Colorectal Cancer In Egypt Research Articles

Colonoscopy screening for colorectal cancer in Egypt: a nationwide cross-sectional study

BackgroundCurrent guidelines advocate for colorectal cancer (CRC) screening in adults who are at risk by using direct visualization methods such as colonoscopy. However, in Egypt, there is a paucity of data regarding the current practice of colonoscopy screening. Moreover, more information is needed about the knowledge and attitudes of potential participants regarding the procedure and possible barriers that can limit their participation.MethodsWe conducted a nationwide cross-sectional study using an interview-based survey of patients aged 45 years or above who presented to outpatient clinics of nine university hospitals throughout Egypt. Participants were surveyed to assess their compliance with CRC colonoscopy screening guidelines, their knowledge of and attitude towards colonoscopy screening, and their perspective on potential barriers to colonoscopy screening.ResultsA total of 1,453 participants responded to our survey in the nine study centers. Only a minority of participants (2.3%) were referred for CRC screening. Referral rates were higher among those who knew someone with a history of CRC (5.3% vs 1.5%, p < 0.001) or had a discussion with their physician about CRC (25.8% vs 0.7%, p < 0.001). Few responders (3.2%) had good knowledge regarding CRC screening. After introducing the concept of CRC screening to all participants, most patients (66.7%) showed a positive attitude towards having the procedure. Financial burden and fear of results were the two most frequently cited barriers to undergoing CRC screening (81.1%; and 60.1%, respecteively).ConclusionsDespite the positive attitude, there is insufficient knowledge about CRC screening among eligible participants in Egypt. This has probably contributed to low compliance with current CRC screening guidelines and needs to be addressed at the national level.

A Comparative Study of Epidemiology, Clinicopathologic Features and Outcome of Colorectal Cancer Patients between Ain Shams University Hospitals and Luxor International Hospital

Abstract Background Colorectal cancer (CRC) is one of the leading causes of mortality and morbidity in the world. It is the third most common malignancy after lung &amp; breast and the fourth leading cause of cancer-related deaths worldwide, accounting for approximately 1,400,000 new cases and about 700,000 deaths worldwide. Objectives The aim of this retrospective study is to compare the epidemiology, clinicopathologic features, different treatment modalities and outcomes regarding disease free survival (DFS), progression free survival (PFS) &amp; overall survival (OS) of colorectal cancer disease between cases presented to Ain shams university hospital &amp; to Luxor international hospital in 3 consecutive years. Patients and Methods The study is retrospective comparative study. Clinical oncology department in Ain Shams University Hospital and Luxor International Hospital. The data Collected from January 2013 to December 2015. This study analyzed hospital records of patients who diagnosed with colorectal cancer (CRC) and allocated into two groups: Group A: CRC patients presented to Ain-Shams University Hospital from January 2013 to December 2015, group B: CRC patients presented to Luxor International Hospital from January 2013 to December 2015. Results There was no statistically significant difference regarding age parameter in LIH when compared to ASU, but the study was consistent with higher incidence in patients who were aged more than forty- accounted about 70.5% in all CRC cases. Cases less than 40 years old, in group A were 35.2%, while in Group B were 23.5%. Even there was no statistically significant difference but it may be attributable to more westernization in Lower Egypt. Other explanation may be due to decreased low socioeconomic status and different lifestyle factors in more developing region what increase risk of colorectal cancer. Among our cases, there is no statistically significant difference regarding gender between the two hospitals. Both sexes almost were affected equally, females appeared to be at a slightly higher risk of developing CRC cancer with current prevalence 1.3:1 in ASU group, and 1.1:1 in LIH group. Conclusion The need to increase awareness about CRC in Egypt especially upper Egypt, is recommended. An awareness campaign should be performed to promote detection of CRC at its earliest and most curable stage by recognizing early symptoms and enabling early referrals for colonoscopy. Those at higher risk should be offered more intensive surveillance. Similarity of the data from different centers suggests that this is the picture of colorectal cancer typical of Egypt.

