Colorectal carcinoma in Ibadan, Nigeria: a 20-year survey--1971 to 1990.

Background/aims: Five hundred and four (504) cases of histologically proven adenocarcinoma of the large bowel were seen in the University College Hospital, Ibadan, between 1971 and 1990. The rise in incidence predicted by the writers in the seventies is confirmed but it is feared that the economic depression may make alternative medicine attractive and turn patients away from the hospitals. The sex ratio has approached that seen in the West but the average age incidence has not changed.

Methodology: One hundred and forty-one (141) case notes were available for critical evaluation.

Results: These case notes show that patients still present rather late and some still find the idea of terminal colostomy sufficiently repugnant to refuse surgery. This disease is no respecter of persons and the clinical features are in no way different from those already recorded. Most of the colonic tumors are located on the right side of the colon. This has been the pattern in the African population--a phenomenon now reported frequently in the West.

Conclusions: The colon/rectum ratio has been reversed in favor of the rectum but unfortunately, this has not had a positive influence in early presentation and diagnosis. The "silent majority" on the right side of the colon can only add to the problem of late presentation. A plea is, therefore, made for adeq-uate investigations of 40 years old and above presenting with vague pain in the right iliac fossa and/or features of hemorrhoids which may herald carcinoma on the right and left, respectively.