Colorectal Cancer

USTH Endoscopy Unit

ARE WE EFFECTIVE IN
SCREENING?
NINO BENJAMIN D. LIMJOCO
First Year GI FELLOW
 BACKGROUND
According to the 2018 Global Cancer Statistics, colorectal cancer ranks
third in terms of incidence and second in terms of mortality with over
1.8 million new colorectal cancer cases and 881,000 deaths estimated
to occur in 2018. 
The five year survival rate of CRC:
• In developed countries =65 %.
• In the Philippines = 40%. Bray, F. et al. Global cancer statistics 2018:
GLOBOCAN estimates of incidence and
mortality worldwide for 36 cancers in 185
countries.
 BACKGROUND
Colorectal cancer (CRC) is an increasingly prevalent malignancy in the
Philippines.
According to the 2010 Philippine Cancer Facts and Estimates it is the
most common cancer of the gastrointestinal tract.

JDS et al The Joint Philippine Society of

Gastroenterology (PSG) and Philippine Society of
Digestive Endoscopy (PSDE) Consensus Guidelines on
the Management of Colorectal Carcinoma
 BACKGROUND
In the 2015 Cancer Facts and Estimates,
Colorectal Cancer : 3rd for both sexes (9%)
4th among males (11%)
3rd among females (7%).
9,625 new cases in both sexes

Laudico, A. et al. 2015 Philippine Cancer

Facts and Estimates. Philippine Cancer
Society, Manila 2015.
 BACKGROUND
Increases at 50 years (males and females) then a steady increase from
1980 to 2007, with an annual change of 1.3% for both males and
females

Laudico, A. et al. 2015 Philippine Cancer Facts and

Estimates. Philippine Cancer Society, Manila 2015.
 BACKGROUND
Thus, it is often thought of as a disease of the elderly, which makes
screening limited to these set of patients. However a significant
proportion of patients 40 years old and younger present with this
disease.

Chang, R. L. et al, Colorectal Cancer in the Young: a

Five-year review of Cases. PJSS Vol. 58, No.1,
January to March 2003
 Colorectal Cancer in the young
(JRRMMH) 2003
32 colon cancer & 41 rectal cancer patients : < 40 years old
• Right sided colon lesions
• Distal third in location of rectal cancer .
• Aggressive tumors
• Advanced lesions on surgery.

Chang, R. L. et al, Colorectal Cancer in the Young: a Five-year

review of Cases. PJSS Vol. 58, No.1, January to March 2003.
Philippine General Hospital 2008
(unpublished)
20 percent of patients showed that the most common location of the
tumor was the rectum.
Adenocarcinomas (76%).
Mostly stage 3B at diagnosis (70%)
Majority were smokers (52%), occasional alcoholic beverage drinkers
(35%), overweight (48%), predominantly meat diet (78%), and with no
family history of cancer (88%).
The most common initial presentation was hematochezia (36%).
Ang, E et al. CLINICODEMOGRAPHIC PROFILE OF
COLORECTAL CANCER IN THE YOUNG: ITS
IMPLICATIONS IN CLINICAL PRACTICE (2008)
AUFMC (2018) unpublished (Colorectal
Cancer in the Young)
• Males
• Hematochezia
• (+) Family history of Colon or Rectal cancer
• Left Sided Lesions
• STAGE 3B
• Moderately Differentiated Adenocarcinoma

NDL et al Characteristics and Risk Factors of Colorectal

Carcinoma in the Young at Angeles University Foundation
Medical Center from July 2013 to June 2018
 BACKGROUND
The natural history CRC presents a unique opportunity for early
intervention because the colon is accessible to examinations which
enable early identification and efficient removal of precursor
premalignant and/or early malignant lesions.
 SIGNIFICANCE
• This study aims to update current local data on colorectal carcinoma
to guide clinicians in better care of our patients (e.g., earlier
surveillance for early detection of cancer)
 OBJECTIVES
• To determine the demographics and clinical characteristics of patients
with colorectal carcinoma at UST
• To describe patients with colorectal carcinoma in terms of
• Demographics
• Baseline Characteristics
• Clinical Presentation
• Clinical Stage
 Patients with Colon Cancer who underwent Colonoscopy
6

