Modern Management of Colorectal Cancer

Colorectal cancer affects approximately 1:20 of the population and in South Africa is largely managed by general surgeons. Management of this disease has undergone very significant changes over the last two decades. Until very recently; only two academic general surgery departments included a specialist colorectal unit; and this remains so in the majority of our universities. This has resulted in a generation of surgical graduates who are unfamiliar with; and unskilled in current best management practices for this disease. Rectal cancer is particular challenging and attracts extremely high morbidity and mortality; with poor oncological outcomes. Repeatedly; outcome has been shown to be worse in the hands of generalists; rather than specialist colorectal surgeons; of whom there are very few in the country. This review presents the most important advances of the last 20 years and highlights current controversies and frontiers

Colorectal carcinoma in Port Harcourt

Background: Colorectal carcinoma, the commonest malignant tumour of the gastrointestinal tract, is rather uncommon in Nigeria, occurring often at a relatively early age. Aim: To report experience with colorectal carcinoma in the University of Port Harcourt Teaching Hospital (UPTH). Methodology: Patients treated for colorectal cancer at the UPTH over a 19- year period (1987-2006) and had complete information, were studied. Data were collected from patients/' case notes, ward registers, theatre records and histopathology reports. The data were analyzed with respect to age, gender, clinical features and investigations. Other indices studied were treatment, postoperative complications, duration of hospital stay and outcome/mortality. Results: The records of 36 cases were available for study. Male to female ratio was 2:1. The 41-60 year age range recorded the highest number of cases (52.8%). Weight loss, change in bowel habit, rectal bleeding, and abdominal/rectal mass constituted the main symptoms. Diagnosis was made from clinical examination, double contrast barium enema and proctosigmoidoscopy/biopsy. The rectum and caecum/ascending colon were commonly affected. The appropriate surgical treatment was duly performed. Some patients had postoperative adjuvant treatment using 5-fluorouracil only. Postoperative complications included surgical site infection, persistent perineal discharge, perineal pain, and obstruction of colostomy, hepatic encephalopathy and obstructive uropathy. The average duration of hospital stay was 12 days and follow-up assessment ranged from 3 months to 14 years. The postoperative mortality at three years was high. Conclusion: Colorectal carcinoma is relatively uncommon in our environment. The younger age groups tend to be more affected. Late presentation resulted in poor survival in spite of surgical treatment and adjuvant therapy