in nonirradiated controls. Therefore, surgeons and histopathologists must ensure adequate sampling and accurate staging is done for patients with irradiated rectal cancer.