According to estimates from the World Health Organisation (WHO) in 2019,(1) cancer is the

first or second leading cause of death before the age of 70 years in 112 of 183 countries and
ranks third or fourth in a further 23 countries. In the 19th century, stomach cancer was one of
the major causes of cancer-related death. The situation changed in the 20th century in
high-income countries after an improvement in the socioeconomic status of the populations
and the introduction of antibiotics. However, stomach cancer is still an important cause of
death in many countries. Stomach cancers, often referred to as gastric cancers, are mostly
gastric adenocarcinomas. They are classified according to stage (early or advanced),
anatomical location (in the proximal or distal part of the stomach), and histological subtype.
The 2010 WHO classification of gastric cancer specifies five main histological subtypes:
tubular, papillary, mucinous, poorly cohesive (including signet ring cell carcinoma), and
mixed. Tubular, papillary, and mucinous adenocarcinomas correspond to the intestinal type
described by Laurén in 1965, and poorly cohesive carcinomas correspond to the diffuse type
of Laurén (Table 5.4.1). Although both the intestinal and diffuse types of gastric cancer are
related mainly to H. pylori infection, the intestinal type is often related to environmental
factors, diet, and lifestyle, and the diffuse type is more often associated with genetic
abnormalities. The molecular profiles of gastric cancer were recently identified and classified
by the Cancer Genome Atlas (TCGA) Research Network and the Asian Cancer Research
Group (ACRG). (2)
Colorectal cancer tends to occur more frequently in men than in women, although the
male-to-female ratio decreases from 1.6 in countries with high SDI to 1.0 in countries with
low SDI.((3))

Epidemiology
The incidence of gastric cancer is still high, and it is the third most common cause of cancer
death worldwide, responsible for an estimated 783 000 deaths in 2018.((1))
Colon cancer is the second leading cause of cancer-related deaths worldwide. In
2020, more than 1.9 million new cases of colorectal cancer and more than 930 000
deaths due to colorectal cancer were estimated to have occurred worldwide. Large
geographical variations in incidence and mortality rates were observed.

AIMS AND OBJECTIVES:

1. To assess the level of awareness and knowledge on risk factors, early signs and
symptoms, prevention and treatment of gastric and colon cancers in India,
among the adult population of urban and rural areas.
2. To find out the association between sociodemographic variables and their
knowledge of gastric and colon cancers.

MATERIAL AND METHODS:

A Facility based cross-sectional study was conducted among men and women of age
18-65 years attending OPD in Urban Primary Health Centre Sanathnagar, ESI Hospital
Jeedimetla and ESI Hospital Ramachandrapuram of Hyderabad, during September 2022,
regarding knowledge of risk factors, symptoms, prevention and treatment of gastric and
colorectal cancers. Without a pre-interview education, using simple random sampling
310 adults (152 from urban and 158 from rural areas) including attendees, were
interviewed for 5-7 minutes each, through a questionnaire framed based on previous
studies on gastric and colon cancers, which was pretested on 3 women and 2 men
attending OPD and was modified accordingly. The purpose of the study was explained
and informed consent was obtained through Google Forms. The questions were read out
to the participants in their local language and their responses were recorded on the
Google forms by the interviewers. Cancer patients, pregnant women, and people coming
to OPD with acute conditions were excluded from the study. The questionnaire contains
10 sections namely consent form, socio-demographic details, common questions on
cancer knowledge, questions on knowledge of gastric cancer and colorectal cancer,
screening and treatment for respective cancers. Socio-demographic details include
name, age, gender, religion, education status, marital status, occupation, per capita
income, locality, and addictions. Questions on knowledge of cancers include risk factors,
signs and symptoms, prevention and treatment.

Scores and cut-off values for knowledge?

The collected data was analysed based on their demographic details, such as numbers
and percentages using MS Excel. Chi-square test for categorical data, T-test for
comparison and continuous data and SPSS software version 26 for calculation of P value
were used.

No intervention was made post-data collection.

