Introduction Colorectal cancer is a significant cause of morbidity and mortality in the UK with 40,000 new cases each year. The purpose of this study is to present the descriptive epidemiology of colorectal cancer in a district general hospital setting (Leighton Hospital – catchment area of 300,000 people).
Methods All patients referred to the hospital between 01/01/12-31/12/13 were included.Data were obtained from case notes and computer based data:
Date of referral
Route of referral
Treatment and recurrence
Literature search via Medline. Statistical analysis by SPSS statistical package
380 patients (155 female(40.8%) and 225 (59.2%) male).
Anatomical Site 11.3% had cancer in Caecum, 6.3% in Ascending Colon, 2.6% in Hepatic Flexure, 4.8% in Transverse Colon, 1.6% in Splenic Flexure, 4.8% in Descending Colon, 26.8% in Sigmoid, 32.1% in Rectum, 2.6% in Anus and 7.1% in other anatomical sites e.g appendix
Type of Referral 42.3% of patients were referred by GP, 12.3% by physicians, 16.2% by general surgeons, 14.1% by other specialties and 15.3% diagnosed via the Bowel Screening Programme (BSP)
TNM staging 113 patients (29.7%) had TxNxM1 and 267 with TxNxM0. From those with M0, 151 (56.6%) were N0M0 while the rest 43.4% had mets to at least one regional lymph node (N1 or greater)
Surgical treatment 287 patients(75.5%) underwent surgical resection(including removal of liver mets) and 24.5% did not have a surgical procedure
Chemotherapy 164 patients(43.2%) had chemotherapy (adjuvant or palliative), 138 did not require chemo post-operatively and 78 were not suitable for it.
Recurrence From a total of 335 patients (45 patients were treated in different hospitals), 173 of them (51.6%) did not have any recurrence until June 2015 while the rest 48.4% had recurrence or died from the cancer.
Conclusion Compared to the National UK data, this is a representative sample of new bowel cancer diagnosis in terms of demographics and anatomical site (55.7% male, 44.3% female, 95% 50 years old or more). Only exception is the higher number of descending and rectal tumours in Leighton Hospital.
GPs continues to play an important role in diagnosis of bowel cancer but BSP has also improved the rate of diagnosis
Regarding TNM staging, 30% of patients were diagnosed in advanced stage which is higher than the UK(10% diagnosed at stage 4) and creates questions as to how effectively people are referred for specialist review in Leighton Hospital.
Finally, 76.7% of the patients survived one year after their diagnosis (75.7% in the UK) and 75.5% underwent major resection (62% in the UK)
Overall, this study demonstrates that a district general hospital can provide a colorectal service comparative to national standards.
Disclosure of Interest None Declared