Anatomical distribution of colorectal cancer over a 10 year period in a district general hospital: is there a true “rightward shift”? | Postgraduate Medical Journal

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Anatomical distribution of colorectal cancer over a 10 year period in a district general hospital: is there a true “rightward shift”?

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Colorectal cancer site varies with age and gender
Daniel R McGrath
Published on: 8 December 2004

Published on: 8 December 2004
Colorectal cancer site varies with age and gender
- Daniel R McGrath, SpR, Surgery
- Other Contributors:
  Allan D. Spigelman
Dear Editor
Whilst providing useful information on the long term natural history of colorectal cancer, the article by Gomez et al[1] made some basic anatomical errors. The rectum is a clearly defined separate entity from the left colon and we feel should be considered as such when comparing incidence by anatomical site. This is clearly demonstrated by the well recognised gender difference for rectal cancer....
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Dear Editor
Whilst providing useful information on the long term natural history of colorectal cancer, the article by Gomez et al[1] made some basic anatomical errors. The rectum is a clearly defined separate entity from the left colon and we feel should be considered as such when comparing incidence by anatomical site. This is clearly demonstrated by the well recognised gender difference for rectal cancer. In a prospective study of more than 2000 patients collected over a three month period in Australia,[2] we found a statistically significant male to female ratio for rectal cancer of almost 2:1. Similarly, when rectal cancer was considered as a third site separate from the left colon a statistically significant age distribution of colorectal cancer was found; the older the patient the more likely they were to have a more proximal tumour.[3] Such age and gender factors were not considered in the analysis by Gomez et al. As average life expectancy is increasing, these factors may well explain the perceived proximal shift, which will impact on screening programmes for colorectal cancer.
References
1. Gomez, D, Dalal, Z, Raw, E, Roberts, C, Lyndon, PJ. Anatomical distribution of colorectal cancer over a 10 year period in a district general hospital: is there a true "rightward shift"? Postgrad Med J, 2004; 80: 667-9.
2. Spigelman, AD, McGrath, DR (2002) The National Colorectal Cancer Care Survey. Australian clinical practice in 2000. National Cancer Control Initiative, Melbourne.
3. McGrath, DR, Spigelman, AD. The impact of age on the treatment of colorectal cancer in Australia. Ann R Coll Surg Eng, 2004; 86: 228.
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Conflict of Interest:
None declared.
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