Anatomical subsite and diagnostic implications of colorectal cancer in zaria (Guinea savannah)-1981-2005.

Objective: To study the clinicopathological characteristics of Colorectal Cancer (CRC) in the Guinea Savannah region; identify sub site; ascertain any change in the anatomical sub-site between 1981-2005; relate tumour stage/differentiation, to age young =40 years and = 41years old patients Highlight option for diagnosis in the sub region.

Setting: There were 262 patients consisting of 125 retrospective and 137 prospective cases seen in the premier tertiary health institution in Northern Nigeria.

Results: The Male:Female ratio = 1.37:1, mean age 39.8 years, cluster age group 3rd-6th decade( 82.1%), patients = 40years constituted 48.2% . Main clinical features present for more than 6 months were bloody mucus discharge (83.5%), palpable rectal mass (67.9%), pain (67%), tenesmus (60.1%). Ignorance of the disease was rife amongst non-specialists, spiritualists and the patients. The left colon was eleven times more commonly affected than the right colon. The rectum was the commonest sub site (74.3%). In 2 out of every 3 patients, the tumour was digitally palpable per rectum. There was no shift in the distribution sub site in (1981-1990), and (1991-2005). 97.2% the tumours were adenocarcinoma. 68.9% patients had advanced disease Duke C or D. 3 out of every 4 patients (= 40 years age group) had advanced disease. Histological prognostic grade of tumour was inversely related to =40 years age group. Routine digital rectal examination as an investigative armamentarium,and public awareness may reduce the prevalence of advanced CRC in the low resource subregion,we advocate their use.