Colorectal cancer (CRC) is the third most common cause of cancer diagnosed in the United States and the second leading cause of cancer death [
Colorectal cancer is the 3rd and the 4th most commonly diagnosed cancer, respectively, in Iranian men and women [
This hospital-based cross-sectional descriptive study was approved by the Scientific and Ethical Review Board of Urmia University of Medical Sciences. It was conducted at academic training and private hospitals of Urmia, the capital of West-Azerbaijan province. The location of West Azerbaijan province in the northwest of Iran is depicted in Figure
The location of West Azerbaijan province (Our study) in the northwest of Iran, compared to the place of previous reports from Iran (the Tehran, Markazi, Hamadan, Kurdistan, Golestan, and Mazandaran provinces).
546 patients who underwent surgical procedures with the pathologic diagnosis of colorectal cancer within 8 years (2001–2008) were enrolled in this study. The following data were obtained: age at diagnosis, gender, presenting symptoms (including abdominal pain, change in bowel habit, hematochezia or melena, weakness, anemia, and weight loss), anatomical site of tumor, and pathological type of tumor (grade and stage of tumor).
In this study, the TNM (tumor, lymph nodes, metastasis) staging system was used for determining the severity of disease and the local or distant extent of disease spread. The TNM staging system of the American Joint Committee on Cancer (AJCC) is the preferred staging system for CRC.
Statistical analysis was performed using SPSS software ver16 package. Frequencies were provided using descriptive statistics.
A total of 546 patients were enrolled in this study. 306 patients (56%) were men, and 240 (44%) were women. The mean age at diagnosis was
The presenting symptoms were rectal bleeding (26%), abdominal pain (25%), large bowel obstruction (23%), change in bowel habits (14%), weakness and anemia (5%), abdominal mass (4%), and bowel perforation and peritonitis (3%). Overall, in 26% of them, the patients were presented with acute abdomen due to bowel obstruction, perforation, or the like.
Regarding the histological diagnosis, 95% of tumors were adenocarcinoma, 4% were lymphoma, and 1% was other rare tumors. About the grade of tumor, 64% had well-differentiated tumors, followed by moderately and poorly differentiated tumors, respectively, in 30% and 6% of patients.
Regarding the stage of cancer according to TNM staging system, 6% of patients were in stage I, followed by 37% in stage II, 33% in stage III, and 24% in stage IV.
The tumor was located in rectum in 244 patients (44.5%), right colon in 192 patients (35%), and left colon in 110 cases (20%).
The prevalence of cancer in Iran is much higher than the universal average (160 per 100,000 Iranian population compared to 66.8 and 73.9 per 100,000 for women and men worldwide). This rate is 201 cases per each 100,000 population for the West Azerbaijan province, which is significantly higher than other parts of the country. West Azerbaijan has the forth place after Guilan (223.4/100,000), Isfahan (218/100,000), and Yazd (217.4/100,000) provinces [
There is a paucity of data regarding the colorectal cancer from northwestern provinces of Iran. Some important characteristics demonstrated in our findings were listed as follows.
The mean age of our patients was
In this study, 26% of subjects were presented with acute abdomen because of bowel obstruction or perforation, which is against the findings of others that reported acute and subacute presentation in less than 10% of their patients. It is important because subacute presentations make the appropriate treatment impossible [
In our study, the pathology of tumor was adenocarcinoma in 95%, lymphoma in 4%, and rare tumors in 1% which is similar to several other reports [
Unfortunately 57% of our patients were presented in 3rd or 4th stage. This is in accordance with other reports from Iran [
The most prevalent site of tumor was rectum (almost 45%) in our study, unlike in the United States and in concordance with many other studies from this region [
The increasing incidence of right-sided CRC has been noted in some developed countries; thus, they had to change their screening methodology and to consider other measures such as CT colonography or stool DNA tests beside the more invasive colonoscopy method [
According to the literature, survival improves substantially if the colorectal cancer is diagnosed while it is still localized [
Of course it should be noted that, even in countries such as the United States with strong protocols in favor of performing CRC screening programs, every 5 seconds someone who should be screened for CRC is not. And only one third of people who expected to have CRC are screened for it. Unfortunately, 20% of CRC patients who do receive screening demonstrated to be diagnosed in the later, less-treatable stages [
Developing a road map for finding the most appropriate screening method and the best age cutoff for performing the CRC screening in Iran is recommended. Reviewing the experience of screening programs in developed countries such as the US could help us in reaching a successful national screening program. The measures should be taken to maximize the compliance of patients and physicians with the mentioned screening program.
Our limitation in studying the clinicopathologic features of CRC patients in west Azerbaijan province was the population we enrolled that all of them were the patients, which their disease ended to surgery. The patients who die at end stages of cancer without any surgical intervention, or the CRC patients who have not received any surgical treatment yet, were not included in our study.
In conclusion, in west Azerbaijan province of Iran, patients with colorectal cancer present in younger age and more advanced stages in comparison with the developed countries, in which almost 60% of CRC cases occur. The authors emphasize on the importance of implementing an appropriate screening program with considering the region-specific characteristics of CRC patients.
The authors would like to thank Urmia University of Medical Sciences for the grants provided for their study.