Research Article ISSN 2639-8478

Cancer Science & Research

The Epidemiology of Colorectal Cancer in Erbil

Hawro Hamza1* and Kakil Rasul2

Postgraduate Fellow (Medical Oncology), Medical Oncology

1
Correspondence:
*
Department, Oncology Center, Rizgary Teaching Hospital, Erbil, Hawro Taha Hamza, Medical Oncology Department, Oncology
Kurdistan, Iraq. Center, Rizgary Teaching Hospital, Erbil, Kurdistan, Iraq, Tel:
00964 750 467 20 77; E-mail: hawro_hamza@yahoo.com.
Senior Consultant Hematology/Oncology, National Center for
2

Cancer Care and Research (NCCCR), Associate Professor in

Received: 16 March 2018; Accepted: 08 April 2018
Clinical Medicine, Weil Cornell Medical College, Qatar.

Citation: Hawro Hamza, Kakil Rasul. The Epidemiology of Colorectal Cancer in Erbil. Cancer Sci Res. 2018; 1(2); 1-6.

ABSTRACT
Background and Objectives: Colorectal cancer (CRC) is a major cause of morbidity and cancer related mortality
throughout the world. It is the third most common cancer worldwide and the fourth most common cause of cancer-
related death. The objective of this study is to study the epidemiology of colorectal cancer in Erbil city.

Methods: Retrospective analysis of the data from registry units in Rizgary Oncology Center and Nanakaly Cancer
Hospital in Erbil during the period of Jan – Dec 2016.

Results: Data of total 118 patients collected, 55.08% of patients were male and 44.92% were female with a male to
female ratio of approximately "1.22:1". The highest number of patients was in the age range of 60-69 years. Left
side tumors were more common, 77.12% of patients. The presence of 41.53% of the patients in stage III makes that
stage majority. The most common histopathological type was adenocarcinoma NOS, 90.68%. Overall one-year
survival was 77.1%. The one-year survival of rectal tumors is 66%.

Conclusions: The study concluded that the male to female ratio is "1.22:1". The highest number of patients was
in the age range of 60-69 years. The percentage of patients below the age of 40 years was 20.51%. The left side
tumors were 77% while right side tumors were 23%. The majority of the patients were in stage III and IV, 67%. The
most common histopathological type was adenocarcinoma NOS, 90.68%. Overall one-year survival was 77.1%.
Rectal tumors had the worst one-year survival, 66% only.

Keywords cases diagnosed annually which accounts for nearly 10% of all
Colorectal cancer, Colon cancer, Rectal cancer, Epidemiology, incident cancers and mortality from CRC is estimated at about
Survival. 609,000 [4].

Introduction Age has an impact on CRC incidence being greater than all
Colorectal cancer (CRC) is a major cause of morbidity and cancer other demographic factors. Therefore, sporadic CRC increases
related mortality throughout the world [1]. It is the third most significantly above the age of 45 years for all groups. Colorectal
common cancer worldwide and the fourth most common cause of cancer is generally believed to be a disease of older people, as
cancer-related death [2]. more than 90% of patients being diagnosed above the age 55
years [5]. In Western countries, about 2%-8% of all CRCs occur
Colorectal cancer is the third most common cancer in men (746,000 in young age (< 40 year-old) patients [6-10]. By contrast, many
cases, 10.0% of the total) and the second in women (614,000 cases, studies have revealed that 15%-35% of CRCs in Middle-Eastern
9.2% of the total) worldwide. Almost 55% of the cases occur in countries occur in young age patients [11,12]. These observations
more developed regions [3]. led some authors to suggest a difference in genetic susceptibility
to cancer to interpret this wide different proportion of CRC among
Globally, it is believed that approximately 1,200,000 new CRC Middle-eastern and Western countries.
Cancer Sci Res, 2018 Volume 1 | Issue 2 | 1 of 6
A study that using data from the Surveillance Epidemiology and Patients and Methods
End Results (SEER) program found an increasing incidence of Retrospective analysis of the data that is being collected from
CRC over the last 20 years in patients aged 20 to 49. The most registry units in Rizgary Oncology Center and Nanakaly Cancer
significant rise was in the age group 40 to 44 where colon and Hospital, which are the only public cancer centers in the Erbil city
rectal cancers raised 56% and 94%, respectively. Depending on during the period Jan 2016 – Dec 2016. All hospital medical records
the findings and the fact that CRC leans to be more aggressive that contain history and physical examination, histopathology
in younger patients, the authors recommended the colonoscopic reports, imaging reports, endoscopy reports, and treatments
age-based screening for average risk patients beginning at the age received by histologically proven colorectal cancer patients have
of 40 [13]. been taken. The needed information was taken from the records,
and the patients or their relatives were contacted by phone if any
In nearly all countries, age-standardized incidence rates are less data was missing or incomplete.
for women than for men. CRC is 25% more likely to occur in men
than in women, and the rate is 20% higher in African Americans Results
compared with whites [14]. Data of total 118 patients collected, 55.08% (65) of patients were
male and 44.92% (53) were female with a male to female ratio of
Colonic carcinogenesis is thought to be a multifactorial process; approximately 1.22.
nevertheless, the direct etiology of CRC remains uncertain [15].
The patients' age ranged from 17 - 86 years, with the median age at
Nearly 20% of cases of CRC are associated with familial clustering, diagnosis of 54 years (mean age of approximately 53 years). The
and first-degree relatives of patients with colorectal adenomas highest number of patients was in the age range of 60-69 years (29
or invasive colorectal cancer are at increased risk for colorectal patients 24.79%) (Figure 1).
cancer [16-20].

Genetic susceptibility to colorectal cancer includes well-defined

inherited syndromes, such as Lynch syndrome (also known as
hereditary nonpolyposis colorectal cancer HNPCC) and familial
adenomatous polyposis (FAP) [21-23].

Approximately 5%-10% of CRC cases arise because of well-

recognized hereditary conditions; however, the vast majorities are
sporadic forms in subjects without family history or any apparent
predisposing conditions [24].

Epidemiological studies, in addition to familial tendency and the

influence of genetic susceptibility, have recognized environmental
Figure 1: Age Distribution.
risk factors that connected to an increased risk, including Western
dietary practices, alcohol consumption, smoking tobacco, and
The number of patients below the age of 40 years was 24 (20.51%).
physical activity [25-27].
The left side tumors were the most common, 91 (77.12%) of the
patients.
Dietary factors may affect the oncogenesis by modifying intestinal
transit time, altering the recycling and flow of bile, or changing
The majority of the patients were in stage III, 49 (41.53%) of the
the composition of intestinal bacterial flora. Increased body mass
patients (Figure 2).
index (BMI), and central obesity are emergent risk factors for
colorectal cancer. The Framingham Study found that a BMI > 30
increases the risk of colon cancer by 1.5 fold among middle-aged
(30 - 54 year individuals) and by 2.4-fold for individuals aged 55
- 79 years [28].

Objectives
The epidemiology of colorectal cancer is not well studied in many
of the developing countries. The objective of this study is to know
the epidemiology and the pathological pattern of colorectal cancer
patients in Erbil city, to compare the local data with the regional
and global data, to collect demographic and anatomic pathology
data, and to find the effect of well-known risk factors on these
patients.
Cancer Sci Res, 2018 Volume 1 | Issue 2 | 2 of 6
Figure 2: Stage Distribution. Overall one-year survival was 77.1% and one-year survival for
stages I, II, III and IV were 76.9%, 85.7%, 79.6% and 64.3%
The most common histopathological type was adenocarcinoma respectively (Table 1).
NOS, 107 (90.68%) of the patients.
The most common histologic grade was grade II, 88 (74.58%) of Rectal tumors had the worst one-year survival (66% only)
the patients (Figure 3). accounting for about 64.3% of CRC deaths in one-year duration
(Table 2).

Discussion
During the period of Jan – Dec 2016, data of 118 patients collected,
there is a slight male predominance, 55.08% (65) of patients were
male and 44.92% (53) were female with a male to female ratio of
approximately "1.22:1". This is nearly consistent with the previous
studies and cancer data registries in Qatar (58% vs 42% and M:F
1.4:1) [29], Jordan (57.5% vs 42.5% and M:F 1.35:1) [30], Iran
(54.9% vs 44% and M:F 1.24:1) [31], Croatia (57.3% vs 42.7%
and M:F 1.34:1) [32], UK (M:F 1.27:1) [33], (M:F 1.2:1) [34],
(55% vs 45% and M:F 1.2:1) [35], Canada (51.9% vs 48.1% and
M:F 1.08:1) [36] and US (46 vs 35.1/100.000 and M:F 1.31:1) [37].
Figure 3: Grade Distribution.

Status
Alive Dead Unknown
Count Row N % Column N % Count Row N % Column N % Count Row N % Column N %
I 10 76.9% 11.0% 3 23.1% 21.4% 0 0.0% 0.0%
II 24 85.7% 26.4% 2 7.1% 14.3% 2 7.1% 15.4%
Stage
III 39 79.6% 42.9% 6 12.2% 42.9% 4 8.2% 30.8%
IV 18 64.3% 19.8% 3 10.7% 21.4% 7 25.0% 53.8%
All Stages 91 77.1% 100% 14 11.9% 100% 13 11.0% 100%
Table 1: Survival According to the Stage.

Status
Location Alive Dead Unknown
Count Row N % Column N % Count Row N % Column N % Count Row N % Column N %
Ascending 16 94.1% 17.6% 1 5.9% 7.1% 0 0.0% 0.0%
Transverse 5 100% 5.5% 0 0.0% 0.0% 0 0.0% 0.0%
Descending 7 77.8% 7.7% 1 11.1% 7.1% 1 11.1% 7.7%
Sigmoid 16 88.9% 17.6% 1 5.6% 7.1% 1 5.6% 7.7%
Colon NOS 3 100% 3.3% 0 0.0% 0.0% 0 0.0% 0.0%
Rectosigmoid 11 78.6% 12.1% 2 14.3% 14.3% 1 7.1% 7.7%
Rectum 33 66.0% 36.3% 9 18.0% 64.3% 8 16.0% 61.5%
CRC NOS 0 0.0% 0.0% 0 0.0% 0.0% 2 100% 15.4%
Table 2: Survival According to the Location of Tumor.
The patients' age ranged from 17 - 86 years, with mean age of 53 The highest number of patients was in the age range of 60-69
years. This is lower than the other studies and cancer data registries years (29 patients 24.79%) (Figure 1) which is consistent with the
in Qatar (age range 33 – 83 years, mean age 57.1 years) [29], (age other studies in Qatar [29], Croatia [32], Taiwan [39], lower by
range 31 – 80 years, median age 62 years) [38], Iran (median age about a decade in comparison with other studies and cancer data
57 years) [31], Croatia (mean age 65.3 years) [32], UK (mean age registries in UK [34,35], Canada [36] and France [41], but higher
70 years) [33], US (median age 67 years) [37], Taiwan (mean age by a decade in comparison with the other studies and cancer data
62 years) [39], Austria (mean age 67 years and median age 69 registries in Qatar [38] and Egypt [42].
years) [40], but slightly higher than a Jordanian study (age range
14 – 81 years, mean age 49) [30]. The number of patients under the age of 40 was 24 (20.51%)
Cancer Sci Res, 2018 Volume 1 | Issue 2 | 3 of 6
(Figure 3). This is a bit comparable with the other studies in the accurate especially for the patients that are clinically staged or
neighboring countries (Qatar 20% [29], Iran 17% [31], Jordan received neoadjuvant treatment. Some variables that included in
20.2% [43] and Saudi Arabia 23% [44]). However, it is more than the questionnaire could not be analyzed because of incomplete
twice or thrice in comparison to the other studies in some other histopathological reports that did not mention all recommended
Asian countries (Taiwan 6.2% [39], Singapore 5.1% [45] and information especially molecular studies like MMR, RAS and
Japan 10% [46]), and three to five times higher than studies done BRAF studies due to lack of advanced laboratory services. Finally,
in Europe (France 3% [41], Georgia 8.6% [47], Italy 4.2% [48] not all patients might be registered in these two public centers
and Sweden 2.5% [49]), New Zealand 5.5% [44] and USA 6% during that period, since there are private sectors that manage
[50]. The number is much less than other studies in Egypt 38% cancer patients.
[42] and India 38% [51]. The increasing proportion of young age
CRC cases recorded in Iraq, and many regional and neighboring Conclusions
countries, may be due to the young age-structure of these countries. The study concluded that the male to female ratio is "1.22:1". The
highest number of patients was in the age range of 60-69 years.
The left side tumors were the most common, 91 (77.12%) of the The percentage of patients below the age of 40 years was 20.51%.
patients which is consistent with the other study in Qatar (79.5%) The left side tumors were 77% while right side tumors were 23%.
[29], but less than other studies and cancer data registries in UK The majority of the patients were in stage III and IV, 67%. The
(69%) [35], Austria (64.7%) [40], and US (50%) [52]. The majority most common histopathological type was adenocarcinoma NOS,
of the patients were in stage III, 49 (41.53%) of the patients (Figure 90.68%. Overall one-year survival was 77.1%. Rectal tumors had
2) which is higher than the other studies and cancer data registries the worst one-year survival, 66% only.
in Qatar (35.5%) [29] and (41%) [38], UK (26%) [34].
Acknowledgements
The histopathological types were adenocarcinoma NOS, signet Dr. Bestoon S. Hasan, MBChB, HD CO, for his support with some
ring carcinoma, and mucinous carcinoma, 107 (90.68%), 6 (5.08%) of the data…
and 5 (4.24%) of the patients, respectively. The adenocarcinoma
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