Colorectal Cancer in Egypt: Clinical, Life-Style, and Socio-Demographic Risk Factors

Background: Colorectal cancer (CRC) is cancer of the colon and rectum. It arises from the mucosa that lining the colon, rectum or both. Aim of the work: Determination of the clinical, lifestyle, and socio-demographic risk factors of colorectal cancer in Egypt. Patients and Methods: A hospital-based, case-control study design was performed. 160 cases with CRC and 300 healthy subjects were recruited in this study. An endoscopic, radiological and pathological methods and clinical examinations had been done for the collection of data. Results: The most significant risk factors for medical and family were obesity, DM, bowel habit change, inflammatory bowel disease (IBD), precancerous colonic lesions, no NSAIDs use, no HRT use, cholecystectomy, and family history of CRC (ORs=2.12, 2.13, 1.97, 4.91, 5.46, 3.69, 6.3, 3.84, and 8.88; respectively). Conclusion: The most important risk factors of CRC were obesity, DM, IBD, precancerous colonic lesions, and family history of CRC. Risk factors of CRC are commonly controllable.

Study of Toll‑Like Receptor 4 Gene Polymorphisms in Colorectal Cancer: Correlation with Clinicopathological Features

ABSTRACT Polymorphisms of Toll-like receptor 4 (TLR4) as a key player in cell proliferation, apoptosis, and angiogenesis have been linked to colorectal cancer (CRC) in different populations. We aimed in this study to determine genetic associations of TLR4 variants with CRC progression in Egyptian patients. Genotype and allelic frequencies of Asp299Gly (rs4986790) and Thr399Ile (rs4986791) were compared between 127 CRC patients and 141 healthy Egyptians using restriction fragment length polymorphism, and were correlated to clinicopathological findings. Results revealed that the variant alleles (G of Asp299Gly) and (T of Thr399Ile) were significantly associated with CRC among Egyptians. Confirmed by haplotype analysis, AT and GT haplotypes were more frequent in CRC patients than controls with increased CRC odds (OR = 3.54 and 3.45, 95% CI = 1.48–8.48 and 1.09−10.83, respectively). In addition, the G allele of Asp299Gly SNP was observed to be significantly associated with progressive CRC, including stage IV (P = .001), grade III (P = .025), N2 lymph nodes (P = .020), and metastasis (P = .001). On the other hand, Thr399Ile variant did not show any association with tumor behavior. Taken together, we conclude a significant association of Asp299Gly and Thr399Ile variants with the risk of development of CRC in Egypt. Asp299Gly variant, but not the Thr399Ile variant, may serve as a biomarker of this disease progression in Egyptian population.

Immunohistochemical Expression of MMR Proteins with Clinicopathological Correlation in Colorectal Cancer in Egypt.

BACKGROUND:Microsatellite instability (MSI) is the genetic pathway underlying 15% of sporadic colorectal carcinoma (CRC) and hereditary non-polyposis CRC. MSI-H CRC has a distinct clinicopathological characteristic including excess mucin and signet ring component, proximal colon, Crohn’s like reaction, lymphocytic infiltration, and better survival.AIM:This research aims to screen Egyptian CRC patients for MSI status by IHC testing of expression of the MMR proteins in correlation to its clinicopathological features.MATERIAL AND METHODS:Immunohistochemistry study for mismatch repair proteins (MMR) was done on 115 cases of CRC. Their expressions were assessed and correlated to clinicopathological parameters in an attempt to obtain the most significant predictors of MSI.RESULTS:MSI (low and high) represents 67% of the study cases. The most frequent expression pattern was combined loss of MLH, and PMS2 (38% of MSI) followed by a combined loss of MSH2, and MSH6 (29% of MSI). There was significant correlation of expression pattern of MMR proteins with the laterality, lymphovascular emboli, perineural invasion, grade, T stage, N stage, signet ring component, tumor infiltrating lymphocyte, and peritumoral lesion (0.014, 0.035, 0.012, 0.033, 0.013, 0.000, 0.041, 0.012, and 0.009 respectively). Proximal location (right sided) and lower grade, higher nodal stage, and marked TIL were selected as predictors of MS-H CRC (0.005, 0.031, 0.025, and 0.000 respectively).CONCLUSION:All clinicopathological and histological parameters should be assessed in CRC for the sake of predicting MSI. The optimal approach to MSI evaluation is (IHC) assessment of MMR proteins.

