Prevalence, clinicopathologic findings and associated factors of advanced colorectal neoplasia among patients undergoing colonoscopy at Muhimbili national hospital

Abstract

ABSTRACT Colorectal Cancer (CRC) is the 3rd most common cancer worldwide. It is the second most common cancer in women and the third most common cancer in men. In 2020 there were more than 1.9 million new cases of CRC worldwide. As the third most common malignancy and the second leading cause of cancer death. It is Africa's fourth most common cause of death secondary to a malignancy, although slight regional variations exist. CRC ranks third amongst all types of cancers in North Africa, while in East, Central, South, and West Africa it is ranked fourth. Factors such as alcohol intake, high red meat diet and a strong family history have been linked to increase occurrence of advanced colorectal neoplasia. The Aim: To determine the prevalence, clinical, colonoscopic, histopathological findings, and associated factors among patients with advanced colorectal neoplasia at Muhimbili National Hospital (MNH) identified between November, 2023 – March 2024. Methodology: This was a hospital-based cross-sectional study. A sample of 200 participants fulfilling the eligibility criteria were included in the study. Colonoscopy and pathological confirmation of advanced colorectal neoplasia were the measures of interest. A structured questionnaire was used to obtain patients’ socio-demographic, clinical, and laboratory data. All study patients had a colonoscopy done at MNH – Upanga or Mloganzila site. Data processing was through SPSS v 23. Variables were summarized as means and proportions. Multivariate analyses of variance were used to evaluate the relationships between ACRN and associated factors.. Ethical approval was sought from the Muhimbili University of Health and Allied Sciences (MUHAS) Research and Ethics Committee. Permission to conduct the study was obtained from the MNH administration. Results: A total of 200 participants were studied with an age of 56 years, with an IQR 42-66. Over half of the participants were male (59%) and the majority were married/cohabiting (74%). vi A slight higher proportion had completed primary education (51%), followed by completed secondary education (25.5%). A higher proportion of participants were unemployed (34.2%). Most participants did not have any comorbidities (60%). Of the 40% with comorbidities, the most common were hypertension (30%), heart disease (19%) and Diabetes Mellitus (10%). Most participants presented with abdominal pain (60.2%), blood in stool (57.1%) and constipation (51.1%). Majority of participants presented a lesion (81%), with most presenting with one lesion (64.%), while some had up to 10 or more lesions (2%). Most participants presented a lesion in the rectum (32.47%), followed by the sigmoid and ascending colon (8.23%). Most participants presented a fungating mass (14.7%), followed by polypoid/polyp (10.17%) and internal hemorrhoids (6.9%). Among all participants, 25.5% were found to have advanced colorectal neoplasia compared to the remaining 74.5%. Assessment of factors associated with the presence of an ACRN, grouping of the sample by age showed that participants 45 years and older had 1.2 more odds of having an ACRN but it was not significant. Gender did not have an effect on odds of having an ACRN. A positive family history increased the odds of having an ACRN. Having a first degree relative with CRC increased the odds of having an ACRN by 4.6 (4.56,4.8), p-value = 0.031. Conclusion: The prevalence of ACRN among patients undergoing colonoscopy at MNH was 25.5%. About 81% of patients undergoing colonoscopy have a visible lesion. There are various relationships between age, sex, social/behavioral history and diet with the presence of an ACRN at colonoscopy but the only statistically significant relationship was the increased odds of an ACRN at colonoscopy if a participant has a first-degree relative with a history of CRC.