Clinicopathological spectrum of colorectal cancer among the population of the Kwazulu-Natal Province in South Africa

INTRODUCTION: The burden of colorectal carcinoma (CRC), once considered rare in Africa, may be changing with the disease being increasingly diagnosed and there is a suggestion that age and race influence tumour behaviour. To describe the clinicopathological spectrum of CRC among the different population groups and age groups in a South African setting. METHODS: analysis of prospectively collected data from an on-going colorectal cancer database, including demographics, clinical presentation, site, staging and grading on all patients enrolled over an 18-year period. RESULTS: a total of 2232 patients with CRC were accrued over the study period (Africans, 798; Indians, 890; Coloureds, 104; and Whites, 440). Mean age was 57.7 (SD 14.4) but varied considerably by race (p = 0.001) and Africans were significantly younger. Young adults (aged =40 years) totalled 305 and older patients (aged 40 years) totalled 1927. The proportion of young patients (40 years old) was 28%, 7%, 9% and 3% among Africans, Indian, Coloured and White patients respectively. There were minimal variations in anatomical sub-site distribution. There was no difference in staging regardless of age and race. Tumour stage was similar in all population groups as well as in older and young adults. Mucinous differentiation was more common in Africans and in young patients and poor differentiation was more common in African patients. Africans had a significantly lower resection rate compared to the other population groups (p =0.001). Younger patients had a significantly lower resection rate compared to the other population groups (p = 0.001). CONCLUSION: African patients were the youngest compared to the other population groups. Mucinous differentiation predominated in Africans and young adults and poor differentiation predominated in Africans, resection rate was lower for African patients and in young patients.