Data from patients with CRC diagnosis treated in Braga, Northern Portugal, between January 1 st and January 1 st was used to describe the distribution of colorectal carcinoma. The data was collected prospectively and includes: This data was organized in two Excel databases colon and rectal cancer.
Clinical and preoperative diagnostic examinations included: Tumour localization was recorded and classified as right sided caecum, ascending colon, hepatic flexure and transverse colon or left sided splenic flexure, descending colon, sigmoid colon and rectum between anal verge and 15 cm at rigid rectoscopy. Operative reports by surgeons, including presence of perforation, tumour mobility and type of surgery, were also collected.
All patients received antibiotic and thrombosis prophylaxis and all operations were performed by or under supervision of senior surgeons. An emergency surgery was defined as a surgery performed for obstruction or perforation of the colon or rectum. The histopathological reports included: The level of positive lymph nodes was not described in all specimens.
The histological type of CRC was determined by two experienced pathologists and tumour staging was graded according to TNM classification, sixth edition. All patients were followed up periodically and their outcomes were investigated and collected until July The study protocol was approved by the Ethics Committee of Braga Hospital. All patients provided written consent. All clinical, surgical and follow-up data was collected and stored in an Excel PC database and all data was analysed statistically using the Statistical Package for the Social Sciences, version Overall survival OS was defined as time from disease diagnosis until death from any cause and Survival free disease DFS was defined as time from disease diagnosis until disease relapse; both were assessed using the Kaplan-Meier method.
The casuistic included patients, Except for the group older than 81 years old, CRC incidence was more frequent in men Table 1. From overall patients, 4. Most of patients, Of the symptomatic patients, Among the patients, tumours In symptomatic patients, Other frequent symptoms observed were: Most cancers were left-colon, Diagnosis was made by total colonoscopy in Pre-operative colon biopsy revealed colon adenocarcinoma in Most patients with disseminated disease had hepatic metastasis, followed by lymph node metastasis.
Histological staging was determined by two experienced pathologists and tumour staging was graded according to TNM classification, sixth edition American Joint Committee on Cancer. In the majority of patients Of the patients examined, Most patients, Although no specific marker of lymphatic or hematogenous vessels was used, we documented that patients A total of patients Follow-up time ranged between 2 and 7 years; Stage IIIB was the stage most frequently associated with tumour recurrence.
Most metastasis occurred in liver, followed by lymph node and lung. Local recurrence occurred in nine cases. Most metastasis and recurrence was asymptomatic The remaining cases presented patients with abdominal pain 4. Most rectal cancer patients Of the rectal cancers, most In rectal cancer patients, diagnosis was made by total colonoscopy in Synchronous lesions were observed in Pre-operative biopsy revealed rectal adenocarcinoma in Of the patients, Pelvic magnetic resonance MR and rectal endoscopic ultrasound EUS were used in combination for local staging.
Post-operative histological staging was determined by two experienced pathologists and tumour staging was graded according to the TNM classification, sixth edition American Joint Committee on Cancer. Most patients with rectal cancer were stage IIA In 8 patients, post-operative histological stage was not determinate because the patients underwent surgery without resection ex. Most patients, 80 As previous mentioned, although no specific marker of lymphatic or hematogenous vessels was used, we documented that A total of 52 patients Follow-up time ranged from 2 to 7 years; Local recurrence occurred in nine patients.
Most patients with metastasis and recurrences In the case of symptomatic patients, the most frequent symptoms were a rectal mass 9. Overall survival OS was defined as time from disease diagnosis until death from any cause and Survival free disease DFS was defined as time from disease diagnosis until disease relapse; both were assessed using the Kaplan-Meier method Figures 1 and 2.
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When the patients were divided into two groups by location-colon and rectum-no significant difference was found between the survival rates of the colon cancer group and rectal cancer group; this was assessed using the logrank test Figure 3. Comparison between colon and rectum cancer survival assessed by log-rank test. CRC epidemiological data abounds in the worldwide literature, but in the case of the Portuguese population, this data is scarce and the existing studies are retrospective studies based in cancer registries but with little data that allows the characterization of the affected population.
