Detection rate of colorectal adenoma or cancer in unselected colonoscopy patients: Indonesian experience in a private hospital.

Aru W Sudoyo,Levina S Pakasi,C Rinaldi A Lesmana,Lidwina Cahyadinata,Laurentius A Lesmana,Ening Krisnuhoni

doi:10.7314/apjcp.2014.15.22.9801

Abstract

Colorectal cancer is currently the third most common cancer in Indonesia, yet colonoscopy--the most accepted mode of screening to date--is not done routinely and national data are still lacking. To determine the detection rate of colorectal cancers and adenomas in unselected patients undergoing colonoscopy for various large bowel symptoms at the Digestive Disease and GI Oncology Centre, Medistra Hospital in Jakarta, Indonesia. Colonoscopy data from January 2009 to December 2012 were reviewed. New patients referred for colonoscopy were included. Data collected were patient demographic and significant colonoscopy findings such as the presence of hemorrhoids, colonic polyps, colonic diverticula, inflammation, and tumor mass. Histopathological data were obtained for specimens taken by biopsy. Associations between categorical variables were analyzed using chi-square test, while mean differences were tested using the t-test. A total of, 1659 cases were included in this study, 889 (53.6%) of them being men. Polyps or masses were found in 495 (29.8%) patients while malignancy was confirmed in 74 (4.5%). Patients with a polyp or mass were significantly older (60.2 vs 50.8 years; p<0.001; t-test) and their presence was significantly associated with male gender (35.0% vs 23.9%; prevalent ratio [PR] 1.71; 95% confidence interval [CI] 1.38-2.12; p<0.001) and age>50 years (39.6% vs 16.6%; PR 3.29; 95% CI 2.59-4.12; p<0.001). Neoplastic lesions was found in 257 (16.1%), comprising 180 (11.3%) adenomas, 10 (0.6%) in situ carcinomas, and 67 (4.2%) carcinomas. Polyps or masses were found in 30% of colonoscopy patients and malignancies in 16.1%. These figures do not represent the nation-wide demographic status of colorectal cancer, but may reflect a potentially increasing major health problem with colorectal cancer in Indonesia.

Highlights

In Indonesia, colorectal cancer has in the last few decades become the third most common cancer in the country after lung and breast cancer, with a mortality of 18.958 patients (Globocan 2012), mostly thought to be influenced by several risk factors i.e., dietary changes and tobacco smoking
As most colorectal cancers are believed to arise from precancerous polyps or adenomas (Lengauer et al, 1998), basically an epithelial neoplasm with malignant potential, taking 5-10 years for the adenoma to progress into invasive cancer, the removal thereof by endoscopic polypectomy is supposed to eliminate or lower occurrence of colorectal cancer (Winawer et al, 1993)
Many countries in the world neither recommend nor will their governments pay for screening colonoscopy

Summary

Introduction

In Indonesia, colorectal cancer has in the last few decades become the third most common cancer in the country after lung and breast cancer, with a mortality of 18.958 patients (Globocan 2012), mostly thought to be influenced by several risk factors i.e., dietary changes and tobacco smoking. Based on the Vienna classification, high-grade adenomas category 4 or 5.1 is indicated for curable resection (Schlemper et al, 2000), colonoscopy is an accepted method for colorectal cancer screening worldwide (Whitlock et al, 2008). Colorectal cancer is currently the third most common cancer in Indonesia, yet colonoscopy - the most accepted mode of screening to date - is not done routinely and national data are still lacking. Conclusions: Polyps or masses were found in 30% of colonoscopy patients and malignancies in 16.1%. These figures do not represent the nation-wide demographic status of colorectal cancer, but may reflect a potentially increasing major health problem with colorectal cancer in Indonesia

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