Colorectal Cancer in Northern Tanzania:Increasing Trends and Late Presentation PresentMajor Challenges

Ayesiga M. Herman, MD1,2; Alexander T. Hawkins, MD, MPH3; Kennedy Misso, MD1; Christian Issangya, MD2; Murad Tarmohamed, MD2;Alex Mremi, MMed4; Furaha Serventi, MD5; David Msuya1,2; and Rune Philemon, MMed2
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A trend of increasing incidence of colorectal cancer (CRC) has been observed in northern Tanzania.Studies have shown a six-fold increase in CRC in the past decade, with 90% of patients presenting in late stages,with resultant high morbidity and mortality rates. In this study, we aimed to document the burden of CRC in thenorthern zone of Tanzania from 1998 to 2018, focusing on patient presentation, clinical features, and treatmentat a tertiary hospital.


Pathological and clinical records for all patients from 1998 to 2018 were identified and reviewed.Records of patients whose CRC was diagnosed histologically were retrospectively reviewed.


Approximately 313 CRC cases were documented. The majority age group (29.1%) was between 50and 64 years (mean [standard deviation], 54.28 [16.75] years). However, together, the age groups of patientsyounger than 50 years was 41.5% (n = 130). Of 174 patients with complete records, most (29.3%) werebetween 35 and 49 years of age. The median age was 52 (interquartile range, 40-67) years. Men accounted for62.1% of patients and were mostly from the Kilimanjaro region. More than half (54.7%) presented.3 monthsafter symptom debut; 62.6%first sought care at lower-level health facilities. Most (64.9%) presented asemergencies, necessitating colostomy for fecal diversion as the initial surgical procedure in 60.3% of patients.Colonoscopy was performed for 38.6% of the study participants. Most tumors (72.7%) originated from thesigmoid and rectum. Adenocarcinoma was the most prevalent histologic type.


High proportions of young individuals with CRC pose great concern and a need for further ap-praisal. Furthermore, late emergency presentation and low colonoscopy rates highlights underlying systemchallenges and need for education campaigns.