In the developed world, CRC represents a major public health problem [ 18 ]. In Portugal, it is the second most frequent cancer and the second cause of death by cancer [ 14 , 16 ] and, although CRC epidemiological data abounds in the worldwide literature, this data is scarce for the Portuguese population. Braga Hospital, in the North of Portugal, has a reference area of , patients, but no epidemiological data exists in literature. Thus, we designed this prospective study to characterize the patients treated at this hospital, comparing with others of high incidence population studies.
In this study, most of the patients , Except for the group older than 81 years old, CRC incidence was more frequent in men. Similar results to the ones of the present study were found in literature and the Portuguese Cancer Registry, with CRC being more frequent at advanced age and in men. The last results about Portuguese population document that CRC is more frequent in men, although when observing separately colon and rectal cancer, we found that colon cancer is slightly more frequent in women Similar results were observed in epidemiological Brazilian data [ 19 , 20 ].
Advanced age is the most significant risk factor for diagnosis of CRC, which is defined as a disease of elderly people, with the majority of cases arising after years of age and with an incidence relatively lower under 40 years of age. Early onset of CRC is assumed to be indicative of genetic susceptibility [ 22 ], often associated with a positive family history [ 28 ]. In some studies, such younger patients presented more advanced disease and more aggressive tumour grades at diagnosis and had less favourable prognosis [ 26 - 29 ]. Prevalence of advanced colorectal neoplasms increases with age and is higher among men than women [ 18 , 25 , 29 - 31 ].
Cross-sectional analyses estimated that men reach an equivalent prevalence at a much younger age than women [ 30 ]. Age range regarding number of deaths for prostate, bronchial and lung cancers was higher among those aged 60 to 69 years. Number of deaths for breast, uterine and ovarian cancer was higher among those aged 50 to 59 years.
Women diagnosed with breast cancer in the analyzed period lost, on average, 9 years of life. Data presented in this study enabled to affirm that south region concentrated the highest national incidence of hospital register for cancer with high mortality rate in the studied period. Among analyzed markers, hospital cancer registers used as basis for our study are important to measure relevance of this disease in public health because they represent assistances yearly for each type of cancer in one or more institutions and it can enable calculation of incidence of any cancer.
For this reason, it is important to highlight that prostate cancer, breast cancer, bronchial cancer, and lung cancer have higher mortality rates in Brazil, and high rate can be observed in south of the country. Aspects related to weakness of Brazilian system in cancer prevention, it diagnosis in advanced phase cases, population's habits and precarious life conditions, difficult to access health system and get screening 11 can affect the observed numbers. Southern Brazilian population has a good socioeconomic development profile that positively reflect prevention and early treatment of diseases.
Age seems to be the main risk factor for cancer because of increase in life expectation followed by increase of chronic-degenerative diseases such as cancer. Southern Region is highlighted because it presents better life expectations than the rest of the country throughout the years, and this represents an important fact to explain increased incidence of cancers registered in the study. This fact explain, e.
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Cancers that were most common among men, we observed high number of prostate cancer records within this population in the studied period, although the predominance of European descent individuals. Southern Region has predominance of Caucasian population and prostate cancer has a higher incidence among African-descent individuals.
This suggests that other regional factors, besides age, may influence high prevalence of this neoplasia in studied population with active investigation of prostate cancer by screening exams. Despite high incidence and high mortality rates by prostate cancer are relatively low compared with other types of cancers, 14 mainly because this entails a relatively aggressive cancer.
In bronchial and lung cancer the high number of registers and deaths can be closed correlated with smoking, mainly because this region has the highest prevalence of smokers in the country. Regarding cancer among women, the prevalence of smoking in the region is still an important risk factor to increase incidence of gynecology cancers, such as uterine cancer.