Evaluation of one-stage management of left side cancer colon

Background: Colorectal cancer in Egypt remains a heavy burden as about 40% of cases occur in individuals under 40years of age. The one-stage resection and anastomosis surgery on the left colon due to carcinomas was lately proposed to be safely done. Aim of the work was to evaluate the immediate results of the one-stage resection and anastomosis surgery procedure for left colonic cancer patients and analyzing the relationship between occurrence of complications and clinico-pathological circumstances.Methods: This is a prospective clinical study included 20 patients with mean age 59.4years (70% males and 30% females) having left side cancer colon. All patients underwent history taking, clinical examination and one-stage resection and anastomosis surgery.Results: High percentage of leakage was noticed in females &gt;50years, in diabetics, adenocarcinoma and ischemic heart disease. The leakage rate increased in those who stayed more in the hospital and decreased with the intraoperative preparation. High death rate was noticed in females &gt;50years and in diabetic patients with ischemic heart disease, adenocarcinoma, and obstructed colon. The pre and intraoperative preparation decreased the risk of death. High percentage of wound infection was noticed in males &lt;50years and in diabetic patients with adenocarcinoma and obstructed colon. The risk of wound infection was increased in patients who received intraoperative preparation and who stayed a week or less in the hospital.Conclusions: The incidence of postoperative complications was sound within values generally reported in other studies. Nonetheless, more effort is required to determine risk factors for such postoperative complications to improve the long-term as well as short-term survival in colorectal cancer patients.

Colorectal cancer in Egypt is commoner in young people: Is this cause for alarm?

BackgroundColorectal cancer (CRC) is the third most common cancer worldwide after lung and breast cancers with two-thirds of all CRCs occurring in the more developed regions of the world. CRC affects men and women of all racial and ethnic groups, and is most often found in those aged 50years or older. AimThe aim of the study was to determine the prevalence of CRC among patients undergoing colonoscopy in Egypt. Materials and methodsThis was a descriptive cross-sectional hospital-based study. A total of 412 consecutive patients who underwent planned pancolonoscopy from January 2000 to January 2012 at our institution were assessed. All endoscopic examinations leading to a diagnosis of CRC were evaluated. The following parameters were analyzed: frequency of CRC, patient characteristics, indication for endoscopic examination, endoscopic findings, localization of CRC and histopathology. ResultsCRC was diagnosed in 57 patients (14% of all colonoscopies). Fifty-six percent were female. The mean age was 51±15years (age range: 16–80years). Twenty-five percent of cancers occurred in patients aged less than 40years. The most frequent indication for colonoscopy was rectal bleeding (39%). The most common colonoscopy finding was mass (96%). Sixty-eight percent of CRC were located in the left colon and rectum. Ninety-one percent of CRC were adenocarcinoma. ConclusionsCRC is not uncommon among Egyptian patients subjected to colonoscopy. There are relatively higher CRC rates in patients under 40years of age than reported in the West. This has implications relating to future epidemiological trends in Egypt. Physicians must have a greater awareness of the potential for CRC in young people in the Middle East.

Colorectal cancer in Egypt.

The aim of this study was to review the age distribution and pathology features of colorectal cancer in Egypt. A seven-year review (retrospective in first six years, prospective in the seventh) of all colorectal adenocarcinoma patients (N = 177; 104 males; mean age, 46; range, 19-74 years) presented to the Department of Surgery, Ain Shams University, was performed. Data from three other major hospitals throughout the country were retrieved and compared with Ain Shams data. Retrospective data were retrieved from patients' files and surgery and pathology records. Family history of colorectal cancer and other characteristic hereditary nonpolyposis colorectal cancer tumors was obtained prospectively in all patients. According to Ain Shams data, the disease had no predilection to a specific age group. Thirty-eight percent of the tumors occurred in patients aged less than 40 years, and only 15 percent of patients were aged above 60 years. None of the young patients fulfilled the Amsterdam criteria for hereditary nonpolyposis colorectal cancer. Seventy-five percent of tumors occurred in the left side, 3 percent were Dukes A, and 58 percent were Dukes C. Synchronous and metachronous tumors occurred in 2.8 and 4.5 percent of patients, respectively. Adenomas were present in 5.6 percent of patients and bilharziasis in 3.4 percent of resection specimens. Data from different centers were remarkably similar to Ain Shams results. Colorectal cancer in Egypt has no age predilection and more than one-third of tumors affects a young population. The high prevalence in young people can neither be explained on a hereditary basis nor can it be attributed to bilharziasis. The disease usually presents at an advanced stage, and predisposing adenomas are rare. Similarity of the data from different centers suggests that this is the picture of colorectal cancer typical of Egypt.

