Primary large intestinal malignant neoplasm: A clinicopathological comparative study

N Rajesh Kumar^1*, Komala H M²

¹Associate Professor, ²Assistant Professor, Department of Pathology, Annapoorna Medical college and Hospital, NH 47, Sankari road, Serangapadi, Salem, INDIA.

Email: rajeshprnatesan@gmail.com, way2drjomal@gmail.com

Abstract         Objectives: The aim of the study is to determine the clinico-pathological features of primary colorectal malignant tumors and comparison with earlier studies. Materials and Methods: 92 patients with primary colorectal tumors diagnosed over a 5 year period studied clinically and histopathologically they were classified using the WHO classification of colorectal malignancies. primary gastrointestinal tumors Diagnosis. Result: 92 patients (30.6%) were colorectal malignancies arising out of 300 primary gastrointestinal malignancies, with a female to male ratio of 1 : 1.5. Majority were males, majority were non vegetarians and most of the males were alcoholics and smokers. The mean age of the male patients was 53 years with age varying from 21 –84 years, while for females, the mean age was 58 years, ranging from 17-68 years. Abdomen pain and altered bowl habits was the most common presenting symptom (60%), and the most common primary site was rectum 43 (46.7%), followed by anal canal 17 (18.4%). Most of the colorectal tumors were polypoidal 45(48.9%), followed by ulcerative 34(36.9%) and annular constricting 13(14.2%) and adenocarcinoma was the common histological type. Conclusion: Primary large bowel malignancy constitute about 30.6% of all gastricintestinal malignancies males commonly affected (1.5:1) and more common in alcoholics and non vegetatrians. Abdomen pain and altered bowel habits was the common presenting symptom, polypoidal growth 46.9%, followed by ulcerative type 36.9% and annular constricting growth 14.2% is common gross presentation (67.7 %). Common site involved is rectum 46.7%. Adenocarcinoma 81.5 was the common histological type followed by squamous cell carcinoma 6.5%.

Keywords: Primary large bowel malignancy, colorectal carcinomas.

INTRODUCTION

Colon cancer is the fourth common cancer in males and females and the second most frequent cause of death¹. The incidence of bowel cancer is related to economic development, and no other form of cancer is so closely linked to the alterations on dietary habits with which this is usually associated ². Virtually 98% of all cancers in the large intestine are ade­nocarcinomas. They represent one of the prime challenges to the medical profession, because they usually arise in polyps and produce symptoms relatively early and at a stage generally curable by resection. Yet, there are an estimated 148,300 new cases per year and about 56,600 deaths, accounting for 10% of all cancer-related deaths in the United States³. The peak incidence for colorectal carcinoma is between ages 60 and 79. Fewer than 20% of cases occur before age 50. Colorectal carcinomas in young persons are usually associated with ulcerative colitis or one of the polyposis syndromes. With lesions in the rectum, the male-to-female ratio is 1.2:1; for more proximal tumors there is no gender difference. Colorectal carcinoma has a worldwide distribution, with the highest death rates in the United States, Australia, New Zealand, and Eastern European countries. Its incidence is substantially lower-up to 10 fold-in Mexico, South America, and Africa. Environmental factors, particularly dietary practices, are implicated in these striking geographic contrasts in incidence. Japanese and Polish families that have migrated from their low-risk areas to the United States have acquired, over the course of 20 years, the rate prevailing in the new environment. Both groups, for the most part, adopted the common dietary practices of the U.S. population. Other studies implicate obesity and physical inactivity as risk factors for colon cancer³.

MATERIALS AND METHODS

A total of 300 patients with gastrointestinal tumors out of which 92 large bowel malignant tumors diagnosed at Tertiary Care Hospital in Tamil Nadu, India over a period of 5 years till may 2016 were studied and medical records of all the patients were reviewed. The clinical, the data on large bowel tumors was analyzed with respect to age, sex and site incidence, clinical presentations, gross and histological information was recorded in a structured questionnaire form. The laboratory and radiological work- up done. The demographics, clinical presentation and associated syndromes, the lab investigations and computed tomography (CT), magnetic resonance imaging (MRI) and endoscopy findings were collected. The immunohistochemical profile and special stains was performed were ever indicated.

OBSERVATION AND RESULTS

Site of origin of malignancies in large intestine

In the large intestine, rectum (46.7%) was the maximum involved site; next in order were anal canal (18.4%), caecum (8.69%), sigmoid colon (7.6%), hepatic flexure (5.4%), Ascending colon (4.34%), splenic flexure (2.17%), rectosigmoid (2.17%), anorectum (2.17%) transverse colon (1%) descending colon (1%). There was male preponderance in rectum, sigmoid colon, caecum, ascending colon, and hepatic flexure and female preponderance in transverse colon, splenic flexure and descending colon.

Table 1: Site of origin of malignancies in large intestine

Gross appearance of large intestine malignancies

Majority of malignant large intestinal tumors macroscopically presented as ulcerative (34%) or polypoidal growth (45%)and in minority of patients presented as annular constricting (14.3%)

Table 2: Gross appearance of large intestine malignancies

Incidence, age and sex wise distribution of various histological types of large intestine malignancies

Adenocarcinoma was the most common malignant tumor comprising 81.5% of all the large intestinal malignant tumors followed by squamous cell carcinoma (6.52%), two cases of Non Hodgkins lymphoma and two cases of malignant melanoma, one case each of mixed carcinoid adenocarcimoma, signet ring cell carcinoma and adenosquamous carcinoma. These commonly occurred in males. The youngest case was a 19 years old and the oldest case was 83 years old. Adenocarcinoma were common in 4^th, 5^th and 6^th decades and there was high male predominance.

Table 3: Incidence and sex wise distribution of various histological types of large intestine malignancies

Table 4: Incidence, age and sex wise distribution of various histological types of large intestinal malignancies

DISCUSSION

In the present study of gastrointestinal malignancies, maximum incidence was observed in stomach (50.6%) followed by large intestine (30.6%), esophagus (15%) and small intestine (3.6%) while esophagus (42%) followed by stomach (24%) and intestine (34%) was most commonly involved in the earlier study⁴. An overall male preponderance among malignancies of GI tract, and female preponderance among small intestine malignancies observed in the present series is similar to available reports⁴. The peak incidence in 6^th decade and the mean age of 52.7 years observed in the present study also correlates with the earlier studies⁴.

In the present study the median age was 52 years and male preponderance which is similar to reports by earlier workers^4,5,6,7,8. However higher median age with female preponderance was also reported⁹.[Table:5]

Table 5: Comparative analysis of age and sex incidence of large intestinal malignancies

In the large intestine, rectum (46.7%) was the most commonly involved site similar to earlier studies^4,9,6,8. [Table:6]

CONCLUSION

The current study showed 15% esophageal of the gastrointestinal malignancies, stomach is the commonest site followed by large intestine, esophagus, and small intestine in decreasing order of frequency. Primary large bowel malignancy constitute about 30.6% of all gastrointestinal malignancies males commonly affected (1.5:1) and more common in alcoholics and non vegetatrians. Abdomen pain and altered bowel habits was the common presenting symptom, polypoidal growth 46.9%, followed by ulcerative type 36.9% and annular constricting growth 14.2% is common gross presentation (67.7 %). Common site involved is rectum 46.7%. Adenocarcinoma 81.5 was the common histological type followed by squamous cell carcinoma 6.5%.

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