Age of ovarian cancer diagnosis ranged from These findings suggest possible existence of family heritage about one in each 10 cases of women with ovarian cancer that present standard that gives susceptibility for early occurrence of hereditary breast and ovarian cancer syndrome. In this sense, we observed in Rio Grande do Sul a high prevalence of breast cancer among young women.
In this situation, this neoplasia is presented as aggressive disease of difficult treatment, 22 which explain the high mortality rate observed after 50 years. Other indicators analyzed regarding mortality, the number of productive years of life lost, is an indicator that reflect total sum of years of potential life lost.
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For this reason, a residue of this tobacco use is expected in more advanced age ranges, especially among men. Great number of years of life lost for ovarian cancer is because of this disease aggressiveness and also because it is discovered in more advanced phases, which results in extremely low survival rate.
On the other hand, in uterine cancer, we observed low rate of years of potential life lost compared with prostate cancer, breast cancer, and bronchial and lung cancer. This finding emphasizes the importance of oncological care programs in Brazil to promote women health that massive investments occurred since to implement a national oncological care plan.
Prostate cancer had a reduced impact on years of potential life lost compared with cancer of high incidence in south region.
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The number of years of life lost by men can have an important relationship with extended survival of patients with prostate cancer that can achieve up to 5 years after diagnosis and treatment. Based on mean life expectancy of Brazilian population that in was considered around 75 years old, we can affirm that almost one fifth of total years of individual's life is lost when people had suffered neoplasias such as bronchial and lung cancer.
There is also the socioeconomic impact because of productive years of life lost, especially in cases of uterine cancer, because this latter is a potentially avoidable cancer. Our data suggest that these significant losses of productive years in Southern Region is a negative socioeconomic impact to Brazil. Both incidence and mortality of cancer are still high in Brazil with significant number of registers and deaths compare with worldwide rates. There is no agreement between number of hospital-based cancer registers and number of deaths because of cancer considering that, in some years, the register is lower than number of deaths.
In addition, we observed a great number of death because of uterine cancer in south Brazil. National Center for Biotechnology Information , U.
Journal List Einstein Sao Paulo v. Published online Apr 6. Author information Article notes Copyright and License information Disclaimer. Received Feb 13; Accepted Aug 4. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Methods This was a critical review of literature based on analysis of data concerning incidence and mortality of prostate cancer, breast cancer, bronchial and lung cancer, and uterine and ovarian cancer.
Results The southern Brazil is the leading region of cancer incidence and mortality. Conclusion Both cancer incidence and the mortality are high in Brazil. Open in a separate window. Estimated number of cancer cases selected by study in population of south Brazil in Table 1 Hospital-registers and deaths for cancer according to primary site incidence and categorization by States.
Table 2 Mortality, crude, adjusted rates by cancer per age, world and Brazilian population from per , men and women, according to primary site of men and women incidence. Mean potential years of life lost for cancer Estimation for breast cancer, uterine and ovarian cancer that was calculated for each 1, women and, for lung and prostate cancer, for each 1, inhabitants of south region between and from premise that high limit would be 80 years. World Cancer Report The individual and combined effects of obesity and type 2 diabetes on cancer predisposition and survival.
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Disparities in cervical and breast cancer mortality in Brazil. Universidade Federal do Rio Grande do Sul; The influence of nutritional risk factors in the development of breast cancer in outpatients from the countryside of Rio Grande do Sul, Brazil. Rio de Janeiro RJ: Aspects related to delay in diagnosis and treatment of breast cancer in a hospital in Pernambuco. Mortalidade por cancer no Brasil Rev Assoc Med Bras. Morbi-mortality by cancer in Recife in the 90s.
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Knowledge, attitudes and practices regarding the detection of prostate cancer. Quinn M, Babb P. Patterns and trends in prostate cancer incidence, survival, prevalence and mortality.
Lung cancer, cancer of the trachea, and bronchial cancer: Tobacco smoking and cancer in Brazil: