Background: Globally, colorectal cancer is the third most commonly diagnosed cancer. Sidedness in colorectal (CRC) cancer has an impact on prognosis. Internationally cancer shifted to the right side, also outcome poorer at the right side in compared to left side. The risk of developing colorectal cancer is influenced by both environmental and genetic factors. The aim of the study was to find out the sidedness for colorectal cancer in Kurdistan region-Iraq and to determine the relevant characteristics of sidedness of patients with colorectal cancer in Sulaymaniyah region.
Methods: Cross-sectional study, started at January 2018 to January 2019. The data were collected from Hiwa hospital registries in Sulaymaniyah city which is the only cancer center in the city, all cases diagnosed and registered in the hospital for years 2017 and 2018 were included. The process of collection of relevant information done by a questionnaire designed for this issue, sidedness plus all relevant characteristic information’s collected.
Results: One hundred ninety-eight patients with colorectal cancer were included in the study. Mean age of the patients were 57.4 years, mean of age in the right-sided tumor (59.6 years) in higher than left-sided tumor (55.9 years). The group of patients aged below 50 years represents 36.4% of all cases. Overweight and obesity more reported among left-sided tumors more than the right-sided tumor. Right-sided tumors occur in older age. Abdominal pain and anemia were statistically significantly associated with right-sided tumor (P-value=0.01 and 0.02) and lower GI bleeding statistically significantly associated with left-sided tumor (P-value=0.04). Staging of both left and right-side tumors reveals that both of them mainly present in stage (III and IV). Lymph nodes dissected in both right and left-sided tumors in two third of them were adequate. Both left-sided (99%) an d right sided (95%) pathology reveal negative margin. Lymphovascular invasion is more reported for right-sided tumors (44%) when compared to left-sided tumors (38%). The mucinous type was more common with the right-sided tumor. Among stage (III) cases recurrence rates for distant metastasis equal to 60%, while it is 40% for local recurrence.
Conclusion: Right-sided tumors occur in older age group and were diagnosed in late stages (in more than half of the patients), due difficulties in endoscopic exploration, health education, health promotion (36.4% of cases occurred below the age of 50 years). Screening programs are the cornerstone in order to detect the tumor in the earlier stage, shifting of age groups toward younger ages require more epidemiological studies.
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