OBSERVATION AND RESULTS

SOCIODEMOGRAPHIC DETAILS

Rural (158)

Variables Males (89) Females (69) Total (158) P value

Age group 0.9

( in years ) (P > 0.05)

<20 3(3.4%) 4(5.8%) 7(4.4%)

21-30 24(27%) 18(26%) 42(26.5%)

31-40 30 (33.7%) 22(31.9%) 52(32.9%)

41-50 18 (20.2%) 15(21.7%) 33(20.9%)

 51-60 09 (10.1%) 8(11.6%) 17(10.8%)

60+ 05(5.6%) 02(2.9%) 07(4.4%)

Religion 0.39

(P > 0.05)

Hindu 77 (86.52%) 55 (79.7%) 132 (83.5%)

Christian 06 (6.74%) 09(13.0%) 15 (9.5%)

Muslim 06 (6.74%) 05 (7.2%) 11 (6.9%)

Educational 0.05
status
(P > 0.05)

Illiterate 11 (12.4%) 19 (27.5%) 30 (19.0%)

Elementary 01 (1.1%) 04 (5.8%) 05 (3.2%)

Lower primary 06 (6.7%) 09 (13.0%) 15 (9.5%)

Upper secondary 39 (43.8%) 24 (34.8%) 63 (39.9%)

University or 34 (38.2%) 13 (18.9%) 47 (29.8%)

college

Marital status 0.00

(P < 0.05)

Married 62 (69.7%) 58 (84.0%) 120 (76.0%)

Unmarried 27 (30.3%) 03 (4.3%) 30 (19.0%)

Widow 00 (0) 08 (12.0%) 08 (5.0%)

Separated 00 (0) 00 (0) 00 (0)

Occupation Statistics
could not be
applied

Professional 04 (4.5%) 00 (0) 04 (2.5%)

Semi professional 02 (2.2%) 05 (7.2%) 07 (4.4%)

Skilled 24 (27%) 04 (5.8%) 28 (17.7%)

Semi-skilled 14 (15.73%) 00 (0) 14 (8.9%)

Unskilled 35 (39.33%) 23 (33.4%) 58 (36.7%)

Unemployed 10 (11.24%) 37 (53.6%) 47 (29.7%)

0.2

Per capita (P > 0.05)

income

Per month

(In Rs.)

500-1000 00 (0) 01 (1.4%) 01 (0.6%)

1000-10,000 75 (84.3%) 62 (89.8%) 137 (86.7%)

10,000-20,000 14 (15.7%) 06 (8.7%) 20 (12.6%)

Ration card 0.13

(P > 0.05)

Pink 06 (6.74%) 05 (7.2%) 11 (7.0%)

White 63 (70.8%) 58 (84.0%) 121 (76.6%)

None 18 (20.22%) 05 (7.2%) 23 (14.5%)

Not aware 02 (2.24%) 01 (1.4%) 03 (1.95%)

Urban (152)
Variable Male (95) Female(57) Total (152) P value

Age group 0.72

( in years ) (P > 0.05)

<20 06 (6.3%) 03(5.3%) 09 (5.92%)

 21-30 26 (27.3%) 15(26.3%) 41 (26.97%)

31-40 26 (27.3%) 17(29.8%) 43 (28.29%)

41-50 23 (24.2%) 17(29.8%) 40 (26.32%)

51-60 09 (9.5%) 04(7.02) 13 (8.55%)

60+ 05 (5.3%) 01(1.75) 06 (3.95%)

Religion 0.78

(P > 0.05)

Hindu 79 (83.1%) 44(77.19%) 123 (80.92%)

Christian 06 (6.3%) 01(1.75%) 07 (4.61%)

Muslim 10 (10.52) 12(21.05) 22 (14.47%)

Educational
status

Illiterate 25 ( 26.3%) 19(33.33%) 44 (28.95%)

Elementary 03 (3.15%) 02(3.51%) 05 (3.29%)

Lower primary 09 (9.47%) 05(8.7%) 14 (9.21%)

Upper 31 (32.6%) 21(36.84%) 52 (34.21%)

secondary

University or 27 (28.4%) 10(17.54%) 37 (24.34%)

college

Marital status

Married 80 (84.2%) 51(89.4) 131 (86.18%)

Unmarried 15 (15.7%) 06(10.5%) 21 (13.82%)

Window 00 (0%) 00(0%) 00

Separated 00 (0%) 00(0%) 00

Occupation
 Professional 06 (6.31) 0 (0%)

Semi-professio 00 (0%) 3 (5.26%)

nal

Skilled 22 (23.1%) 1 (1.75%) 23 (15.13%)

Semi skilled 25 (26.3%) 4 (7.02%) 29 (19.08%)

Unskilled 29 (30.5%) 10 (17.54%) 39 (25.66%)

Unemployed 12 (12.63%) 39 (68.42%) 51 (33.55%)

Per capita
income

Per month

(In Rs.)

500-1000 01 (1.05%) 2(3.51%) 03 (1.97%)

1000-10,000 83 (87.3%) 51(89.4%) 134 (88.16%)

10,000-20,000 11 (11.5%) 02(3.51%) 13 (8.55%)

20000+ 00(0) 02(3.51) 02 (1.32%)

Ration card

Pink 04 (4.21%) 05(8.77%) 09 (5.92%)

White 70 (73.6%) 40(70.1%) 110 (72.37%)

None 20 (21.05%) 10(17.54%) 30 (19.74%)

Not aware 01 (1.05%) 02(3.51%) 03 (1.97%)

Variable Yes No Total P
value

1) Have you heard of colorectal

cancer?
- Rural 21 68 89 0.15
Male 10 59 69 (>0.0
Female 5)
- Urban
Male 13 82 95 0.20
Female 4 53 57 (>0.0
5)

Male Female

Rural Urban P Rural Urba P

VARIABLE Value n value

2) What are the risk factors for

colorectal cancer?
- Family history
Yes
11 13 0.06 11 11 0.8
No 05 00 (>0.05 02 01 (>0.0
Don’t know 73 82 ) 56 45 5)

- Previous history of bowel

disease
Yes
09 93 0.000 04 01 0.28
No 01 00 01 00 01 (>0.0
Don’t know 79 02 (<0.05 65 55 5)
)
- Diabetes Mellitus type 2
Yes 07 01 0.05 02 01 0.6
No 02 01 (>0.05 01 00 (>0.0
80 95 ) 66 56 5)
Don’t know
- Obesity
Yes 12 10 0.44 04 05 0.8
No 03 01 (>0.05 00 00 (>0.0
Don’t know 74 84 ) 65 52 5)

- Older age > 50 years

Yes 11 09 0.04(< 04 04 0.9
No 05 00 0.05) 01 01 (>0.0
Don’t know 73 86 64 52 5)
- Excess red and processed
meat consumption
Yes 0.01
No 09 01 (<0.05 02 01 0.69
Don’t know 05 03 ) 01 02 (>0.0
75 91 66 54 5)
- High-fat diet 0.06
Yes 12 07 (>0.05 03 04 0.7
No 03 00 ) 01 01 (>0.0
Don’t know 74 88 65 52 5)

- Low fibre diet ( vegetables and

fruits)
0.19
Yes 08 07 (>0.05 04 01 0.39(
No 05 01 ) 01 02 >0.05
Don’t know 76 87 64 54 )
- Smoking
Yes 0.21
19 13 (>0.05 10 09 0.97
No
01 00 ) 00 00 (>0.0
Don’t know 69 82 59 48 5)
- Alcohol 0.08
Yes 21 12 (>0.05 09 09 0.90
No 01 00 ) 00 00 (>0.0
Don’t know 67 83 60 48 5)

- Lack of physical activity

0.47
Yes 13 11 (>0.05 04 06 0.61
No 01 00 ) 01 01 (>0.0
Don’t know 75 84 64 50 5)
- Male gender
Yes 0.42
07 05 (>0.05 03 00 0.27
No
03 01 ) 01 01 (>0.0
Don’t know 79 89 65 56 50

3) What are the symptoms of

colorectal cancer?
- Change in bowel habits (
new onset diarrhoea or 0.65
constipation) (>0.0
Yes 13 07 0.08 05 02 5)
No 02 00 (>0.05 01 01
 Don’t know 74 88 ) 63 54

- Blood in stools 0.91

Yes 15 11 0.33 08 08 (>0.0
01 00 (>0.05 00 00 5)
No
73 84 0 61 49
Don’t know

- Bleeding back passage 0.20

Yes 11 02 0.007 05 02 (>0.0
No 02 00 (<0.05 00 02 5)
Don’t know 76 93 ) 64 53

- Pain in the back passage 0.42

Yes 09 04 0.16 06 03 (>0.0
No 01 00 (>0.05 00 01 5)
Don’t know 79 91 ) 63 53

- Incomplete or no
emptying of bowel 0.11
Yes 09 02 0.02 05 01 (>0.0
No 02 00 (<0.05 00 02 5)
Don’t know 78 93 ) 64 54

- Chronic pain in the

abdomen
0.54
Yes 17 08 0.03 06 05 (>0.5
No 02 00 (<0.05 00 01 0)
Don’t know 70 87 ) 63 51

- Lump in the abdomen

Yes 0.23
16 10 0.27 05 08 (>0.0
No 02 01 (>0.05 00 01 5)
Don’t know 71 84 ) 64 48

- Feeling of abdominal
fullness 0.54
Yes 15 09 0.25 05 04 (>0.0
02 01 (>0.05 00 01 5)
No
72 85 ) 64 52
Don’t know
 - Bloating 0.13 0.11
Yes 15 07 (>0.05 05 01 (>0.0
No 02 03 ) 00 02 5)
Don’t know 72 85 64 54

- Nausea/vomiting
0.11
Yes 13 07 0.22 05 01 (>0.0
No 02 01 (>0.05 00 02 5)
Don’t know 74 87 ) 64 54

- Loss of appetite 0.24

Yes 18 10 0.056 06 09 (>0.0
02 00 (>0.05 00 01 5)
No 69 85 ) 63 47
Don’t know

- Unexplained weight loss 0.07 0.62

Yes 17 10 (>0.05 07 09 (>0.0
No 02 00 ) 01 01 5)
70 85 61 47
Don’t know

- Persistent unexplained
tiredness 0.14 0.09
Yes 15 10 (>0.05 04 09 (>0.0
No 02 00 0 00 01 5)
Don’t know 72 85 65 47

VARIABLE YES NO TOTAL p value

1. Have you heard of gastric cancer?

- Rural
Male 30 59 89
Female 26 43 68

- Urban
Male
Female
 Male Female

VARIABLE Rural Urban p Rural Urban p

Value Value
1. RISK FACTORS

- Family history
Yes 20 23 20 15
No 06 1 02 0
Don’t 63 70 47 42
know
- Alcohol drinking
Yes 25 23 24 15
No 2 1 0 0
Don’t 62 70 45 42
know
- Smoking
Yes 25 21 21 15
2 2 0 0
No
62 71 48 42
Don’t
know

- H. Pylori infection
Yes 10 2 4 1
No 2 2 0 1
Don’t 76 90 65 55
know

- Stomach ulcer
Yes 18 10 12 3
No 1 1 0 0
70 83 57 54
Don’t
know
- Stress 3
Yes 11 7 9 1
No 8 2 2 53
Don’t 70 85 58
know

- Old Age
Yes 15 11 10 6
No 8 3 2 1
Don’t 66 80 57 50
know
- Smoked Foods 10 11 4 2
Yes 8 2 1 1
No 71 81 64 54
Don’t
know
- Stomach Surgery 10 1 4 1
Yes 7 6 3 0
No 72 87 62 56
Don’t
know
- Pickled Foods
5 4 7 1
Yes
10 3 2 3
No
74 87 60 53
Don’t
know
- Male Sex 5 5 1 0
Yes 6 2 2 1
No 78 87 66 56
Don’t
know
2. WARNING
SYMPTOMS
- Gastrointestinal bleeding
Yes 26 19 20 11
No 0 2 1 0
63 73 48 46
Don’t
know
- Nausea Vomiting 22 16 11 4
Yes 4 3 0 1
No 63 75 58 52
Don’t
know
- Abdominal Lump
Yes 25 24 23 12
No 1 1 0 0
Don’t 63 69 46 45
Know
- Weight loss 27 23 19 12
Yes 2 2 0 0
No 60 69 50 45
Don’t
know
- Abdominal pain
Yes 27 24 19 11
No 2 1 1 0
Don’t 60 69 49 46
know
- Early satiety 19 17 10 6
Yes 5 2 2 0
No 65 75 57 51
 Don’t
know

DISCUSSION

CONCLUSION

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LIMITATIONS: