Colorectal adenocarcinoma in Uganda: are right-sided and left-sided colon cancers two distinct disease entities?

Richard Wismayer; Julius Kiwanuka; Henry Wabinga; Michael Odida

doi:10.1186/s12957-023-03094-7

Colorectal adenocarcinoma in Uganda: are right-sided and left-sided colon cancers two distinct disease entities?

World J Surg Oncol. 2023 Jul 22;21(1):215. doi: 10.1186/s12957-023-03094-7.

Authors

Richard Wismayer^{1

2

3}, Julius Kiwanuka⁴, Henry Wabinga⁵, Michael Odida^{5

6}

Affiliations

¹ Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda. richardwismayer@chs.mak.ac.ug.
² Department of Surgery, Habib Medical School, IUIU University, Kampala, Uganda. richardwismayer@chs.mak.ac.ug.
³ Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda. richardwismayer@chs.mak.ac.ug.
⁴ Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
⁵ Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
⁶ Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

Abstract

Introduction: In Western countries, right-sided colon cancers (RSCC) present at an older age and advanced stage. Researchers believe that there is a difference between left-sided colon cancer (LSCC) and RSCC. In Uganda, however, it is unknown whether differences exist in the pathological profile between RSCC and LSCC. The aim of this study was to determine the differences in clinicopathological characteristics between RSCC and LSCC in Ugandan patients.

Methodology: A cross-sectional study was conducted in which colorectal adenocarcinoma formalin-fixed paraffin-embedded tissue (FFPE) blocks were obtained from 2008 to 2021. Colorectal specimens were obtained from prospectively recruited patients. In the retrospective study arm, FFPE blocks and data were obtained from the archives of pathology laboratory repositories. Parameters studied included age, sex, location of the tumour, grade, stage, lymphovascular (LVI) status, and histopathological subtype between LSCC and RSCC.

Results: Patients with RSCC were not older than those with LSCC (mean age, 56.3 years vs 53.5 years; p = 0.170). There was no difference in the stage between RSCC and LSCC. Poorly differentiated tumours were more commonly found in RSCC than in LSCC (18.7% vs 10.1%; p = 0.038). Moderately and poorly differentiated colonic tumours were more common with RSCC (89.3%) than with LSCC (75.1%) (p = 0.007). Younger patients had more poorly differentiated tumours than older patients (19.6% versus 8.6%; p = 0.002). LVI was more common with RSCC than with LSCC (96.8% vs 85.3%; p = 0.014). Mucinous adenocarcinoma (MAC) was more common with RSCC (15.8%) compared with LSCC (8.5%) (p = 0.056) although statistical significance was borderline.

Conclusions: Clinicopathological features of RSCCs tend to be different from those of LSCCs. RSCCs tend to be associated with MAC, a higher grade and LVI status compared to LSCC. LSCC and RSCC present predominantly with an advanced stage; therefore, national screening programmes for the early detection of CRC are necessary to reduce mortality in our Ugandan population.

Keywords: Colorectal adenocarcinoma; Grade; Left-sided colon cancer; Lymphovascular invasion (LVI); Right-sided colon cancer; Stage.

MeSH terms

Adenocarcinoma* / epidemiology
Colonic Diseases*
Colonic Neoplasms* / epidemiology
Colorectal Neoplasms* / epidemiology
Cross-Sectional Studies
Humans
Middle Aged
Retrospective Studies
Uganda / epidemiology