Familial aggregation of colorectal cancer in Egypt is not related to HNPCC

Familial aggregation of colorectal cancer in Egypt is not related to HNPCC

Familial aggregation of colorectal cancer in Egypt is not related to HNPCC

Familial aggregation of colorectal cancer in Egypt is not related to HNPCC

Oxidative DNA damage and aromatic DNA adducts in patients with colorectal cancer in Egypt

Oxidative DNA damage and aromatic DNA adducts in patients with colorectal cancer in Egypt

Polymorphism of glutathione S-transferase loci GSTM1 and GSTT1 and susceptibility to colorectal cancer in Egypt

Egypt has an unusually high proportion of early-onset colorectal cancer under age 40 years. Environmental exposures and low DNA repair capacity are among the risk factors. Because GSTM1 and GSTT1 gene deficiencies may act as risk modifiers for colorectal cancer risk, we investigated the relationship between genetic polymorphism in these genes and colorectal cancer risk in Egyptians. Sixty-six patients and 55 controls were included. Genotyping for GSTM1 and GSTT1 was conducted using PCR techniques and the results were related to epidemiologic and clinical information. No overall association was observed between GSTM1 or GSTT1 null genotypes and colorectal cancer risk. However, the data suggest a possible role for GSTM1 genotype in influencing tumor site. Furthermore, GSTM1 and GSTT1 genotypes, in conjunction with gender and place of residence, may play a role in modifying disease risk. Further studies on a larger population in Egypt are needed to generalize the results of this study.

Familial aggregation of colorectal cancer in Egypt.

We have investigated the familial aggregation of colorectal cancer and hereditary nonpolyposis colorectal cancer (HNPCC) in Egypt because of the high incidence of colorectal cancer in Egyptian children and young adults and the prevalence of consanguinity there. In a pilot study, we conducted detailed interviews with 111 Egyptian colorectal cancer patients and 111 healthy Egyptian controls about their family histories of colorectal cancer, and other cancers, consanguinity, age at diagnosis, symptoms and recurrence. Eight patients (7.2%) had one or more first- or second-degree relatives under age 40 with colorectal cancer, suggestive of HNPCC by the Amsterdam criteria. One of these families had a typical history of HNPCC, with 4 relatives having colorectal cancer in 3 generations; 3 of these relatives were younger than age 45 at colon cancer diagnosis, and other relatives had extracolonic tumors. Another 14 patients (12.6%) had a first- or second-degree relative with a family history of other neoplasms such as endometrial, urinary and hepatobiliary cancers that could also be related to HNPCC. Four patients with early-onset colon cancer and a family history of other HNPCC-related cancers reported that their parents were first-degree cousins.

Diet and cooking practices in Egypt: Exploration of potential relationship to early-onset colorectal cancer

Colorectal cancer in the seventh most common cancer in Egypt. However, the proportion of persons under age 40 who have colorectal cancer is 5 to 6 times that of western countries. High fiber and low fat intake represented by a high-vegetable, low meat diet is characteristic of other age groups in Egypt. The objective of this study was to describe diet and cooking practices of 204 apparently healthy Egyptians between 20 and 40 years of age who were living in urban or rural areas in Egypt. We collected information about diet and methods of cooking red meat (frying, grilling, and baking). The results showed that participants in the study consumed a diet high in fiber, calcium, and vitamin C. The diet was low in red meat intake. Approximately 17 to 64% of the people in urban and rural areas did not eat red meat at least once a week that was fried, grilled or baked. More than 95% of the study population reported eating fresh vegetables more than once a day. Total fat intake was on the average 31% of kilo-calories in the urban region and 23 % in the rural region. Fiber consumption ranged from 37 grams per day in the urban region to 50 grams per day in the rural region. The eating habits of the Egyptians with high grain, fruit, and vegetable consumption, which are typically protective, may suggest that diet may be a vehicle for contaminants in these foods which may increase risk of colorectal cancer. Thus, diet should be included in future studies of colorectal cancer in Egypt to further understand this relationship.

Serum organochlorine pesticide levels in patients with colorectal cancer in Egypt.

The widespread use of pesticides in Egypt, the high incidence of colorectal cancer in Egyptian children and young adults, and the published U.S. case reports in which pesticides have been connected with colorectal cancer led the authors to investigate the possible association between organochlorines and colorectal cancer. The authors conducted a pilot study to describe serum organochlorine levels among 31 Egyptian colorectal patients and 17 controls. High levels and large interindividual variability of p,p'-dichloro-diphenyldicholoroethylene (DDE), dichloro-diphenyl-trichloroanthane (DDT), beta-hexachlorocyclohexane (beta-HCH), and hexachlorobenzene (HCB) levels were found among most subjects, especially those from rural areas. Farming and aging were each associated positively with high serum organochlorines. Colorectal cancer patients had higher serum organochlorines levels than controls. The high levels of organochlorines reported and their relation to age, residence, occupation, and disease status justify further study of the possible association between organochlorine pesticides and colorectal cancer in a larger population in Egypt.