Risk Factors Associated with the Development of Colorectal Cancer in Sokoto, Nigeria

Abstract:

Background: Colorectal cancer is a leading cause for patient presentation to surgical clinics worldwide. Risk factors and stage of disease presentation varies widely from different regions of the world. While sporadic cancers account for majority of cases in the general population, hereditary factors have assumed prominence in the etiopathogenesis of the disease in recent times due to advancement in molecular screening and diagnosis. In most developed economies disease presentation is early with better outcome compared to the low income countries of Africa and parts of Asia where it continues to carry poor prognosis as a result of late presentation. Aim: To determine the risk factors associated with development of colorectal cancer among adults presenting to the surgical clinic of a tertiary hospital in North-west Nigeria and highlight the predominant clinical stage of the disease. Method: A seven-year prospective study between 2012 and 2018 where consecutive patients presenting to our clinic with colorectal cancer were recruited and administered questionnaires to obtain information on demographics, clinical stage and risk factors. Results: A total of 109 patients were seen. Of this, 54.1% (59) were males while 45.9% (50) were females giving a male: female ratio of 1.2:1.0. The mean age was 44.7 years while the median age was 45.0 years. Fifty-one percent (56) of patients had no identifiable risk for colorectal cancer, 22.9%(25) admitted to excess intake of roasted beef and cheese, 11.0%(12) had positive family history of colorectal cancer, 5.5%(6) had history of familial adenomatous polyposis (FAP) confirmed by histology, 3.7% (4) were treated for colonic schistosomiasis in the past while ulcerative colitis, angiosarcoma and carcinoid tumor accounted for 1.8%(2) of risks each. Fifty-one percent (56) of patients presented with TNM stage III disease, 35.8% (39) with stage IV and 12.8% (14) with stage II. No patient was seen with stage I disease. Conclusion: Diet rich in animal fat and roasted beef together with family history constitutes important risks for colorectal cancer in this study. Majority of the patients were young and presented with late disease.