NCPR CC Registry Report 2008 2013
December 2014
© National Cancer Patient Registry-Colorectal Cancer
Jointly published by:
National Cancer Patient Registry-Colorectal Cancer and Clinical Research Centre (CRC)
Contact:
National Cancer Patient Registry-Colorectal Cancer
Registry Coordinating Centre
c/o Clinical Research Centre
Hospital Sultanah Bahiyah
KM 6, Jalan Langgar
05460 Alor Setar, Kedah
Malaysia
General line: 604-7407391
Fax: 604-7407373
Website: https://app.acrm.org.my/CCD
Disclaimer
Data reported were supplied by NCPR-CC. Interpretation and reporting is the responsibility of the
editors and do not reflect the official policy of the publisher or the authors’ affiliated institutions. The
data represents absolute numbers and not rates. Caution is advised before drawing conclusions from
the data. The registry is dynamic; numbers may vary between this report and real time data as the
registry continues to be updated.
This report is copyrighted. Reproduction and dissemination of this report in part or in whole for
research, educational or other non-commercial purposes are authorized without any prior written
permission from the copyright holders provided the source is fully acknowledged.
Suggested citation is:
Muhammad Radzi Abu Hassan, Wan Khamizar Wan Khazim, Zabedah Othman, Nik Raihan Nik
Mustapha, Rosaida Mohd Said, Tan Wei Leong, Mohd Azri Mohd Suan, Shahrul Aiman Soelar (eds),
The Second Report of the National Cancer Patient Registry-Colorectal Cancer, 2008-2013, Kuala
Lumpur, Malaysia 2014.
The electronic version of this report can be downloaded at https://app.acrm.org.my/CCD
ACKNOWLEDGEMENT
We would like to thank all contributing parties for their support and encouragement in
making this registry report a reality.
We would especially like to thank the following:
Director-General of Health, Ministry of Health Malaysia for support for the registry
and approval to publish this report.
Ministry of Health, Malaysia for the research grants to fund the registry.
The members of our steering committee for their expertise, time and effort dedicated
to the registry.
National Clinical Research Centre for its leadership, guidance and technical support.
Our source data providers from Ministry of Health Malaysia, University Hospitals and
private hospitals, without whose commitment, hard work and timely data collection
and submission, this report would not be possible.
Head of Pathology, Gastroenterogy, Oncology and Colorectal Surgery services.
Head of Anatomic Pathology and all Histopathologists involved.
All Hospital Directors, Clinicians and Surgeons of participating centers.
State epidemiologists involved.
The registry coordinating centre team and technical support team, for their continuous
commitment and contribution.
Health Informatics Centre for funding the reports’ printing.
About National Colorectal Cancer Registry in Malaysia
Introduction
The National Colorectal Cancer Registry started back in October 2007 involving nine
hospitals throughout Malaysia. The National Cancer Patients Registry is a multi-centre and
multidisciplinary project involving gastroenterologists, colorectal surgeons, pathologists and
oncologists. The registry has expanded from involvement of nine hospitals to 34 hospitals
throughout Malaysia from 2007 until 2013.
Furthermore, the registry is fully funded by a Ministry of Health grant disbursed through the
Clinical Research Centre (CRC) since its establishment as the registry is crucial to our
understanding of colorectal carcinoma in Malaysia. The registry coordinating centre/office is
based in Clinical Research Centre, Hospital Sultanah Bahiyah, Alor Setar, Kedah.
Rationale
The registry is mainly collecting data on prevalence, incidence, clinical aspects and treatment
modalities of colorectal cancer in Malaysia.
The main reason of the establishment of this National Colorectal Registry is to systematically
collect data on all aspects of colorectal cancer relevant to its prevention, management and
treatment evaluation in Malaysia. This registry will be able to function as guidance for
Ministry of Health, Malaysia in formulating policy to improve colorectal cancer prevention,
management and control. On top of that, the registry will be beneficial for NonGovernmental Organizations (NGO), private healthcare providers and healthcare industry in
program planning and evaluation.
Objectives
Objectives of the registry are:
1. To estimate the incidence and mortality rate of colorectal cancer in Malaysia.
2. To determine the socio-demographic profiles of patients with colorectal cancer in
Malaysia.
3. To identify the risk factors of patients with colorectal cancer.
4. To study the stage at diagnosis and histological types of colorectal cancer patients
5. To evaluate the treatment modalities for colorectal cancer.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 1
ORGANIZATION:
Steering Committee
Expert Panel
NCPR-CC Office
Source Data
Providers
2 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
User / Target Group
SOURCE DATA PROVIDERS / SDP:
Comprehensive cancer registration was achieved through data obtained from a combination
of sources, viz.:
(a) Notifications by the medical profession,
(b) Pathology records, and
(c) Hospital records
Histopathologists were the key persons in providing primary information on colorectal cancer
cases. For cancer cases obtained from sources other than physician’s notifications, the data
were checked against known registered cases in the registry. For missed notifications, the
doctors-in-charge would be informed and reminded to notify. Until year 2013, we have 34
SDP’s that tirelessly providing the valuable data on colorectal cancer. The list of all SDP’s
involved is as below;
Hospital Ampang
Hospital Sultanah Aminah, Johor Bahru
Hospital Duchess of Kent, Sandakan
Hospital Sultanah Bahiyah, Alor Star
Hospital Kepala Batas, Pulau Pinang
Hospital Sultanah Nur Zahirah, Kuala
Hospital Kuala Lumpur
Hospital Kulim
Hospital Taiping
Hospital Melaka
Hospital Tengku Ampuan Afzan,
Hospital Miri
Hospital Pulau Pinang
Hospital Putrajaya
Hospital Queen Elizabeth, K. Kinabalu
Hospital Tuanku Fauziah, Kangar
Hospital Raja Perempuan Zainab II,
Hospital Tuanku Jaafar, Seremban
Kelantan
Hospital Umum Sarawak, Kuching
Hospital Raja Permaisuri Bainun, Ipoh
Hospital Universiti Sains Malaysia,
Hospital Seberang Jaya, P. Pinang
Hospital Selayang, Selangor
Pusat Perubatan Universiti Malaya
Hospital Serdang, Selangor
Kedah Medical Centre, Alor Setar
Hospital Sibu, Sarawak
Mawar Medical Centre, Seremban
Hospital Sultan Abdul Halim, Sg. Petani
Metro Specialist Hospital, Sg. Petani
Hospital Sultan Ismail, Johor Bahru
Hospital Pantai, Sg. Petani
Putra Medical Centre, Alor Setar
Terengganu
Kuantan
Hospital Tengku Ampuan Rahimah,
Klang
Kelantan
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 3
STEERING COMMITTEE
NAME
INSTITUTION
Dato’ Dr Muhammad Radzi Abu Hassan
Department of Internal Medicine,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Dr Wendy Lim Wan Dee
Department of Internal Medicine,
Prince Court Hospital
Datin Dr Nik Raihan Nik Mustapha
Department of Pathology,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Dato’ Dr Wan Khamizar Wan Khazim
Department of Surgery,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Datuk Dr Yunus Gul Alif Gul
Department of Surgery,
Prince Court Hospital
Datuk Dr Ryan Ponnudurai
Department of Surgery,
Prince Court Hospital
Dr Hajjah Rosaida Hj Mohd Said
Department of Internal Medicine,
Hospital Ampang, Kuala Lumpur
Dr Arjunan Saravanan
Department of Internal Medicine,
Hospital Kuala Lumpur
Dr Hajjah Zabedah Hj Othman
Department of Radiotherapy and Oncology,
Hospital Kuala Lumpur
Datuk Dr Fitjerald Henry
Department of Surgery,
Hospital Selayang, Selangor
Prof. Dr April Roslani
Department of Surgery,
Univerity of Malaya Medical Center,
Kuala Lumpur
4 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
Prof Dr Nor Hayati Othman
Department of Pathology,
Hospital Universiti Sains Malaysia, Kelantan
Miss Jasiah Zakaria
Department of Surgery,
Hospital Tuanku Jaafar, Seremban,
Negeri Sembilan
Mr Chan Koon Khee
Department of Surgery,
Hospital Sultanah Aminah, Johor Bahru,
Johor
Dr Mohd Roslan bin Haron
Oncology Treatment Center,
Hospital Sultan Ismail, Johor Bahru, Johor
Dr Ahmad Shanwani Bin Mohamed Sidek
Department of Surgery,
Hospital Raja Perempuan Zainab II, Kelantan
Mr Nik Azim Nik Abdullah
Department of Surgery,
Hospital Umum Sarawak
Datuk Dr Jayaram Menon
Department of Internal Medicine,
Hospital Queen Elizabeth, K. Kinabalu,
Sabah
Dr Noor Laili Mokhtar
Department of Pathology,
Hospital Serdang, Selangor
Dr Mukarramah bt Che Ayub
Department of Pathology,
Hospital Raja Perempuan Zainab II, Kelantan
Assoc. Prof. Dr Gurjeet Kaur
A/P Chatar Singh
Department of Pathology,
Advanced Medical & Dental Institute,
Universiti Sains Malaysia, Penang
Dr Andee Dzulkarnaen Zakaria
Department of Surgery,
Hospital Universiti Sains Malaysia
Prof Datuk Dr Ismail Sagap
Department of Surgery,
Hospital Universiti Kebangsaan Malaysia
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 5
Assoc. Prof. Dr Raja Affendi Raja Ali
Department of Internal Medicine,
Hospital Universiti Kebangsaan Malaysia
Dr Gerald Lim Chin Chye
Department Of Radiotherapy & Oncology,
Hospital Kuala Lumpur
Dr Goh Pik Pin
Director,
National Clinical Research Center
Dr Jamaiyah Haniff
National Registry Unit,
Ministry of Health Malaysia
Mr Patrick Lum See Kai
Precision Soft Sdn Bhd
Miss Teo Jau Shya
ClinData Consulting Sdn Bhd
6 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
MEDICAL WRITING COMMITTEE
NAME
INSTITUTION
Dato’ Dr Muhammad Radzi Abu Hassan
Department of Internal Medicine,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Datin Dr Nik Raihan Nik Mustapha
Department of Pathology,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Dato’ Dr Wan Khamizar Wan Khazim
Department of Surgery,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Dr Hajjah Rosaida Hj Mohd Said
Department of Internal Medicine,
Hospital Ampang, Kuala Lumpur
Datuk Dr Fitjerald Henry
Department of Surgery,
Hospital Selayang, Selangor
Dr Hajjah Zabedah Hj Othman
Department of Radiotherapy and Oncology,
Hospital Kuala Lumpur
Dr Tan Wei Leong
Medical Officer,
Clinical Research Center,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Dr Mohd Azri Mohd Suan
Medical Officer,
Clinical Research Center,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Mr Shahrul Aiman Soelar
Statistician,
Clinical Research Center,
Hospital Sultanah Bahiyah Alor Setar, Kedah
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 7
National Colorectal Cancer Registry Coordinating Centre / Secretariat
NAME
INSTITUTION
Dr Madihah Ahmad
Medical Officer,
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Faizah Ahmad
Manager,
Research Officer,
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Ibtisam Ismail
Research Officer,
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Mr Shahrul Aiman Soelar
Statistician,
Clinical Research Center,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Siti Rohani Suddin
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Aliah Mat Ali
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Jambi Md Hussain
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Neoh Poh Tiew
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Nor Hafiza Johari
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Zainab Shafie
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Wan Muhana Abdullah
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Siti Aishah Aris
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Siti Ertina Asli
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
8 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
LETTER FROM THE PRINCIPAL INVESTIGATOR
The National Cancer Patient Registry-Colorectal Cancer is proud to present its second report
which incorporates results from 2008-2013.
The total data captured from the 34 Site Data Providers in six-year period was 4501.
Analyzing and coming out with this report was not an easy task. I take this opportunity to
congratulate the entire team involved from the data collection to data entry and finally to the
actual writing of this report. National Colorectal Cancer Registry is important, not just
because its’ valuable epidemiological data, but also management and outcome data which
will be a source of information for a national plan to combat this dreadful disease. This
information will be important for us when we formulate screening policies. This is especially
critical as colorectal cancer can be easily identified and treated if detected early. Hence,
prevention will be the most important tenet and strategy employed in the management of
colorectal cancer.
In addition, it is also a platform that will be used to develop more research with other
stakeholders. This is of paramount importance because combating such a prevalent disease
will involve multidisciplinary cooperation and effort that this registry can provide. Needless
to say, we hope that the availability of this database allows us to do more than formulating
policies. The possibilities in research and investigations in other aspects of colon cancer are
endless and hopefully with more data from more centers, this will be realized.
We want to thank all the source data providers for their support in making this report
possible. Furthermore, I would like to extend our gratitude to the Director General of Health
and Clinical Research Centre, Malaysia for their continuous support for the National
Colorectal Cancer Registry.
Thank you.
Dato’ Dr Muhammad Radzi Abu Hassan
Principal Investigator
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 9
TABLE OF CONTENTS
Acknowledgement
About NCPR-Colorectal Cancer In Malaysia
1
Organization
2
Source Data Providers
3
Steering Committee
4
Medical Writing Committee
7
National Colorectal Cancer Registry Coordinating Centre
8
Letter from The Principal Investigator
9
Table of Contents
10
List of Tables
11
List of Figures
13
Executive Summary
15
Chapter 1: Demographics
19
Chapter 2: Risk Factor and Clinical Presentation
27
Chapter 3: Primary Diagnosis and Final Staging
37
Chapter 4: Pathology
43
Chapter 5: Treatment Modalities
55
Chapter 6: Incidence and Mortality Rate
63
Appendix
69
10 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
LIST OF TABLES
Table 1.1: Total patients enrolled in the NCPR-Colorectal Cancer by centre, 20082013
20
Table 1.2: Demographics of patients enrolled in the NCPR-Colorectal Cancer, 20082013
22
Table 1.3: Age groups by gender and ethnicity of patients enrolled in the NCPRColorectal Cancer, 2008-2013
24
Table 1.4: Gender by ethnicity and education level of patients enrolled in the NCPRColorectal Cancer, 2008-2013
26
Table 2.1: Status of diabetes mellitus for patients enrolled in the NCPR-Colorectal
Cancer, 2008-2013
28
Table 2.2: Diabetes mellitus by age groups, ethnic and education level of patients
enrolled in the NCPR-Colorectal Cancer, 2008-2013
28
Table 2.3: Smoking status of patients enrolled in the NCPR-Colorectal Cancer, 20082013
30
Table 2.4: Smoking status by age groups, ethnic and education level of patients
enrolled in the NCPR-Colorectal Cancer, 2008-2013
30
Table 2.5: Family history of patients enrolled in the NCPR-Colorectal Cancer, 20082013
32
Table 2.6: Family history by age groups, ethnic and education level of patients
enrolled in the NCPR-Colorectal Cancer, 2008-2013
32
Table 2.7: Past medical history of other cancers of patients enrolled in the NCPRColorectal Cancer, 2008-2013
33
Table 2.8: Symptom of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
35
Table 3.1: Primary cancer site of patients enrolled in the NCPR-Colorectal Cancer,
2008-2013
38
Table 3.2: Primary cancer site by age groups of patients enrolled in the NCPRColorectal Cancer, 2008-2013
40
Table 3.3: Final TNM staging of patients enrolled in the NCPR-Colorectal Cancer,
2008-2013
40
Table 3.4: Final TNM staging by age groups, ethnic and education level of patients
enrolled in the NCPR-Colorectal Cancer, 2008-2013
41
Table 3.5: Final TNM staging by family history of patients enrolled in the NCPRColorectal Cancer, 2008-2013
42
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 11
Table 4.1: Number of lymph nodes, tumour size, angiolymphatic invasion and venous
lymphocytes of patients resected specimen enrolled in the NCPR-Colorectal Cancer,
2008-2013
44
Table 4.2: Final TNM staging by number of lymph nodes, tumour size,
angiolymphatic invasion and venous lymphocytes of patients resected specimen
enrolled in the NCPR-Colorectal Cancer, 2008-2013
44
Table 4.3: Proximal , distal and circumferential of patients resected specimen enrolled
in the NCPR-Colorectal Cancer, 2008-2013
46
Table 4.4: ypTNM staging of patients with resected specimen enrolled in the NCPRColorectal Cancer, 2008-2013
47
Table 4.5: pTNM staging of patients enrolled in the NCPR-Colorectal Cancer, 20082013
49
Table 4.6: Tumour differentiation by TNM staging of patients enrolled in the NCPRColorectal Cancer, 2008-2013
50
Table 4.7: Polyps of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
51
Table 4.8: Synchronous tumour present of patients enrolled in the NCPR-Colorectal
Cancer, 2008-2013
52
Table 4.9: Synchronous tumour in patients enrolled in the NCPR-Colorectal Cancer,
2008-2013
53
Table 5.1: Treatment modalities of patients enrolled in the NCPR-Colorectal Cancer,
2008-2013
56
Table 5.2: Treatment modalities of patients resected specimen enrolled in the NCPRColorectal Cancer, 2008-2013
57
Table 5.3: Final TNM staging by treatment modalities of patients enrolled in the
NCPR-Colorectal Cancer, 2008-2013
58
Table 5.4: Surgery method, operation performed and protocol/regimen of patients
enrolled in the NCPR-Colorectal Cancer, 2008-2013
60
Table 5.5: Final TNM staging by treatment modalities of patients enrolled in the
NCPR-Colorectal Cancer, 2008-2013.
61
Table 6.1: Status of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
64
Table 6.2: Age-adjusted rates (per 100,000) by gender of patiens in the NCPRColorectal Cancer, 2008-2013
66
Table 6.3: Age-adjusted rates (per 100,000) by ethnic of patiens in the NCPRColorectal Cancer, 2008-2013
67
Table 6.4: Patient status by final TNM staging of patients enrolled in the NCPRColorectal Cancer, 2008-2013
69
12 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
LIST OF FIGURES
Figure 1.0 : Data flow
18
Figure 1.1: Distributions of gender and ethnicity by age groups
24
Figure 1.2: Trends in the incidence and mortality of patients in the NCPRColorectal Cancer, 2008-2013
66
Figure 1.3: Trends in the incidence and mortality by ethnic of patiens in the NCPRColorectal Cancer, 2008-2013
67
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 13
14 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
EXECUTIVE SUMMARY
Incidence and mortality
From 2008 to 2013, overall incidence rate for colorectal cancer was 21.3
cases per 100, 000 populations in Malaysia. Age-adjusted incidence rate
of colorectal cancer was 1.33 times higher among male than female. The
incidence rate of colorectal cancer per 100,000 population by ethnicity
was highest in Chinese (27.4 cases per 100,00 population).
From 2008 to 2013, overall mortality rate for colorectal cancer was 9.8
cases per 100,000 populations. Likewise, age-adjusted mortality rate of
colorectal cancer was about 1.42 times higher among male than female.
International comparisons in incidence and mortality:
From 2007 to 2011, incidence rate for colorectal cancer in United States
of America was 43.7 per 100,000 populations annually and their
mortality rate was 15.9 per 100,000 populations annually.
In Asia, Japan had incidence rate of 41.7 per 100,000 populations and
22.8 per 100,000 populations for female in 2008. As for the mortality
rate, male was 15.2 per 100,000 populations while female was 8.9 per
100,000 populations (2008, U.S National Institute of Health).
In Malaysia, our overall incidence rate was 21.3 cases per 100,000
populations from 2008 until 2013. Our mortality rate for the same
duration was 9.8 cases per 100,000 populations.
Demographics
In the six-year period between 2008 and 2013, mean age for colorectal
cancer patients was 61.6 year old (standard deviation of 12.7).
Registered colorectal cancer was more dominant among male than female
for the entire period from 2008 to 2013.
The proportion of colorectal cancer increased with age for both men and
women in the six-year duration.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 15
Risk factors and clinical presentation
In this registry, there were 22.3% of colorectal cancer patient with
diabetes mellitus. The trend of diabetes mellitus was persistent between
19.3% and 25.6%.
For these six-year duration, there were 9.6% of active smoker, 13.2% of
former smoker and 38.4% were non-smoker.
Even though family history is a known risk factor for colorectal cancer,
there were merely 6.4% patients with positive family history.
The most common presentation of colorectal cancer was altered bowel
habits (41.7%).
Primary diagnosis and final staging
The commonest site of colorectal cancer was at colon according to ICD
10 from 2008 until 2013. However, rectum and rectosigmoid were the
commonest site of colorectal cancer when colon is specifically divided
into small segment.
Left sided tumour constitutes more than three quarter of the colorectal
cancer notified.
Over the past six-year period, majority of our patient were diagnosed at
stage III according to final TNM staging.
Pathology of colorectal cancer
The most common histologic tumour type seen in colorectal cancer
patients in Malaysia is adenocarcinoma of usual-type (95.5%), most of
which were moderately-differentiated.
The majority of our patients were presented with locally advanced tumour
(pT3 and pT4). In addition, more than half had nodal metastasis.
16 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
Treatment modalities
There was 70.8% of colorectal cancer patients had surgery performed and
35.9% of colorectal patients had chemotherapy. For rectal cancer, 26.3%
of our patients received radiotherapy.
As for complimentary or alternative treatment, 5.5% of our patients
received the care while there was merely 1.6% of colorectal cancer
patients received palliative care in this registry.
The data on chemotherapy and radiotherapy are still insufficient for
analysis.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 17
SELECTION OF THE PATIENTS
The figures produced in this report are based on National Cancer Patient Registry –
Colorectal data. 316 cases were requested the case to delete. The resulting sample of 6971
cases was then restricted to year of diagnosis between 2008 and 2013. Duplicate records were
identified on the Patient ID.
Figure 1.0: Data flow
18 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
CHAPTER 1
DEMOGRAPHICS
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 19
DEMOGRAPHICS
Table 1.1: Total patients enrolled in the NCPR-Colorectal Cancer by centre, 2008-2013
Year
Participating
Overall
2008
2009
2010
2011
2012
2013
Hospitals
n
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
1
67
1
(0.2)
25
(2.5)
22
(2.2)
13
(1.7)
6
(0.8)
0
(0.0)
2
36
7
(1.1)
16
(1.6)
12
(1.2)
1
(0.1)
0
(0.0)
0
(0.0)
3
132
2
(0.3)
21
(2.1)
24
(2.5)
26
(3.5)
39
(5.2)
20
(5.4)
4
353
99
(15.0)
61
(6.1)
84
(8.6)
69
(9.2)
39
(5.2)
1
(0.3)
5
20
0
(0.0)
4
(0.4)
5
(0.5)
1
(0.1)
7
(0.9)
3
(0.8)
6
112
1
(0.2)
22
(2.2)
39
(4.0)
31
(4.2)
19
(2.5)
0
(0.0)
7
29
1
(0.2)
19
(1.9)
8
(0.8)
1
(0.1)
0
(0.0)
0
(0.0)
8
276
17
(2.6)
95
(9.6)
88
(9.0)
50
(6.7)
17
(2.2)
9
(2.4)
9
40
4
(0.6)
7
(0.7)
17
(1.7)
4
(0.5)
4
(0.5)
4
(1.1)
10
321
69
(10.5)
50
(5.0)
54
(5.5)
65
(8.7)
53
(7.0)
30
(8.1)
11
175
40
(6.1)
28
(2.8)
35
(3.6)
36
(4.8)
20
(2.6)
16
(4.3)
12
133
1
(0.2)
42
(4.2)
33
(3.4)
27
(3.6)
30
(4.0)
0
(0.0)
13
85
8
(1.2)
22
(2.2)
27
(2.8)
12
(1.6)
10
(1.3)
6
(1.6)
14
282
86
(13.1)
75
(7.6)
69
(7.1)
4
(0.5)
7
(0.9)
41
(11.1)
15
22
20
(3.0)
0
(0.0)
0
(0.0)
0
(0.0)
1
(0.1)
1
(0.3)
16
31
2
(0.3)
19
(1.9)
10
(1.0)
0
(0.0)
0
(0.0)
0
(0.0)
17
27
1
(0.2)
3
(0.3)
6
(0.6)
5
(0.7)
11
(1.5)
1
(0.3)
18
179
3
(0.5)
4
(0.4)
5
(0.5)
19
(2.5)
110
(14.6)
38
(10.3)
19
210
70
(10.6)
61
(6.1)
42
(4.3)
29
(3.9)
5
(0.7)
3
(0.8)
20
403
85
(12.9)
80
(8.1)
76
(7.8)
62
(8.3)
65
(8.6)
35
(9.5)
21
146
7
(1.1)
33
(3.3)
35
(3.6)
30
(4.0)
29
(3.8)
12
(3.3)
22
68
5
(0.8)
16
(1.6)
11
(1.1)
19
(2.5)
9
(1.2)
8
(2.2)
23
54
0
(0.0)
0
(0.0)
0
(0.0)
15
(2.0)
9
(1.2)
30
(8.1)
24
223
5
(0.8)
29
(2.9)
27
(2.8)
41
(5.5)
73
(9.7)
48
(13.0)
25
54
0
(0.0)
17
(1.7)
6
(0.6)
10
(1.3)
18
(2.4)
3
(0.8)
26
194
5
(0.8)
42
(4.2)
45
(4.6)
42
(5.6)
59
(7.8)
1
(0.3)
27
560
75
(11.4)
123
(12.4)
121
(12.4)
110
(14.7)
83
(11.0)
48
(13.0)
28
128
34
(5.2)
38
(3.8)
48
(4.9)
5
(0.7)
2
(0.3)
1
(0.3)
29
42
2
(0.3)
8
(0.8)
12
(1.2)
6
(0.8)
10
(1.3)
4
(1.1)
30
8
0
(0.0)
1
(0.1)
3
(0.3)
2
(0.3)
2
(0.3)
0
(0.0)
31
15
0
(0.0)
7
(0.7)
3
(0.3)
1
(0.1)
1
(0.1)
3
(0.8)
32
2
0
(0.0)
1
(0.1)
1
(0.1)
0
(0.0)
0
(0.0)
0
(0.0)
33
38
4
(0.6)
13
(1.3)
1
(0.1)
4
(0.5)
13
(1.7)
3
(0.8)
34
36
5
(0.8)
11
(1.1)
9
(0.9)
6
(0.8)
5
(0.7)
0
(0.0)
4501
659
(100.0)
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Overall
20 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
There were 34 hospitals throughout Malaysia in this registry with a total of 4501
colorectal cancer patients registered over six-year period (2008-2013).
The number of colorectal cancer patients captured in the registry was consistent
throughout this six-year period except slight reduction in 2013 (range between 369
and 978 cases per annum).
The number of patients registered in each hospital or medical centre depends on the
number of colorectal cancer patients encountered in their setting.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 21
Table 1.2: Demographics of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
Year
Characteristics
Overall
n
2008
n
2009
(%)
n
2010
(%)
n
2011
(%)
n
2012
(%)
n
2013
(%)
n
(%)
Age (years)
n
4458
654
975
975
739
751
364
Mean
61.6
61.2
62.1
61.6
61.3
61.7
61.4
12.72
12.21
12.32
12.84
12.94
12.55
12.54
Standard Deviation
Age groups (years)
80
265
42
(15.8)
58
(21.9)
63
(23.8)
43
(16.2)
41
(15.5)
18
(6.8)
43
5
(11.6)
18
(41.9)
3
(7.0)
7
(16.3)
5
(11.6)
5
(11.6)
Male
2518
393
(15.6)
546
(21.7)
569
(22.6)
387
(15.4)
422
(16.8)
201
(8.0)
Female
1933
264
(13.7)
444
(23.0)
405
(21.0)
355
(18.4)
310
(16.0)
155
(8.0)
Missing
50
2
(4.0)
3
(6.0)
4
(8.0)
4
(8.0)
24
(48.0)
13
(26.0)
Malay
1922
266
(13.8)
394
(20.5)
432
(22.5)
322
(16.8)
334
(17.4)
174
(9.1)
Chinese
1814
265
(14.6)
426
(23.5)
386
(21.3)
296
(16.3)
307
(16.9)
134
(7.4)
Indian
259
36
(13.9)
63
(24.3)
58
(22.4)
45
(17.4)
35
(13.5)
22
(8.5)
Others
484
90
(18.6)
108
(22.3)
101
(20.9)
79
(16.3)
71
(14.7)
35
(7.2)
Missing
22
2
(9.1)
2
(9.1)
1
(4.5)
4
(18.2)
9
(40.9)
4
(18.2)
No formal education
417
115
(27.6)
83
(19.9)
80
(19.2)
45
(10.8)
64
(15.3)
30
(7.2)
Primary
576
96
(16.7)
146
(25.3)
132
(22.9)
103
(17.9)
64
(11.1)
35
(6.1)
Secondary
672
91
(13.5)
165
(24.6)
174
(25.9)
99
(14.7)
94
(14.0)
49
(7.3)
Tertiary
201
27
(13.4)
43
(21.4)
59
(29.4)
30
(14.9)
26
(12.9)
16
(8.0)
Missing
2635
330
(12.5)
556
(21.1)
533
(20.2)
469
(17.8)
508
(19.3)
239
(9.1)
Missing
Gender
Ethnic
Education level
22 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
In the six-year period between 2008 and 2013, the mean age for total colorectal
patients was 61.6 year old (standard deviation 12.7).
The registered colorectal cancer was more dominant among male than female for the
entire period from 2008 to 2013.
From 2008 to 2013, the registered colorectal cancer decreased for both male and
female. For male, the rate decreased from 15.6% to 8.0 % while the rate decreased
from 13.7 to 8.0% for female.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 23
Figure 1.1: Distributions of gender and ethnicity by age groups
Table 1.3: Age groups by gender and ethnicity of patients enrolled in the NCPR-Colorectal
Cancer, 2008-2013
Gender
Male
Characteristics
Ethnic
Female
Malay
Chinese
Indian
Others
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
7
(0.3)
4
(0.2)
5
(0.3)
2
(0.1)
0
(0.0)
4
(0.9)
20-24
9
(0.4)
8
(0.4)
10
(0.5)
2
(0.1)
1
(0.4)
4
(0.9)
25-29
27
(1.1)
20
(1.0)
31
(1.6)
2
(0.1)
1
(0.4)
13
(2.8)
30-34
32
(1.3)
33
(1.7)
42
(2.2)
7
(0.4)
5
(1.9)
10
(2.1)
35-39
61
(2.4)
51
(2.7)
54
(2.8)
25
(1.4)
10
(3.9)
23
(4.9)
40-44
106
(4.2)
86
(4.5)
105
(5.5)
39
(2.2)
14
(5.4)
36
(7.7)
45-49
175
(7.0)
149
(7.8)
172
(9.0)
92
(5.1)
20
(7.7)
42
(9.0)
50-54
250
(10.0)
212
(11.1)
229
(12.0)
139
(7.7)
33
(12.7)
61
(13.1)
55-59
330
(13.2)
289
(15.1)
282
(14.8)
241
(13.4)
34
(13.1)
69
(14.8)
60-64
433
(17.3)
273
(14.3)
302
(15.8)
300
(16.6)
45
(17.4)
63
(13.5)
65-69
397
(15.9)
246
(12.9)
257
(13.5)
310
(17.2)
31
(12.0)
47
(10.1)
70-74
346
(13.9)
260
(13.6)
232
(12.2)
307
(17.0)
36
(13.9)
39
(8.4)
75-79
189
(7.6)
157
(8.2)
99
(5.2)
192
(10.6)
18
(6.9)
36
(7.7)
>80
136
(5.4)
126
(6.6)
89
(4.7)
145
(8.0)
11
(4.2)
20
(4.3)
2498
(100.0)
1914
(100.0)
1909
(100.0)
1803
(100.0)
259
(100.0)
467
(100.0)
Age groups (years)
30 days)
594
96
(14.6)
131
(13.2)
141
(14.4)
88
(11.8)
90
(11.9)
48
(13.0)
Active smoker
Smoking Status
Non-smoker
430
78
(11.8)
91
(9.2)
105
(10.7)
74
(9.9)
54
(7.1)
28
(7.6)
Missing
1749
238
(36.1)
376
(37.9)
332
(33.9)
302
(40.5)
343
(45.4)
158
(42.8)
Overall
4501
659
(100.0)
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Table 2.4: Smoking status by age groups, ethnic and education level of patients enrolled in
the NCPR-Colorectal Cancer, 2008-2013
Smoking Status
Characteristics
Overall
Non-smoker
n
n
(%)
30 days)
n
Active smoker
(%)
n
(%)
1
(16.7)
0
(0.0)
(87.5)
1
(12.5)
0
(0.0)
18
(56.3)
3
(9.4)
11
(34.4)
43
26
(60.5)
6
(14.0)
11
(25.6)
35-39
69
43
(62.3)
12
(17.4)
14
(20.3)
40-44
121
76
(62.8)
18
(14.9)
27
(22.3)
45-49
208
125
(60.1)
43
(20.7)
40
(19.2)
50-54
306
214
(69.9)
48
(15.7)
44
(14.4)
55-59
389
261
(67.1)
67
(17.2)
61
(15.7)
60-64
437
255
(58.4)
111
(25.4)
71
(16.2)
65-69
398
237
(59.5)
104
(26.1)
57
(14.3)
70-74
369
232
(62.9)
83
(22.5)
54
(14.6)
75-79
193
124
(64.2)
47
(24.4)
22
(11.4)
>80
158
98
(62.0)
44
(27.8)
16
(10.1)
Male
1521
595
(39.1)
532
(35.0)
394
(25.9)
Female
1206
1118
(92.7)
55
(4.6)
33
(2.7)
Age group (years)
Gender
30 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
Smoking Status
Characteristics
Overall
Non-smoker
n
n
(%)
Malay
1186
715
(60.3)
Chinese
1061
697
(65.7)
Indian
155
106
Others
338
No formal education
Former smoker
(quit > 30 days)
n
Active smoker
(%)
n
(%)
263
(22.2)
208
(17.5)
223
(21.0)
141
(13.3)
(68.4)
28
(18.1)
21
(13.5)
203
(60.1)
77
(22.8)
58
(17.2)
343
238
(69.4)
64
(18.7)
41
(12.0)
Primary
501
279
(55.7)
139
(27.7)
83
(16.6)
Secondary
614
389
(63.4)
124
(20.2)
101
(16.4)
189
125
(66.1)
45
(23.8)
19
(10.1)
Ethnic
Education level
Tertiary
With the ever increasing number of cigarette smoker worldwide, the research
evaluating linkage between cigarette smoking and colorectal cancer is expanding.
For six-year duration of this registry, there were 9.6% of active smoker, 13.2% of
former smoker and another 38.4% were non-smoker.
Percentage of active smoker among colorectal cancer patients was noted to be higher
in male and age group between 25 and 44. There was no noticeable difference in
cigarette smoking status by ethnicity and educational level.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 31
Table 2.5: Family history of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
Year
Characteristics
Overall
2008
n
n
2009
2010
2011
2012
2013
(%)
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
Family history of Colorectal Cancer
Yes
288
42
(6.4)
58
(5.8)
64
(6.5)
50
(6.7)
56
(7.4)
18
(4.9)
No
3424
547
(83.0)
800
(80.6)
732
(74.8)
545
(73.1)
517
(68.4)
283
(76.7)
Missing
789
70
(10.6)
135
(13.6)
182
(18.6)
151
(20.2)
183
(24.2)
68
(18.4)
Overall
4501
659
(100.0)
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Family history of Other Cancer
Yes
343
54
(8.2)
71
(7.2)
65
(6.6)
53
(7.1)
61
(8.1)
39
(10.6)
No
2887
445
(67.5)
636
(64.0)
621
(63.5)
467
(62.6)
486
(64.3)
232
(62.9)
Missing
1271
160
(24.3)
286
(28.8)
292
(29.9)
226
(30.3)
209
(27.6)
98
(26.6)
Overall
4501
659
(100.0)
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Table 2.6: Family history by age groups, ethnic and education level of patients enrolled in
the NCPR-Colorectal Cancer, 2008-2013
Family history of Colorectal Cancer
Characteristics
Overall
No
Family history of Other Cancer
Yes
No
Yes
n
n
(%)
n
(%)
n
(%)
n
(%)
80
265
206
(77.7)
7
(2.6)
169
(63.8)
13
(4.9)
32 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
Family history of Colorectal Cancer
Characteristics
Overall
No
Family history of Other Cancer
Yes
No
Yes
n
n
(%)
n
(%)
n
(%)
n
(%)
Male
2518
1929
(76.6)
162
(6.4)
1623
(64.5)
182
(7.2)
Female
1933
1456
(75.3)
125
(6.5)
1232
(63.7)
159
(8.2)
Malay
1922
1453
(75.6)
117
(6.1)
1299
(67.6)
123
(6.4)
Chinese
1814
1319
(72.7)
144
(7.9)
1052
(58.0)
175
(9.6)
Indian
259
196
(75.7)
10
(3.9)
160
(61.8)
12
(4.6)
Others
484
438
(90.5)
16
(3.3)
363
(75.0)
30
(6.2)
No formal education
417
367
(88.0)
18
(4.3)
322
(77.2)
20
(4.8)
Primary
576
510
(88.5)
45
(7.8)
447
(77.6)
46
(8.0)
Secondary
672
591
(87.9)
50
(7.4)
488
(72.6)
71
(10.6)
Tertiary
201
160
(79.6)
26
(12.9)
145
(72.1)
36
(17.9)
Gender
Ethnic
Education level
Table 2.7: Past medical history of other cancers of patients enrolled in the NCPR-Colorectal
Cancer, 2008-2013
Year
Characteristics
Overall
2008
2010
2011
2012
2013
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
8
3
(0.3)
2
(0.2)
2
(0.3)
1
(0.1)
0
(0.0)
No
3834
990
(99.7)
976
(99.8)
744
(99.7)
755
(99.9)
369
(100.0)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
6
1
(0.1)
2
(0.2)
3
(0.4)
0
(0.0)
0
(0.0)
No
3836
992
(99.9)
976
(99.8)
743
(99.6)
756
(100.0)
369
(100.0)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
2
2
(0.2)
0
(0.0)
0
(0.0)
0
(0.0)
0
(0.0)
No
3840
991
(99.8)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
n
n
(%)
2009
Endometrial
Yes
Gastric
Yes
Small bowel
Yes
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 33
Year
Characteristics
Overall
2008
2010
2011
2012
2013
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
2
1
(0.1)
0
(0.0)
1
(0.1)
0
(0.0)
0
(0.0)
No
3840
992
(99.9)
978
(100.0)
745
(99.9)
756
(100.0)
369
(100.0)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
2
0
(0.0)
1
(0.1)
0
(0.0)
0
(0.0)
1
(0.3)
No
3840
993
(100.0)
977
(99.9)
746
(100.0)
756
(100.0)
368
(99.7)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
17
4
(0.4)
5
(0.5)
4
(0.5)
4
(0.5)
0
(0.0)
No
3825
989
(99.6)
973
(99.5)
742
(99.5)
752
(99.5)
369
(100.0)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
67
25
(2.5)
16
(1.6)
15
(2.0)
9
(1.2)
2
(0.5)
No
3775
968
(97.5)
962
(98.4)
731
(98.0)
747
(98.8)
367
(99.5)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
n
n
(%)
2009
Hepatobiliary
Yes
Urinary tract
Yes
Ovarian
Yes
Other
Yes
Even though family history is a known risk factor for colorectal cancer, there were
merely 288 (6.4%) patients with positive family history in this registry.
However the proportion of family history of other malignancies was higher (7.6%).
34 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
Table 2.8: Symptom of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
Year
Characteristics
Overall
2008
2009
2010
2011
2012
2013
n
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
Yes
444
77
(42.5)
65
(38.2)
85
(40.5)
50
(33.8)
104
(36.2)
63
(24.9)
No
805
104
(57.5)
105
(61.8)
125
(59.5)
98
(66.2)
183
(63.8)
190
(75.1)
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Yes
122
18
(9.9)
24
(14.1)
23
(11.0)
12
(8.1)
34
(11.8)
11
(4.3)
No
1127
163
(90.1)
146
(85.9)
187
(89.0)
136
(91.9)
253
(88.2)
242
(95.7)
Overall
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Yes
387
72
(39.8)
72
(42.4)
79
(37.6)
41
(27.7)
82
(28.6)
41
(16.2)
No
862
109
(60.2)
98
(57.6)
131
(62.4)
107
(72.3)
205
(71.4)
212
(83.8)
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Blood in the stool
Overall
Anemia
Weight loss
Overall
Intestinal obstruction
Yes
116
17
(9.4)
17
(10.0)
21
(10.0)
17
(11.5)
29
(10.1)
15
(5.9)
No
1133
164
(90.6)
153
(90.0)
189
(90.0)
131
(88.5)
258
(89.9)
238
(94.1)
Overall
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Yes
393
68
(37.6)
65
(38.2)
81
(38.6)
47
(31.8)
86
(30.0)
46
(18.2)
No
856
113
(62.4)
105
(61.8)
129
(61.4)
101
(68.2)
201
(70.0)
207
(81.8)
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Yes
295
77
(42.5)
55
(32.4)
45
(21.4)
28
(18.9)
45
(15.7)
45
(17.8)
No
954
104
(57.5)
115
(67.6)
165
(78.6)
120
(81.1)
242
(84.3)
208
(82.2)
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Abdominal pain
Overall
Others
Overall
Diarrhea, constipation, or other change in bowel habits
Yes
521
98
(54.1)
90
(52.9)
111
(52.9)
58
(39.2)
94
(32.8)
70
(27.7)
No
728
83
(45.9)
80
(47.1)
99
(47.1)
90
(60.8)
193
(67.2)
183
(72.3)
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Overall
Not applicable / Unknown
Yes
9
2
(1.1)
0
(0.0)
2
(1.0)
2
(1.4)
2
(0.7)
1
(0.4)
No
1240
179
(98.9)
170
(100.0)
208
(99.0)
146
(98.6)
285
(99.3)
252
(99.6)
Overall
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
* Information on symptoms was only available for 1249 patients.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 35
The most common presentations of colorectal cancer captured in the registry were
altered bowel habits (41.7%), followed by blood in stool (35.5%), abdominal pain
(31.5%), weight loss (31.0%), anemia (9.8%) and intestinal obstruction (9.3%).
For the six-year period, the pattern of presentation had been very consistent in our
registry. In 2013, altered bowel habit remained the most common presentation,
followed by blood in stool, abdominal pain, weight, intestinal obstruction and anemia.
36 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
CHAPTER 3
PRIMARY DIAGNOSIS & FINAL STAGING
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 37
PRIMARY DIAGNOSIS & FINAL STAGING
Table 3.1: Primary cancer site of patients enrolled in the NCPR-Colorectal Cancer, 20082013
Year
Characteristics
Overall
2008
2009
2010
2011
2012
2013
n
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
2409
353
(53.6)
477
(48.0)
538
(55.0)
423
(56.7)
421
(55.7)
197
(53.4)
648
98
(14.9)
170
(17.1)
137
(14.0)
89
(11.9)
112
(14.8)
42
(11.4)
1407
205
(31.1)
338
(34.0)
296
(30.3)
228
(30.6)
217
(28.7)
123
(33.3)
Missing
37
3
(0.5)
8
(0.8)
7
(0.7)
6
(0.8)
6
(0.8)
7
(1.9)
Overall
4501
659
(100.0)
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Caecum
223
36
(5.5)
41
(4.1)
62
(6.3)
38
(5.1)
30
(4.0)
16
(4.3)
Hepatic flexure
160
25
(3.8)
35
(3.5)
39
(4.0)
22
(2.9)
30
(4.0)
9
(2.4)
Ascending colon
206
39
(5.9)
47
(4.7)
46
(4.7)
32
(4.3)
28
(3.7)
14
(3.8)
Transverse colon
181
24
(3.6)
43
(4.3)
40
(4.1)
28
(3.8)
24
(3.2)
22
(6.0)
Splenic flexure
103
22
(3.3)
15
(1.5)
30
(3.1)
10
(1.3)
19
(2.5)
7
(1.9)
Descending colon
179
24
(3.6)
37
(3.7)
45
(4.6)
35
(4.7)
22
(2.9)
16
(4.3)
Sigmoid colon
915
132
(20.0)
195
(19.6)
218
(22.3)
161
(21.6)
142
(18.8)
67
(18.2)
Rectosigmoid
729
109
(16.5)
187
(18.8)
148
(15.1)
103
(13.8)
126
(16.7)
56
(15.2)
1456
218
(33.1)
336
(33.8)
307
(31.4)
240
(32.2)
223
(29.5)
132
(35.8)
Malignant Neoplasms based on ICD10
C18 Colon
C19 Rectosigmoid junction
C20 Rectum
Primary Cancer Site
Rectum
Anorectal
98
7
(1.1)
28
(2.8)
16
(1.6)
20
(2.7)
19
(2.5)
8
(2.2)
Colon
98
12
(1.8)
16
(1.6)
13
(1.3)
24
(3.2)
31
(4.1)
2
(0.5)
Others
16
3
(0.5)
© National Cancer Patient Registry-Colorectal Cancer
Jointly published by:
National Cancer Patient Registry-Colorectal Cancer and Clinical Research Centre (CRC)
Contact:
National Cancer Patient Registry-Colorectal Cancer
Registry Coordinating Centre
c/o Clinical Research Centre
Hospital Sultanah Bahiyah
KM 6, Jalan Langgar
05460 Alor Setar, Kedah
Malaysia
General line: 604-7407391
Fax: 604-7407373
Website: https://app.acrm.org.my/CCD
Disclaimer
Data reported were supplied by NCPR-CC. Interpretation and reporting is the responsibility of the
editors and do not reflect the official policy of the publisher or the authors’ affiliated institutions. The
data represents absolute numbers and not rates. Caution is advised before drawing conclusions from
the data. The registry is dynamic; numbers may vary between this report and real time data as the
registry continues to be updated.
This report is copyrighted. Reproduction and dissemination of this report in part or in whole for
research, educational or other non-commercial purposes are authorized without any prior written
permission from the copyright holders provided the source is fully acknowledged.
Suggested citation is:
Muhammad Radzi Abu Hassan, Wan Khamizar Wan Khazim, Zabedah Othman, Nik Raihan Nik
Mustapha, Rosaida Mohd Said, Tan Wei Leong, Mohd Azri Mohd Suan, Shahrul Aiman Soelar (eds),
The Second Report of the National Cancer Patient Registry-Colorectal Cancer, 2008-2013, Kuala
Lumpur, Malaysia 2014.
The electronic version of this report can be downloaded at https://app.acrm.org.my/CCD
ACKNOWLEDGEMENT
We would like to thank all contributing parties for their support and encouragement in
making this registry report a reality.
We would especially like to thank the following:
Director-General of Health, Ministry of Health Malaysia for support for the registry
and approval to publish this report.
Ministry of Health, Malaysia for the research grants to fund the registry.
The members of our steering committee for their expertise, time and effort dedicated
to the registry.
National Clinical Research Centre for its leadership, guidance and technical support.
Our source data providers from Ministry of Health Malaysia, University Hospitals and
private hospitals, without whose commitment, hard work and timely data collection
and submission, this report would not be possible.
Head of Pathology, Gastroenterogy, Oncology and Colorectal Surgery services.
Head of Anatomic Pathology and all Histopathologists involved.
All Hospital Directors, Clinicians and Surgeons of participating centers.
State epidemiologists involved.
The registry coordinating centre team and technical support team, for their continuous
commitment and contribution.
Health Informatics Centre for funding the reports’ printing.
About National Colorectal Cancer Registry in Malaysia
Introduction
The National Colorectal Cancer Registry started back in October 2007 involving nine
hospitals throughout Malaysia. The National Cancer Patients Registry is a multi-centre and
multidisciplinary project involving gastroenterologists, colorectal surgeons, pathologists and
oncologists. The registry has expanded from involvement of nine hospitals to 34 hospitals
throughout Malaysia from 2007 until 2013.
Furthermore, the registry is fully funded by a Ministry of Health grant disbursed through the
Clinical Research Centre (CRC) since its establishment as the registry is crucial to our
understanding of colorectal carcinoma in Malaysia. The registry coordinating centre/office is
based in Clinical Research Centre, Hospital Sultanah Bahiyah, Alor Setar, Kedah.
Rationale
The registry is mainly collecting data on prevalence, incidence, clinical aspects and treatment
modalities of colorectal cancer in Malaysia.
The main reason of the establishment of this National Colorectal Registry is to systematically
collect data on all aspects of colorectal cancer relevant to its prevention, management and
treatment evaluation in Malaysia. This registry will be able to function as guidance for
Ministry of Health, Malaysia in formulating policy to improve colorectal cancer prevention,
management and control. On top of that, the registry will be beneficial for NonGovernmental Organizations (NGO), private healthcare providers and healthcare industry in
program planning and evaluation.
Objectives
Objectives of the registry are:
1. To estimate the incidence and mortality rate of colorectal cancer in Malaysia.
2. To determine the socio-demographic profiles of patients with colorectal cancer in
Malaysia.
3. To identify the risk factors of patients with colorectal cancer.
4. To study the stage at diagnosis and histological types of colorectal cancer patients
5. To evaluate the treatment modalities for colorectal cancer.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 1
ORGANIZATION:
Steering Committee
Expert Panel
NCPR-CC Office
Source Data
Providers
2 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
User / Target Group
SOURCE DATA PROVIDERS / SDP:
Comprehensive cancer registration was achieved through data obtained from a combination
of sources, viz.:
(a) Notifications by the medical profession,
(b) Pathology records, and
(c) Hospital records
Histopathologists were the key persons in providing primary information on colorectal cancer
cases. For cancer cases obtained from sources other than physician’s notifications, the data
were checked against known registered cases in the registry. For missed notifications, the
doctors-in-charge would be informed and reminded to notify. Until year 2013, we have 34
SDP’s that tirelessly providing the valuable data on colorectal cancer. The list of all SDP’s
involved is as below;
Hospital Ampang
Hospital Sultanah Aminah, Johor Bahru
Hospital Duchess of Kent, Sandakan
Hospital Sultanah Bahiyah, Alor Star
Hospital Kepala Batas, Pulau Pinang
Hospital Sultanah Nur Zahirah, Kuala
Hospital Kuala Lumpur
Hospital Kulim
Hospital Taiping
Hospital Melaka
Hospital Tengku Ampuan Afzan,
Hospital Miri
Hospital Pulau Pinang
Hospital Putrajaya
Hospital Queen Elizabeth, K. Kinabalu
Hospital Tuanku Fauziah, Kangar
Hospital Raja Perempuan Zainab II,
Hospital Tuanku Jaafar, Seremban
Kelantan
Hospital Umum Sarawak, Kuching
Hospital Raja Permaisuri Bainun, Ipoh
Hospital Universiti Sains Malaysia,
Hospital Seberang Jaya, P. Pinang
Hospital Selayang, Selangor
Pusat Perubatan Universiti Malaya
Hospital Serdang, Selangor
Kedah Medical Centre, Alor Setar
Hospital Sibu, Sarawak
Mawar Medical Centre, Seremban
Hospital Sultan Abdul Halim, Sg. Petani
Metro Specialist Hospital, Sg. Petani
Hospital Sultan Ismail, Johor Bahru
Hospital Pantai, Sg. Petani
Putra Medical Centre, Alor Setar
Terengganu
Kuantan
Hospital Tengku Ampuan Rahimah,
Klang
Kelantan
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 3
STEERING COMMITTEE
NAME
INSTITUTION
Dato’ Dr Muhammad Radzi Abu Hassan
Department of Internal Medicine,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Dr Wendy Lim Wan Dee
Department of Internal Medicine,
Prince Court Hospital
Datin Dr Nik Raihan Nik Mustapha
Department of Pathology,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Dato’ Dr Wan Khamizar Wan Khazim
Department of Surgery,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Datuk Dr Yunus Gul Alif Gul
Department of Surgery,
Prince Court Hospital
Datuk Dr Ryan Ponnudurai
Department of Surgery,
Prince Court Hospital
Dr Hajjah Rosaida Hj Mohd Said
Department of Internal Medicine,
Hospital Ampang, Kuala Lumpur
Dr Arjunan Saravanan
Department of Internal Medicine,
Hospital Kuala Lumpur
Dr Hajjah Zabedah Hj Othman
Department of Radiotherapy and Oncology,
Hospital Kuala Lumpur
Datuk Dr Fitjerald Henry
Department of Surgery,
Hospital Selayang, Selangor
Prof. Dr April Roslani
Department of Surgery,
Univerity of Malaya Medical Center,
Kuala Lumpur
4 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
Prof Dr Nor Hayati Othman
Department of Pathology,
Hospital Universiti Sains Malaysia, Kelantan
Miss Jasiah Zakaria
Department of Surgery,
Hospital Tuanku Jaafar, Seremban,
Negeri Sembilan
Mr Chan Koon Khee
Department of Surgery,
Hospital Sultanah Aminah, Johor Bahru,
Johor
Dr Mohd Roslan bin Haron
Oncology Treatment Center,
Hospital Sultan Ismail, Johor Bahru, Johor
Dr Ahmad Shanwani Bin Mohamed Sidek
Department of Surgery,
Hospital Raja Perempuan Zainab II, Kelantan
Mr Nik Azim Nik Abdullah
Department of Surgery,
Hospital Umum Sarawak
Datuk Dr Jayaram Menon
Department of Internal Medicine,
Hospital Queen Elizabeth, K. Kinabalu,
Sabah
Dr Noor Laili Mokhtar
Department of Pathology,
Hospital Serdang, Selangor
Dr Mukarramah bt Che Ayub
Department of Pathology,
Hospital Raja Perempuan Zainab II, Kelantan
Assoc. Prof. Dr Gurjeet Kaur
A/P Chatar Singh
Department of Pathology,
Advanced Medical & Dental Institute,
Universiti Sains Malaysia, Penang
Dr Andee Dzulkarnaen Zakaria
Department of Surgery,
Hospital Universiti Sains Malaysia
Prof Datuk Dr Ismail Sagap
Department of Surgery,
Hospital Universiti Kebangsaan Malaysia
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 5
Assoc. Prof. Dr Raja Affendi Raja Ali
Department of Internal Medicine,
Hospital Universiti Kebangsaan Malaysia
Dr Gerald Lim Chin Chye
Department Of Radiotherapy & Oncology,
Hospital Kuala Lumpur
Dr Goh Pik Pin
Director,
National Clinical Research Center
Dr Jamaiyah Haniff
National Registry Unit,
Ministry of Health Malaysia
Mr Patrick Lum See Kai
Precision Soft Sdn Bhd
Miss Teo Jau Shya
ClinData Consulting Sdn Bhd
6 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
MEDICAL WRITING COMMITTEE
NAME
INSTITUTION
Dato’ Dr Muhammad Radzi Abu Hassan
Department of Internal Medicine,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Datin Dr Nik Raihan Nik Mustapha
Department of Pathology,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Dato’ Dr Wan Khamizar Wan Khazim
Department of Surgery,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Dr Hajjah Rosaida Hj Mohd Said
Department of Internal Medicine,
Hospital Ampang, Kuala Lumpur
Datuk Dr Fitjerald Henry
Department of Surgery,
Hospital Selayang, Selangor
Dr Hajjah Zabedah Hj Othman
Department of Radiotherapy and Oncology,
Hospital Kuala Lumpur
Dr Tan Wei Leong
Medical Officer,
Clinical Research Center,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Dr Mohd Azri Mohd Suan
Medical Officer,
Clinical Research Center,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Mr Shahrul Aiman Soelar
Statistician,
Clinical Research Center,
Hospital Sultanah Bahiyah Alor Setar, Kedah
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 7
National Colorectal Cancer Registry Coordinating Centre / Secretariat
NAME
INSTITUTION
Dr Madihah Ahmad
Medical Officer,
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Faizah Ahmad
Manager,
Research Officer,
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Ibtisam Ismail
Research Officer,
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Mr Shahrul Aiman Soelar
Statistician,
Clinical Research Center,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Siti Rohani Suddin
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Aliah Mat Ali
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Jambi Md Hussain
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Neoh Poh Tiew
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Nor Hafiza Johari
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Zainab Shafie
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Wan Muhana Abdullah
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Siti Aishah Aris
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
Miss Siti Ertina Asli
Clinical Research Centre,
Hospital Sultanah Bahiyah Alor Setar, Kedah
8 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
LETTER FROM THE PRINCIPAL INVESTIGATOR
The National Cancer Patient Registry-Colorectal Cancer is proud to present its second report
which incorporates results from 2008-2013.
The total data captured from the 34 Site Data Providers in six-year period was 4501.
Analyzing and coming out with this report was not an easy task. I take this opportunity to
congratulate the entire team involved from the data collection to data entry and finally to the
actual writing of this report. National Colorectal Cancer Registry is important, not just
because its’ valuable epidemiological data, but also management and outcome data which
will be a source of information for a national plan to combat this dreadful disease. This
information will be important for us when we formulate screening policies. This is especially
critical as colorectal cancer can be easily identified and treated if detected early. Hence,
prevention will be the most important tenet and strategy employed in the management of
colorectal cancer.
In addition, it is also a platform that will be used to develop more research with other
stakeholders. This is of paramount importance because combating such a prevalent disease
will involve multidisciplinary cooperation and effort that this registry can provide. Needless
to say, we hope that the availability of this database allows us to do more than formulating
policies. The possibilities in research and investigations in other aspects of colon cancer are
endless and hopefully with more data from more centers, this will be realized.
We want to thank all the source data providers for their support in making this report
possible. Furthermore, I would like to extend our gratitude to the Director General of Health
and Clinical Research Centre, Malaysia for their continuous support for the National
Colorectal Cancer Registry.
Thank you.
Dato’ Dr Muhammad Radzi Abu Hassan
Principal Investigator
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 9
TABLE OF CONTENTS
Acknowledgement
About NCPR-Colorectal Cancer In Malaysia
1
Organization
2
Source Data Providers
3
Steering Committee
4
Medical Writing Committee
7
National Colorectal Cancer Registry Coordinating Centre
8
Letter from The Principal Investigator
9
Table of Contents
10
List of Tables
11
List of Figures
13
Executive Summary
15
Chapter 1: Demographics
19
Chapter 2: Risk Factor and Clinical Presentation
27
Chapter 3: Primary Diagnosis and Final Staging
37
Chapter 4: Pathology
43
Chapter 5: Treatment Modalities
55
Chapter 6: Incidence and Mortality Rate
63
Appendix
69
10 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
LIST OF TABLES
Table 1.1: Total patients enrolled in the NCPR-Colorectal Cancer by centre, 20082013
20
Table 1.2: Demographics of patients enrolled in the NCPR-Colorectal Cancer, 20082013
22
Table 1.3: Age groups by gender and ethnicity of patients enrolled in the NCPRColorectal Cancer, 2008-2013
24
Table 1.4: Gender by ethnicity and education level of patients enrolled in the NCPRColorectal Cancer, 2008-2013
26
Table 2.1: Status of diabetes mellitus for patients enrolled in the NCPR-Colorectal
Cancer, 2008-2013
28
Table 2.2: Diabetes mellitus by age groups, ethnic and education level of patients
enrolled in the NCPR-Colorectal Cancer, 2008-2013
28
Table 2.3: Smoking status of patients enrolled in the NCPR-Colorectal Cancer, 20082013
30
Table 2.4: Smoking status by age groups, ethnic and education level of patients
enrolled in the NCPR-Colorectal Cancer, 2008-2013
30
Table 2.5: Family history of patients enrolled in the NCPR-Colorectal Cancer, 20082013
32
Table 2.6: Family history by age groups, ethnic and education level of patients
enrolled in the NCPR-Colorectal Cancer, 2008-2013
32
Table 2.7: Past medical history of other cancers of patients enrolled in the NCPRColorectal Cancer, 2008-2013
33
Table 2.8: Symptom of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
35
Table 3.1: Primary cancer site of patients enrolled in the NCPR-Colorectal Cancer,
2008-2013
38
Table 3.2: Primary cancer site by age groups of patients enrolled in the NCPRColorectal Cancer, 2008-2013
40
Table 3.3: Final TNM staging of patients enrolled in the NCPR-Colorectal Cancer,
2008-2013
40
Table 3.4: Final TNM staging by age groups, ethnic and education level of patients
enrolled in the NCPR-Colorectal Cancer, 2008-2013
41
Table 3.5: Final TNM staging by family history of patients enrolled in the NCPRColorectal Cancer, 2008-2013
42
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 11
Table 4.1: Number of lymph nodes, tumour size, angiolymphatic invasion and venous
lymphocytes of patients resected specimen enrolled in the NCPR-Colorectal Cancer,
2008-2013
44
Table 4.2: Final TNM staging by number of lymph nodes, tumour size,
angiolymphatic invasion and venous lymphocytes of patients resected specimen
enrolled in the NCPR-Colorectal Cancer, 2008-2013
44
Table 4.3: Proximal , distal and circumferential of patients resected specimen enrolled
in the NCPR-Colorectal Cancer, 2008-2013
46
Table 4.4: ypTNM staging of patients with resected specimen enrolled in the NCPRColorectal Cancer, 2008-2013
47
Table 4.5: pTNM staging of patients enrolled in the NCPR-Colorectal Cancer, 20082013
49
Table 4.6: Tumour differentiation by TNM staging of patients enrolled in the NCPRColorectal Cancer, 2008-2013
50
Table 4.7: Polyps of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
51
Table 4.8: Synchronous tumour present of patients enrolled in the NCPR-Colorectal
Cancer, 2008-2013
52
Table 4.9: Synchronous tumour in patients enrolled in the NCPR-Colorectal Cancer,
2008-2013
53
Table 5.1: Treatment modalities of patients enrolled in the NCPR-Colorectal Cancer,
2008-2013
56
Table 5.2: Treatment modalities of patients resected specimen enrolled in the NCPRColorectal Cancer, 2008-2013
57
Table 5.3: Final TNM staging by treatment modalities of patients enrolled in the
NCPR-Colorectal Cancer, 2008-2013
58
Table 5.4: Surgery method, operation performed and protocol/regimen of patients
enrolled in the NCPR-Colorectal Cancer, 2008-2013
60
Table 5.5: Final TNM staging by treatment modalities of patients enrolled in the
NCPR-Colorectal Cancer, 2008-2013.
61
Table 6.1: Status of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
64
Table 6.2: Age-adjusted rates (per 100,000) by gender of patiens in the NCPRColorectal Cancer, 2008-2013
66
Table 6.3: Age-adjusted rates (per 100,000) by ethnic of patiens in the NCPRColorectal Cancer, 2008-2013
67
Table 6.4: Patient status by final TNM staging of patients enrolled in the NCPRColorectal Cancer, 2008-2013
69
12 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
LIST OF FIGURES
Figure 1.0 : Data flow
18
Figure 1.1: Distributions of gender and ethnicity by age groups
24
Figure 1.2: Trends in the incidence and mortality of patients in the NCPRColorectal Cancer, 2008-2013
66
Figure 1.3: Trends in the incidence and mortality by ethnic of patiens in the NCPRColorectal Cancer, 2008-2013
67
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 13
14 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
EXECUTIVE SUMMARY
Incidence and mortality
From 2008 to 2013, overall incidence rate for colorectal cancer was 21.3
cases per 100, 000 populations in Malaysia. Age-adjusted incidence rate
of colorectal cancer was 1.33 times higher among male than female. The
incidence rate of colorectal cancer per 100,000 population by ethnicity
was highest in Chinese (27.4 cases per 100,00 population).
From 2008 to 2013, overall mortality rate for colorectal cancer was 9.8
cases per 100,000 populations. Likewise, age-adjusted mortality rate of
colorectal cancer was about 1.42 times higher among male than female.
International comparisons in incidence and mortality:
From 2007 to 2011, incidence rate for colorectal cancer in United States
of America was 43.7 per 100,000 populations annually and their
mortality rate was 15.9 per 100,000 populations annually.
In Asia, Japan had incidence rate of 41.7 per 100,000 populations and
22.8 per 100,000 populations for female in 2008. As for the mortality
rate, male was 15.2 per 100,000 populations while female was 8.9 per
100,000 populations (2008, U.S National Institute of Health).
In Malaysia, our overall incidence rate was 21.3 cases per 100,000
populations from 2008 until 2013. Our mortality rate for the same
duration was 9.8 cases per 100,000 populations.
Demographics
In the six-year period between 2008 and 2013, mean age for colorectal
cancer patients was 61.6 year old (standard deviation of 12.7).
Registered colorectal cancer was more dominant among male than female
for the entire period from 2008 to 2013.
The proportion of colorectal cancer increased with age for both men and
women in the six-year duration.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 15
Risk factors and clinical presentation
In this registry, there were 22.3% of colorectal cancer patient with
diabetes mellitus. The trend of diabetes mellitus was persistent between
19.3% and 25.6%.
For these six-year duration, there were 9.6% of active smoker, 13.2% of
former smoker and 38.4% were non-smoker.
Even though family history is a known risk factor for colorectal cancer,
there were merely 6.4% patients with positive family history.
The most common presentation of colorectal cancer was altered bowel
habits (41.7%).
Primary diagnosis and final staging
The commonest site of colorectal cancer was at colon according to ICD
10 from 2008 until 2013. However, rectum and rectosigmoid were the
commonest site of colorectal cancer when colon is specifically divided
into small segment.
Left sided tumour constitutes more than three quarter of the colorectal
cancer notified.
Over the past six-year period, majority of our patient were diagnosed at
stage III according to final TNM staging.
Pathology of colorectal cancer
The most common histologic tumour type seen in colorectal cancer
patients in Malaysia is adenocarcinoma of usual-type (95.5%), most of
which were moderately-differentiated.
The majority of our patients were presented with locally advanced tumour
(pT3 and pT4). In addition, more than half had nodal metastasis.
16 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
Treatment modalities
There was 70.8% of colorectal cancer patients had surgery performed and
35.9% of colorectal patients had chemotherapy. For rectal cancer, 26.3%
of our patients received radiotherapy.
As for complimentary or alternative treatment, 5.5% of our patients
received the care while there was merely 1.6% of colorectal cancer
patients received palliative care in this registry.
The data on chemotherapy and radiotherapy are still insufficient for
analysis.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 17
SELECTION OF THE PATIENTS
The figures produced in this report are based on National Cancer Patient Registry –
Colorectal data. 316 cases were requested the case to delete. The resulting sample of 6971
cases was then restricted to year of diagnosis between 2008 and 2013. Duplicate records were
identified on the Patient ID.
Figure 1.0: Data flow
18 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
CHAPTER 1
DEMOGRAPHICS
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 19
DEMOGRAPHICS
Table 1.1: Total patients enrolled in the NCPR-Colorectal Cancer by centre, 2008-2013
Year
Participating
Overall
2008
2009
2010
2011
2012
2013
Hospitals
n
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
1
67
1
(0.2)
25
(2.5)
22
(2.2)
13
(1.7)
6
(0.8)
0
(0.0)
2
36
7
(1.1)
16
(1.6)
12
(1.2)
1
(0.1)
0
(0.0)
0
(0.0)
3
132
2
(0.3)
21
(2.1)
24
(2.5)
26
(3.5)
39
(5.2)
20
(5.4)
4
353
99
(15.0)
61
(6.1)
84
(8.6)
69
(9.2)
39
(5.2)
1
(0.3)
5
20
0
(0.0)
4
(0.4)
5
(0.5)
1
(0.1)
7
(0.9)
3
(0.8)
6
112
1
(0.2)
22
(2.2)
39
(4.0)
31
(4.2)
19
(2.5)
0
(0.0)
7
29
1
(0.2)
19
(1.9)
8
(0.8)
1
(0.1)
0
(0.0)
0
(0.0)
8
276
17
(2.6)
95
(9.6)
88
(9.0)
50
(6.7)
17
(2.2)
9
(2.4)
9
40
4
(0.6)
7
(0.7)
17
(1.7)
4
(0.5)
4
(0.5)
4
(1.1)
10
321
69
(10.5)
50
(5.0)
54
(5.5)
65
(8.7)
53
(7.0)
30
(8.1)
11
175
40
(6.1)
28
(2.8)
35
(3.6)
36
(4.8)
20
(2.6)
16
(4.3)
12
133
1
(0.2)
42
(4.2)
33
(3.4)
27
(3.6)
30
(4.0)
0
(0.0)
13
85
8
(1.2)
22
(2.2)
27
(2.8)
12
(1.6)
10
(1.3)
6
(1.6)
14
282
86
(13.1)
75
(7.6)
69
(7.1)
4
(0.5)
7
(0.9)
41
(11.1)
15
22
20
(3.0)
0
(0.0)
0
(0.0)
0
(0.0)
1
(0.1)
1
(0.3)
16
31
2
(0.3)
19
(1.9)
10
(1.0)
0
(0.0)
0
(0.0)
0
(0.0)
17
27
1
(0.2)
3
(0.3)
6
(0.6)
5
(0.7)
11
(1.5)
1
(0.3)
18
179
3
(0.5)
4
(0.4)
5
(0.5)
19
(2.5)
110
(14.6)
38
(10.3)
19
210
70
(10.6)
61
(6.1)
42
(4.3)
29
(3.9)
5
(0.7)
3
(0.8)
20
403
85
(12.9)
80
(8.1)
76
(7.8)
62
(8.3)
65
(8.6)
35
(9.5)
21
146
7
(1.1)
33
(3.3)
35
(3.6)
30
(4.0)
29
(3.8)
12
(3.3)
22
68
5
(0.8)
16
(1.6)
11
(1.1)
19
(2.5)
9
(1.2)
8
(2.2)
23
54
0
(0.0)
0
(0.0)
0
(0.0)
15
(2.0)
9
(1.2)
30
(8.1)
24
223
5
(0.8)
29
(2.9)
27
(2.8)
41
(5.5)
73
(9.7)
48
(13.0)
25
54
0
(0.0)
17
(1.7)
6
(0.6)
10
(1.3)
18
(2.4)
3
(0.8)
26
194
5
(0.8)
42
(4.2)
45
(4.6)
42
(5.6)
59
(7.8)
1
(0.3)
27
560
75
(11.4)
123
(12.4)
121
(12.4)
110
(14.7)
83
(11.0)
48
(13.0)
28
128
34
(5.2)
38
(3.8)
48
(4.9)
5
(0.7)
2
(0.3)
1
(0.3)
29
42
2
(0.3)
8
(0.8)
12
(1.2)
6
(0.8)
10
(1.3)
4
(1.1)
30
8
0
(0.0)
1
(0.1)
3
(0.3)
2
(0.3)
2
(0.3)
0
(0.0)
31
15
0
(0.0)
7
(0.7)
3
(0.3)
1
(0.1)
1
(0.1)
3
(0.8)
32
2
0
(0.0)
1
(0.1)
1
(0.1)
0
(0.0)
0
(0.0)
0
(0.0)
33
38
4
(0.6)
13
(1.3)
1
(0.1)
4
(0.5)
13
(1.7)
3
(0.8)
34
36
5
(0.8)
11
(1.1)
9
(0.9)
6
(0.8)
5
(0.7)
0
(0.0)
4501
659
(100.0)
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Overall
20 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
There were 34 hospitals throughout Malaysia in this registry with a total of 4501
colorectal cancer patients registered over six-year period (2008-2013).
The number of colorectal cancer patients captured in the registry was consistent
throughout this six-year period except slight reduction in 2013 (range between 369
and 978 cases per annum).
The number of patients registered in each hospital or medical centre depends on the
number of colorectal cancer patients encountered in their setting.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 21
Table 1.2: Demographics of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
Year
Characteristics
Overall
n
2008
n
2009
(%)
n
2010
(%)
n
2011
(%)
n
2012
(%)
n
2013
(%)
n
(%)
Age (years)
n
4458
654
975
975
739
751
364
Mean
61.6
61.2
62.1
61.6
61.3
61.7
61.4
12.72
12.21
12.32
12.84
12.94
12.55
12.54
Standard Deviation
Age groups (years)
80
265
42
(15.8)
58
(21.9)
63
(23.8)
43
(16.2)
41
(15.5)
18
(6.8)
43
5
(11.6)
18
(41.9)
3
(7.0)
7
(16.3)
5
(11.6)
5
(11.6)
Male
2518
393
(15.6)
546
(21.7)
569
(22.6)
387
(15.4)
422
(16.8)
201
(8.0)
Female
1933
264
(13.7)
444
(23.0)
405
(21.0)
355
(18.4)
310
(16.0)
155
(8.0)
Missing
50
2
(4.0)
3
(6.0)
4
(8.0)
4
(8.0)
24
(48.0)
13
(26.0)
Malay
1922
266
(13.8)
394
(20.5)
432
(22.5)
322
(16.8)
334
(17.4)
174
(9.1)
Chinese
1814
265
(14.6)
426
(23.5)
386
(21.3)
296
(16.3)
307
(16.9)
134
(7.4)
Indian
259
36
(13.9)
63
(24.3)
58
(22.4)
45
(17.4)
35
(13.5)
22
(8.5)
Others
484
90
(18.6)
108
(22.3)
101
(20.9)
79
(16.3)
71
(14.7)
35
(7.2)
Missing
22
2
(9.1)
2
(9.1)
1
(4.5)
4
(18.2)
9
(40.9)
4
(18.2)
No formal education
417
115
(27.6)
83
(19.9)
80
(19.2)
45
(10.8)
64
(15.3)
30
(7.2)
Primary
576
96
(16.7)
146
(25.3)
132
(22.9)
103
(17.9)
64
(11.1)
35
(6.1)
Secondary
672
91
(13.5)
165
(24.6)
174
(25.9)
99
(14.7)
94
(14.0)
49
(7.3)
Tertiary
201
27
(13.4)
43
(21.4)
59
(29.4)
30
(14.9)
26
(12.9)
16
(8.0)
Missing
2635
330
(12.5)
556
(21.1)
533
(20.2)
469
(17.8)
508
(19.3)
239
(9.1)
Missing
Gender
Ethnic
Education level
22 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
In the six-year period between 2008 and 2013, the mean age for total colorectal
patients was 61.6 year old (standard deviation 12.7).
The registered colorectal cancer was more dominant among male than female for the
entire period from 2008 to 2013.
From 2008 to 2013, the registered colorectal cancer decreased for both male and
female. For male, the rate decreased from 15.6% to 8.0 % while the rate decreased
from 13.7 to 8.0% for female.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 23
Figure 1.1: Distributions of gender and ethnicity by age groups
Table 1.3: Age groups by gender and ethnicity of patients enrolled in the NCPR-Colorectal
Cancer, 2008-2013
Gender
Male
Characteristics
Ethnic
Female
Malay
Chinese
Indian
Others
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
7
(0.3)
4
(0.2)
5
(0.3)
2
(0.1)
0
(0.0)
4
(0.9)
20-24
9
(0.4)
8
(0.4)
10
(0.5)
2
(0.1)
1
(0.4)
4
(0.9)
25-29
27
(1.1)
20
(1.0)
31
(1.6)
2
(0.1)
1
(0.4)
13
(2.8)
30-34
32
(1.3)
33
(1.7)
42
(2.2)
7
(0.4)
5
(1.9)
10
(2.1)
35-39
61
(2.4)
51
(2.7)
54
(2.8)
25
(1.4)
10
(3.9)
23
(4.9)
40-44
106
(4.2)
86
(4.5)
105
(5.5)
39
(2.2)
14
(5.4)
36
(7.7)
45-49
175
(7.0)
149
(7.8)
172
(9.0)
92
(5.1)
20
(7.7)
42
(9.0)
50-54
250
(10.0)
212
(11.1)
229
(12.0)
139
(7.7)
33
(12.7)
61
(13.1)
55-59
330
(13.2)
289
(15.1)
282
(14.8)
241
(13.4)
34
(13.1)
69
(14.8)
60-64
433
(17.3)
273
(14.3)
302
(15.8)
300
(16.6)
45
(17.4)
63
(13.5)
65-69
397
(15.9)
246
(12.9)
257
(13.5)
310
(17.2)
31
(12.0)
47
(10.1)
70-74
346
(13.9)
260
(13.6)
232
(12.2)
307
(17.0)
36
(13.9)
39
(8.4)
75-79
189
(7.6)
157
(8.2)
99
(5.2)
192
(10.6)
18
(6.9)
36
(7.7)
>80
136
(5.4)
126
(6.6)
89
(4.7)
145
(8.0)
11
(4.2)
20
(4.3)
2498
(100.0)
1914
(100.0)
1909
(100.0)
1803
(100.0)
259
(100.0)
467
(100.0)
Age groups (years)
30 days)
594
96
(14.6)
131
(13.2)
141
(14.4)
88
(11.8)
90
(11.9)
48
(13.0)
Active smoker
Smoking Status
Non-smoker
430
78
(11.8)
91
(9.2)
105
(10.7)
74
(9.9)
54
(7.1)
28
(7.6)
Missing
1749
238
(36.1)
376
(37.9)
332
(33.9)
302
(40.5)
343
(45.4)
158
(42.8)
Overall
4501
659
(100.0)
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Table 2.4: Smoking status by age groups, ethnic and education level of patients enrolled in
the NCPR-Colorectal Cancer, 2008-2013
Smoking Status
Characteristics
Overall
Non-smoker
n
n
(%)
30 days)
n
Active smoker
(%)
n
(%)
1
(16.7)
0
(0.0)
(87.5)
1
(12.5)
0
(0.0)
18
(56.3)
3
(9.4)
11
(34.4)
43
26
(60.5)
6
(14.0)
11
(25.6)
35-39
69
43
(62.3)
12
(17.4)
14
(20.3)
40-44
121
76
(62.8)
18
(14.9)
27
(22.3)
45-49
208
125
(60.1)
43
(20.7)
40
(19.2)
50-54
306
214
(69.9)
48
(15.7)
44
(14.4)
55-59
389
261
(67.1)
67
(17.2)
61
(15.7)
60-64
437
255
(58.4)
111
(25.4)
71
(16.2)
65-69
398
237
(59.5)
104
(26.1)
57
(14.3)
70-74
369
232
(62.9)
83
(22.5)
54
(14.6)
75-79
193
124
(64.2)
47
(24.4)
22
(11.4)
>80
158
98
(62.0)
44
(27.8)
16
(10.1)
Male
1521
595
(39.1)
532
(35.0)
394
(25.9)
Female
1206
1118
(92.7)
55
(4.6)
33
(2.7)
Age group (years)
Gender
30 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
Smoking Status
Characteristics
Overall
Non-smoker
n
n
(%)
Malay
1186
715
(60.3)
Chinese
1061
697
(65.7)
Indian
155
106
Others
338
No formal education
Former smoker
(quit > 30 days)
n
Active smoker
(%)
n
(%)
263
(22.2)
208
(17.5)
223
(21.0)
141
(13.3)
(68.4)
28
(18.1)
21
(13.5)
203
(60.1)
77
(22.8)
58
(17.2)
343
238
(69.4)
64
(18.7)
41
(12.0)
Primary
501
279
(55.7)
139
(27.7)
83
(16.6)
Secondary
614
389
(63.4)
124
(20.2)
101
(16.4)
189
125
(66.1)
45
(23.8)
19
(10.1)
Ethnic
Education level
Tertiary
With the ever increasing number of cigarette smoker worldwide, the research
evaluating linkage between cigarette smoking and colorectal cancer is expanding.
For six-year duration of this registry, there were 9.6% of active smoker, 13.2% of
former smoker and another 38.4% were non-smoker.
Percentage of active smoker among colorectal cancer patients was noted to be higher
in male and age group between 25 and 44. There was no noticeable difference in
cigarette smoking status by ethnicity and educational level.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 31
Table 2.5: Family history of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
Year
Characteristics
Overall
2008
n
n
2009
2010
2011
2012
2013
(%)
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
Family history of Colorectal Cancer
Yes
288
42
(6.4)
58
(5.8)
64
(6.5)
50
(6.7)
56
(7.4)
18
(4.9)
No
3424
547
(83.0)
800
(80.6)
732
(74.8)
545
(73.1)
517
(68.4)
283
(76.7)
Missing
789
70
(10.6)
135
(13.6)
182
(18.6)
151
(20.2)
183
(24.2)
68
(18.4)
Overall
4501
659
(100.0)
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Family history of Other Cancer
Yes
343
54
(8.2)
71
(7.2)
65
(6.6)
53
(7.1)
61
(8.1)
39
(10.6)
No
2887
445
(67.5)
636
(64.0)
621
(63.5)
467
(62.6)
486
(64.3)
232
(62.9)
Missing
1271
160
(24.3)
286
(28.8)
292
(29.9)
226
(30.3)
209
(27.6)
98
(26.6)
Overall
4501
659
(100.0)
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Table 2.6: Family history by age groups, ethnic and education level of patients enrolled in
the NCPR-Colorectal Cancer, 2008-2013
Family history of Colorectal Cancer
Characteristics
Overall
No
Family history of Other Cancer
Yes
No
Yes
n
n
(%)
n
(%)
n
(%)
n
(%)
80
265
206
(77.7)
7
(2.6)
169
(63.8)
13
(4.9)
32 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
Family history of Colorectal Cancer
Characteristics
Overall
No
Family history of Other Cancer
Yes
No
Yes
n
n
(%)
n
(%)
n
(%)
n
(%)
Male
2518
1929
(76.6)
162
(6.4)
1623
(64.5)
182
(7.2)
Female
1933
1456
(75.3)
125
(6.5)
1232
(63.7)
159
(8.2)
Malay
1922
1453
(75.6)
117
(6.1)
1299
(67.6)
123
(6.4)
Chinese
1814
1319
(72.7)
144
(7.9)
1052
(58.0)
175
(9.6)
Indian
259
196
(75.7)
10
(3.9)
160
(61.8)
12
(4.6)
Others
484
438
(90.5)
16
(3.3)
363
(75.0)
30
(6.2)
No formal education
417
367
(88.0)
18
(4.3)
322
(77.2)
20
(4.8)
Primary
576
510
(88.5)
45
(7.8)
447
(77.6)
46
(8.0)
Secondary
672
591
(87.9)
50
(7.4)
488
(72.6)
71
(10.6)
Tertiary
201
160
(79.6)
26
(12.9)
145
(72.1)
36
(17.9)
Gender
Ethnic
Education level
Table 2.7: Past medical history of other cancers of patients enrolled in the NCPR-Colorectal
Cancer, 2008-2013
Year
Characteristics
Overall
2008
2010
2011
2012
2013
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
8
3
(0.3)
2
(0.2)
2
(0.3)
1
(0.1)
0
(0.0)
No
3834
990
(99.7)
976
(99.8)
744
(99.7)
755
(99.9)
369
(100.0)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
6
1
(0.1)
2
(0.2)
3
(0.4)
0
(0.0)
0
(0.0)
No
3836
992
(99.9)
976
(99.8)
743
(99.6)
756
(100.0)
369
(100.0)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
2
2
(0.2)
0
(0.0)
0
(0.0)
0
(0.0)
0
(0.0)
No
3840
991
(99.8)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
n
n
(%)
2009
Endometrial
Yes
Gastric
Yes
Small bowel
Yes
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 33
Year
Characteristics
Overall
2008
2010
2011
2012
2013
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
2
1
(0.1)
0
(0.0)
1
(0.1)
0
(0.0)
0
(0.0)
No
3840
992
(99.9)
978
(100.0)
745
(99.9)
756
(100.0)
369
(100.0)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
2
0
(0.0)
1
(0.1)
0
(0.0)
0
(0.0)
1
(0.3)
No
3840
993
(100.0)
977
(99.9)
746
(100.0)
756
(100.0)
368
(99.7)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
17
4
(0.4)
5
(0.5)
4
(0.5)
4
(0.5)
0
(0.0)
No
3825
989
(99.6)
973
(99.5)
742
(99.5)
752
(99.5)
369
(100.0)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
67
25
(2.5)
16
(1.6)
15
(2.0)
9
(1.2)
2
(0.5)
No
3775
968
(97.5)
962
(98.4)
731
(98.0)
747
(98.8)
367
(99.5)
Overall
3842
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
n
n
(%)
2009
Hepatobiliary
Yes
Urinary tract
Yes
Ovarian
Yes
Other
Yes
Even though family history is a known risk factor for colorectal cancer, there were
merely 288 (6.4%) patients with positive family history in this registry.
However the proportion of family history of other malignancies was higher (7.6%).
34 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
Table 2.8: Symptom of patients enrolled in the NCPR-Colorectal Cancer, 2008-2013
Year
Characteristics
Overall
2008
2009
2010
2011
2012
2013
n
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
Yes
444
77
(42.5)
65
(38.2)
85
(40.5)
50
(33.8)
104
(36.2)
63
(24.9)
No
805
104
(57.5)
105
(61.8)
125
(59.5)
98
(66.2)
183
(63.8)
190
(75.1)
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Yes
122
18
(9.9)
24
(14.1)
23
(11.0)
12
(8.1)
34
(11.8)
11
(4.3)
No
1127
163
(90.1)
146
(85.9)
187
(89.0)
136
(91.9)
253
(88.2)
242
(95.7)
Overall
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Yes
387
72
(39.8)
72
(42.4)
79
(37.6)
41
(27.7)
82
(28.6)
41
(16.2)
No
862
109
(60.2)
98
(57.6)
131
(62.4)
107
(72.3)
205
(71.4)
212
(83.8)
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Blood in the stool
Overall
Anemia
Weight loss
Overall
Intestinal obstruction
Yes
116
17
(9.4)
17
(10.0)
21
(10.0)
17
(11.5)
29
(10.1)
15
(5.9)
No
1133
164
(90.6)
153
(90.0)
189
(90.0)
131
(88.5)
258
(89.9)
238
(94.1)
Overall
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Yes
393
68
(37.6)
65
(38.2)
81
(38.6)
47
(31.8)
86
(30.0)
46
(18.2)
No
856
113
(62.4)
105
(61.8)
129
(61.4)
101
(68.2)
201
(70.0)
207
(81.8)
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Yes
295
77
(42.5)
55
(32.4)
45
(21.4)
28
(18.9)
45
(15.7)
45
(17.8)
No
954
104
(57.5)
115
(67.6)
165
(78.6)
120
(81.1)
242
(84.3)
208
(82.2)
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Abdominal pain
Overall
Others
Overall
Diarrhea, constipation, or other change in bowel habits
Yes
521
98
(54.1)
90
(52.9)
111
(52.9)
58
(39.2)
94
(32.8)
70
(27.7)
No
728
83
(45.9)
80
(47.1)
99
(47.1)
90
(60.8)
193
(67.2)
183
(72.3)
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
Overall
Not applicable / Unknown
Yes
9
2
(1.1)
0
(0.0)
2
(1.0)
2
(1.4)
2
(0.7)
1
(0.4)
No
1240
179
(98.9)
170
(100.0)
208
(99.0)
146
(98.6)
285
(99.3)
252
(99.6)
Overall
1249
181
(100.0)
170
(100.0)
210
(100.0)
148
(100.0)
287
(100.0)
253
(100.0)
* Information on symptoms was only available for 1249 patients.
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 35
The most common presentations of colorectal cancer captured in the registry were
altered bowel habits (41.7%), followed by blood in stool (35.5%), abdominal pain
(31.5%), weight loss (31.0%), anemia (9.8%) and intestinal obstruction (9.3%).
For the six-year period, the pattern of presentation had been very consistent in our
registry. In 2013, altered bowel habit remained the most common presentation,
followed by blood in stool, abdominal pain, weight, intestinal obstruction and anemia.
36 | The Second Report of the NCPR-Colorectal Cancer 2008 - 2013
CHAPTER 3
PRIMARY DIAGNOSIS & FINAL STAGING
The Second Report of the NCPR-Colorectal Cancer 2008 - 2013 | 37
PRIMARY DIAGNOSIS & FINAL STAGING
Table 3.1: Primary cancer site of patients enrolled in the NCPR-Colorectal Cancer, 20082013
Year
Characteristics
Overall
2008
2009
2010
2011
2012
2013
n
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
n
(%)
2409
353
(53.6)
477
(48.0)
538
(55.0)
423
(56.7)
421
(55.7)
197
(53.4)
648
98
(14.9)
170
(17.1)
137
(14.0)
89
(11.9)
112
(14.8)
42
(11.4)
1407
205
(31.1)
338
(34.0)
296
(30.3)
228
(30.6)
217
(28.7)
123
(33.3)
Missing
37
3
(0.5)
8
(0.8)
7
(0.7)
6
(0.8)
6
(0.8)
7
(1.9)
Overall
4501
659
(100.0)
993
(100.0)
978
(100.0)
746
(100.0)
756
(100.0)
369
(100.0)
Caecum
223
36
(5.5)
41
(4.1)
62
(6.3)
38
(5.1)
30
(4.0)
16
(4.3)
Hepatic flexure
160
25
(3.8)
35
(3.5)
39
(4.0)
22
(2.9)
30
(4.0)
9
(2.4)
Ascending colon
206
39
(5.9)
47
(4.7)
46
(4.7)
32
(4.3)
28
(3.7)
14
(3.8)
Transverse colon
181
24
(3.6)
43
(4.3)
40
(4.1)
28
(3.8)
24
(3.2)
22
(6.0)
Splenic flexure
103
22
(3.3)
15
(1.5)
30
(3.1)
10
(1.3)
19
(2.5)
7
(1.9)
Descending colon
179
24
(3.6)
37
(3.7)
45
(4.6)
35
(4.7)
22
(2.9)
16
(4.3)
Sigmoid colon
915
132
(20.0)
195
(19.6)
218
(22.3)
161
(21.6)
142
(18.8)
67
(18.2)
Rectosigmoid
729
109
(16.5)
187
(18.8)
148
(15.1)
103
(13.8)
126
(16.7)
56
(15.2)
1456
218
(33.1)
336
(33.8)
307
(31.4)
240
(32.2)
223
(29.5)
132
(35.8)
Malignant Neoplasms based on ICD10
C18 Colon
C19 Rectosigmoid junction
C20 Rectum
Primary Cancer Site
Rectum
Anorectal
98
7
(1.1)
28
(2.8)
16
(1.6)
20
(2.7)
19
(2.5)
8
(2.2)
Colon
98
12
(1.8)
16
(1.6)
13
(1.3)
24
(3.2)
31
(4.1)
2
(0.5)
Others
16
3
(0.5)