5 4.8
4.62
4.4
% of Patients with Colon Cancer

4.29 4.29
4.04 4.15
4.01
4 3.85

0
2010 2011 2012 2013 2014 2015 2016 2017 2018
Year

57/ 56/ 56/ 51/ 48/ 55/ 53/ 57/ 54/

1130 1387 1273 1063 1248 1324 1236 1421 1170
 Number of Patients by Gender
40

36
35
34 34

30 30 30 30
29
27 27
26
Number of Patients

25 25
24 24
23 23
22 22
21
20
18
15

11
10

5 Number of Patients by Gender

0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Year

Male Female
 Number of Patients by Age
40

36
35 35
34
31
30
29 29
28 28
26
Number of Patients

25

20
19
18 18
15 15
14
13
12
11 11
10 10
9
8 8
7 7 7
6 6
5 5
4
3 3 3 3
2
1 1 1
0 0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Year

Less or Equal to 40 41-50 51-60 61 and Above

 Number of Patients by Presenting Symptom
30 Weight Loss Diarrhea Constipation Anemia Screening
Surveillance Hematochezia Abdominal Pain Change in Stool Caliber Abdominal Mass
FIT + Melena 26
25 24
Number of Patients

23

20
20 19

15
13 13

10 10
10 9
8
7
6
5 5
5 4 4 4 4
3 3 3 3 3 3 3 3
2 2 2 2 2 2 2 2 2 2
1 1 1 1 11 1 1 1 1
0
2010 2011 2012 2013 2014
Year
 Number of Patients by Presenting Symptom
30 Weight Loss Diarrhea Constipation Anemia Screening
27 Surveillance Hematochezia Abdominal Pain Change in Stool Caliber Abdominal Mass
FIT + Melena
25 24
Number of Patients

22

20
17

15
12
11
10
10 9
7 7 7
6 6
5 5 5 5 5
5 4 4 4 4 4 4 4 4
3 3 3
2 2 2 2
1 1 1 1 1 1 1 1 1
0
0
2015 2016 2017 2018 2019
Year
 50.00% TUMOR LOCATION
46.43%
45.00% 44.68%
41.82% 42.59%
41.51%
40.00% 39.29% 39.62%
36.84%
38% 36.84%
37.93%
35.00% 34.55%
33.33% 33.33%
32% 31.91%
31.03%
30.00% 30.36% 30%
Percent of Patients

29.82% 29.82% 29.63%

27.78%
26.79%
25.00%
23.40% 23.64%

20.00%
18.87%

15.00%

10.00% Left Right Rectum

5.00%

0.00%
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Year
Left 19 26 17 19 11 19 22 19 23 9
Right 17 15 17 15 15 13 10 17 16 9
Rectum 21 15 22 16 21 23 21 21 15 11
Total 57 56 56 50 47 55 53 57 54 29
 Tumor Location in Patients Less than 50y/o
80.00%

75.00% 75.00%

70.00%
66.67%
62.50%
60.00%

53.33% 54.55%
50.00%
Percentage of Patients 45.45%
44.44%
42.86% 42.86%
40.00%
36.36%
33.33% 33.33%
30.00%
28.57%
27.27%
25.00% 25.00% 25.00% 25.00%
22.22%
20.00%
18.18% 18.18%
13.33% 14.29%
12.50%
10.00%
8.33%

0.00% 0.00% 0.00%

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Year

Left 2 3 1 4 3 4 3 2 2 1
Right 8 6 3 2 1 4 1 4 1 0
Rectum 5 2 8 3 3 6 0 5 5 3
Total 15 11 12 9 7 14 4 11 8 4
 Tumor Location in Patients more than 50 y/o, by Staging
60.00%

51.11%
50.00%

45.00% 45.65%
42.86%
41.46%
40.48%
40.00%
38.10% 38.78%
Percentage of Patients

36.36% 36.59% 36.59% 36.96% 36.00%

35.00% 34.78%
31.82% 31.71% 32.61% 32.00%
30.00%
28.89% 28.26%

21.43% 21.95% 21.74%

20.00% 20.00% 20.00%
18.37%

10.00%

0.00%
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Left 17 23 16 15 8 15 19 17 21 8
Right 9 9 14 13 14 9 9 13 15 9
Rectum 16 13 14 19 18 17 21 16 10 8
Total 42 45 44 41 40 41 49 46 46 25
 60.00% TUMOR LOCATION (SYNCHRONOUS)
52.63% 52.63%
50.00%
50.00% 50.00% 50% 50%

44.00%
41.67%
40.00%
38.46%
Percent of Patients

35.71%
33.33%
32.00% 31.82% 31.58%
30.00%
27.78% 28.57% 27.78%
26.32% 25.00% 25.00%
24.00% 23.08%
22.22% 21.05% 22.22%
20.00%
18.18%
15.79%

10.00%
Left Right Rectum

0.00%
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Year
Left 5 11 7 10 3 10 5 8 5 3
Right 4 6 11 5 5 3 4 10 9 6
Rectum 9 8 4 4 5 6 5 6 4 3
Total 18 25 22 19 13 19 14 24 18 12
 Tumor Location (Synchronous) in Patients less than 50y/o
120.00%

Left Right Rectum

100.00% 100.00% 100.00% 100.00%

Percentage of Patients 80.00%

66.67%
60.00%

50.00% 50.00% 50.00%

40.00%
33.33% 33.33%

25.00% 25.00%
20.00%

0.00%
0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Year

Left 1 1 0 1 0 2 0 1 0 0
Right 1 1 1 0 0 1 1 2 0 0
Rectum 0 1 2 0 0 1 0 1 2 0
Total 2 3 3 1 0 4 1 4 2 0
 Tumor Location (Synchronous) in Patients more than 50 y/o, by Staging
60.00%

56.25% 56.25%

52.63% 53.33%
50.00% 50.00% 50.00%

45.45%

40.00% 40.00%
38.46% 38.46%
36.84%
Percentage of Patients 35.00%
33.33%
31.82% 31.25%
30.00%
27.78%
25.00% 25.00% 25.00%
22.73% 23.08% 23.08%
22.22%
20.00%
18.75%

13.33% 12.50%
10.00% 10.53%

0.00%
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Left 4 10 7 9 3 8 5 7 5 3
Right 3 5 10 5 5 2 3 8 9 6
Rectum 9 7 2 4 5 5 5 5 2 3
Total 16 22 19 18 13 15 13 20 16 12
 Number of Cancer Patients by Stage
23 5% 5%

20
19
18
17

15 15
Number of Patients

13
12 12

89
9 9
8 8 8 8 8
47%

6 6

3 3 3
2 2 2 2
1 1 1 1 1 1 1 1
0 0 0 0 0 0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
-2

Axis Title Stage 1 Stage 2 Stage 3 Stage 4

 Number of Cancer Patients less than 50 y/o, by Staging 5% 3%

5 5 5

44

34%
33 3 3

1 1 1 1 1 1 1 1

00 0 0 0 0 0 0 0 0 0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 58%

-1

-2
Stage 1 Stage 2 Stage 3 Stage 4
Stage 1 Stage 2 Stage 3 Stage 4
 Number of Cancer Patients more than 50 y/o, by 5% 5%
Staging
18
17
1616

14 14

12 12
11
10
9 9
8 8 8 45%
7 7 7 45%
6
5 5
4 4
3 3
2 2 2 2
1 1 1 1 1 1 1
00 0 0 0 0 0 0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
-2
Stage 1 Stage 2 Stage 3 Stage 4
Stage 1 Stage 2 Stage 3 Stage 4
Incomplete/ Unfinished Data
• Family History :
• Stage At the time of Diagnosis (3A):
• Histopath :
• BMI: