Colorectal cancer in patients from Uganda: A histopathological study.

Background: Approximately one million people are diagnosed with colorectal cancer (CRC) globally each year. Uganda is a developing country with an estimated total population of 32.9 million. The incidence of colorectal cancer is reported to be low. The clinical impression is that it occurs predominantly in young people who live in rural areas This study was aimed at determining the demographic and morphological features of a cohort of patients with colorectal cancer from in Mulago and Mbarara hospitals in Uganda.
Methods: Histopathological specimens of 81 Ugandan patientswith CRC (2006-2010) were retrospectively reviewed. Demographic data was retrieved from the medical records. Tumours were examined to determine histological features suggestive of mismatch repair gene mutations (accordingto the revised Bethesda guidelines for microsatellite instability testing).
Results: The medianage of those with CRC was 55 years (range 20-89) at diagnosis. 30.6% and 6.9% of the patients were < 50 and < 30 years old respectively. 94,9% of the tumours were located in the left side of the colon. Mucinous adenocarcinoma was significantly more common in patientsunder the age of 50. Based on the histological and demographic features, 22/81 (27.3%) patients met at leastone of the criteria of the revised Bethesda Guidelines for MSI testing.
Conclusions: Histological and demographic features suggestive of the genetic pathway typically seen in HNPCC were identified in 27.3% of patients. These features appear to be quite different from published data from first world countries. The limited availability of flexible colonoscopy, may contribute to the great preponderance of left-sided neoplasms (especially located in the rectum) and underdiagnoses of right sided tumours.

Keywords
Colorectal cancer; HNPCC; Endoscopy; Uganda; Histopathology; Lynch syndrome