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  • br Statistical analysis of presenting symptoms revealed a si

    2019-09-25


    Statistical analysis of presenting symptoms revealed a sig-nificant inverse relationship between the frequency of rectal bleeding and the duration of symptoms before referral for colonoscopy, so that patients with rectal bleeding tend to present earlier for colonoscopy than do patients without rectal bleeding (p < 0.01).
    There was a significant association between tumor site and the presence of fresh rectal bleeding, so that patients with tumors in the rectosigmoid area tended to have bleeding per rectum more frequently than do patients with more proximal tumors (p < 0.01) this N-octanoyl-L-Homoserine lactone is illustrated in Fig. 4.
    Patients with left-sided (distal) tumors reported abdomi-nal pain less frequently compared to patients with right-sided (proximal) tumors (p < 0.05) Fig. 5. Also there was a signifi-cant correlation between the presence of weight loss and the tumor site, so that patients with distal tumors tend to report
    Weight
    Yes
    0% Rectum Descending Cecum Sigmoid Ascending
    Fig. 6 – Correlation between tumor site and frequency of weight loss.
    weight loss less frequently that do patients with more proxi-mal tumors (p < 0.05) as shown in Fig. 6.
    Discussion
    The mean age of the patients with a new diagnosis of CRC in this study is 55.7 years which is not much different from 51 years and 52.3 years found in studies in Egypt and Iran, respectively.16,17 About 16% of patients in this study were younger than 40 years old and 65% were older than 50 years. This represents a trend for CRC to occur in relatively younger age groups in comparison to studies in developed countries which reports 90% of cases occurring after the age of 50 years.4,5 However, several studies in Africa reported even a higher percentage (35%–42%) of cases below 40 years age group.17,18 The reason for the increasing incidence in young age groups may be genetic, thus underscoring the need to study the prevalence of HNPCC associated CRC in our popula-tion however recent study in USA demonstrated an increase in the incidence of rectal and rectosigmoid cancer in young
    patients aged (<40 years).19 On the other hand, anaphylaxis may be related to dietary factors since young adults tend to be more likely to eat a Westernized diet. In Iraq, there has been a shift from the traditional Iraqi diet, due to upsurge in the number of fast food outlets, and it has become fashionable particu-larly among the youths to eat these Westernized foods which is high in animal protein and fat.20 This study showed a 1:1 male-to-female ratio in our sample of CRC cases. Most studies in other countries showed also a similar gender distribution,21 although some have shown a slight male predominance with an M:F ratio between 1.1:1 and 1.6:1, as reported in two studies in Iran and Africa, respectively.16,22 In terms of anatomi-cal location within the large bowel, this study concurs with other studies which have indicated that the majority of CRCs are located in the distal part of the colon,22–27 however, we reported a higher figure, of 58%, for rectal tumors compared to other studies and the classic literature, which report a rate of rectal cancer between 20% and 29% of all colorectal adenocarcinomas.28,29 It has been reported that the proportion of tumors beyond the reach of the sigmoidoscope increases with age and that sub site distribution also can differ according to race.30 This may partly explain the higher percentage of rec-tal tumors in this study where the younger-than-40 age group represented 16% of all CRC cases compared to the literature values of less than 10%.30,31 A study in Nigeria found a similar high rate for rectosigmoid tumors compared to other subsites but they attributed their findings to the endoscopic practice in the region in which the majority of patients are offered sig-moidoscopy rather than total colonoscopy.28 This is not the case in our center where all patients have total colonoscopy unless this is technically not possible due to N-octanoyl-L-Homoserine lactone luminal obstruc-tion by the tumor mass. In this study we concluded that in our country the CRC occurs in relatively younger age groups in comparison to the developed countries with rectal cancer predominates of all colorectal cancers.