COLORECTAL CANCER: Global Trends & Implications for Uganda Discussant Charles L.M. Olweny MD, FRACP

CAUSES OF DEATH AFTER 1ST FIVE YEARS HEART DISEASE ACCIDENTS CANCER

WHAT IS CANCER? Uncontrolled, purposeless growth of cells, tissues, which if left un attended to may lead to death of cells, tissues and the individual

FACTS ABOUT CANCER 1/3 CAN BE PREVENTED 1/3 CAN BE CURED 1/3 CAN BENEFIT FROM PALLIATION

GOALS OF CANCER TREATMENT CURE PROLONG LIFE PALLIATION

KYADONDO CANCER REGISTRY You cannot improve anything you cannot measure; Kyadondo cancer registry was founded in 1951; Reduced activity in 1980’s; Re-activated in 1989; One of few African registries in 3 volume “Cancer in Five Continents”

TOP 10 MALE CANCERS IN KCR 2007-2009 Kaposi’s sarcoma Prostate cancer Non-Hodgkin’s lymphoma Cancer of oesophagus Liver cancer LARGE BOWEL CANCER Eye Leukemia Stomach Skin Cancers

TOP 10 FEMALE CANCERS IN KCR 2007-2009 Cancer of the Cervix Kaposi’s sarcoma Breast cancer Non-Hodgkin’s lymphoma Liver cancer LARGE BOWEL CANCER Oesophagus Eye Ovary Leukemia

COLORECTAL CANCER IN UGANDA In US colorectal cancer affects mostly >50 year olds, BUT in Uganda 50% of population is under the age 15, and colorectal cancer affects 40-50 year olds; Colorectal cancer is 3rd commonest cancer. In Uganda it is 6th commonest and 20 years ago it did not feature at all in top 10; Risk factors include high fat, low fibre, lack of physical activity , obesity , tobacco, alcohol; ”Disease of life style”

COLORECTAL CANCER Lower survival for Africans &Hispanics More aggressive disease ? As in HD Present late. It can’t be cancer; Traditional healer’s role Lack of appropriate treatment facilities; All diagnostic tests including tumour markers CEA, CA19-9 are available

HIGH RISK First and 2nd degree relatives need close surveillance from 30-40 years onwards To include an an annual check up (physical exam and occult blood); Colonoscopy every 3-5 years

CANCER CURE Attainment of normal life expectancy Curable malignancies include: Leukemias especially acute childhood leukemia; Lymphomas ie. Burkitt’s lymphoma, Hodgkin’s disease and non-Hodgkin’s lymphoma (DLC) and some solid tumours eg. Early stage colon cancer, Germ cell tumour and ??? Early breast cancer

CANCER CURE BY TREATMENT MODALITIES SURGERY :-skin, colon, ???early breast Radiotherapy:- lymphomas, head and neck Chemotherapy:- Hodgkin’s disease, Burkitt’s lymphoma, leukemia and germ cell tumour Combined modality:- ??Early breast carcinoma

PERSONAL THANKS Thank you all for listening to me Thank Francis &Kathryn Omaswa for spearheading this venture Thank Clem Kiire for his insight and willingness to share it all with us Thank UCS for willingness to embrace this venture.