12th Ljudevit Jurak International Symposium on
Comparative Pathology
June 1-2, 2001

L. Tuzoviæ, M. Škarica, D. Brezoveèki, D. Tomas, D. Kovaèeviæ*, M. Belicza
”Ljudevit Jurak” University Department of Pathology and *University Department of Surgery, ”Sestre milosrdnice” University Hospital, Zagreb, Croatia
AIM OF THE STUDY: It is very well known that  war can have an influence on the distribution of various diseases within a human population. The goal of our study was to compare the localization of colorectal cancer, age distribution, sex distribution and anatomical extent of the disease (stage) during the three different periods: distal prewar period (1982-1983), immediate prewar period (1989-1990), and postwar period ( 1998-2000).
 PATIENTS AND METHODS: A total number of 1367 patients were analyzed.  Data regarding the patients was obtained from the computer based colorectal cancer registry  from the  ”Ljudevit Jurak” University Department of Pathology. The following data was analyzed: localization of colorectal cancer, age and sex distribution and anatomical extent of the disease (stage). For the tumor stage purpose all byopsy findings from the immediate pre-war period (1989-1990) and post-war period (1998-2000) were revised and if it was possible Dukes, Astler-Coller and TNM classification was determined. Dukes classification from the year 1932 was used.
RESULTS: The results of our study showed that the most common localization of colorectal cancer among these three periods of time was rectosygmoid. The significance was that the number of cases diagnosed in rectosygmoid area declined over the three periods from 93,8% in the distant pre-war period (1982-1983) to 68,9% in the post-war period (1998-2000). In contrast number of cases diagnosed in the ascending colon increased from 3,1% in the distant pre-war period (1982-1983) to 13,3% in the post-war (1998-2000). No significant difference in the distribution of cancer was found among males and females. Age distribution showed that more than 80% of patients were diagnosed between the age of 50-80 peaking between the ages of 60-69 in the two prewar periods and 70-79 in the postwar period. The revised Dukes classification showed that in the immediate pre-war period (1989-1990) the most common stage was Dukes B which made up 34,4% while Dukes C represented 26,2% of the cases. On the contrary in the post-war period (1998-2000) the most frequent tumor stage was Dukes C with 40,5% of cases, followed by Dukes B which was found in 27,7% of cases, then Dukes A in 27,3 % and Dukes AC in 4,5%. Similar distribution of stages were presented in the Astler-Coller classification. In the immediate pre-war period (1989-1990) we were able to determine TNM stages for 189 cases. The most common tumor stage found was T3N0MX which made up 30,15%. In the post-war period (1998-2000) the most common stage found was also T3N0MX which made up 26,53% of 456 determinable cases.
CONCLUSION: The given results showed the marked change in  the anatomical distribution of the disease. Rectosygmoid cancer is still highly represented in our population but during the three periods we have noted an increase in the incidence of right sided colonic cancer and a decrease in the incidence of rectosygmoid cancer. These changes could be partly due to nutritional habits which have been getting closer to a western type of nutrition. Age at diagnosis is similar to that of the western world with a  peak of presentation between 70 and 79 years of age, respectively. The sex ratio still showed slight male predominance which was not significant and was as quoted in literature.The trend of presentation of patients in a more advanced stages of disease (Dukes C ) could have been due to the effect of war on the health and socioeconomic conditions of the patients. Further epidemiologic studies are needed to check if these trends are continuous or war connected.


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