Download colorectal cancer factsheet - Welsh Cancer Intelligence and

COLORECTAL CANCER FACTSHEET
What does colorectal mean?
Colorectal is a word which means 'the colon and rectum'. The colon and rectum are parts of the gut (gastrointestinal tract). The gut starts at the
mouth and ends at the anus. When we eat or drink the food and liquid travel down the oesophagus (gullet) into the stomach. The stomach churns
up the food and then passes it into the small intestine.
The small intestine (sometimes called the small bowel) is several metres long and is where food is digested and absorbed. Undigested food, water
and waste products are then passed into the large intestine (sometimes called the large bowel). The main part of the large intestine is called the
colon which is about 150 cm long. This is split into four sections, the ascending, transverse, descending, and sigmoid colon. Some water and salts
are absorbed into the body from the colon. The colon leads into the rectum (back passage) which is about 15 cm long. The rectum stores faeces
(stools) before they are passed out from the anus.
Source: www.patient.co.uk
Types of bowel cancer
Adenocarcinomas
More than 95% of colorectal cancers are adenocarcinomas. This means that the cancer started in the gland cells in the lining of the bowel wall. The
gland cells normally produce mucus. This is a slimy substance that makes it easier for the stool to pass through the bowel.
There are one or two particular types of adenocarcinoma of the colon and rectum. You may hear your doctor talking about a mucinous tumour or a
signet-ring tumour. These terms refer to the look of the cells under the microscope.
Mucinous tumours often have the cancer cells in pools of mucus. Signet-ring tumours have mucus inside the cells. The mucus pushes the nucleus
(control centre) of the cell over to one side, making the tumour cell look the shape of a signet ring under the microscope. Only about 1-2% of all
colorectal cancers are signet-ring type. They are treated the same way as other adenocarcinomas of the colon or rectum.
Squamous cell cancers
Squamous cells are the skin-like cells that make up the bowel lining together with the gland cells.
Carcinoid tumours
Carcinoid is an unusual type of slow growing tumour called a neuroendocrine tumour. These are cancers that grow in hormone producing tissues,
usually in the digestive system. They are rare. Between 4 and 17% of carcinoid tumours begin in the rectum. Between 2 and 7% of carcinoid
tumours begin in the large bowel.
Carcinoid is a particular type of cancer and is treated differently to colorectal cancer.
Sarcomas
Sarcomas are cancers of the supporting cells of the body (bone, muscle etc), but are extremely uncommon within the bowel. Most sarcomas found
in the colon or rectum are leiomyosarcomas. This means they are cancers that have started in the smooth muscle. Sarcomas are also treated
differently to adenocarcinomas of the bowel or rectum.
Lymphomas
Lymphomas are cancers of the lymphatic system. Only about 1 in 100 cancers in the colon or rectum are lymphomas. They are treated very
differently to other colorectal cancers.
Source: www.cancerhelp.org.uk, WCISU
People with concerns about their own health should contact their GP or cancer team
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COLORECTAL CANCER FACTSHEET
What causes colorectal cancer?
A cancerous tumour starts from one abnormal cell. In the case of colorectal cancer, it is a cell in a polyp which is the most common site for a
cancerous cell to develop. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes
in the cell. This makes the cell abnormal and multiply 'out of control'.
Risk factors
Although colorectal cancer can develop for no apparent reason, there are certain 'risk factors' which increase the chance that colorectal cancer will
develop. These include:
• Ageing. Colorectal cancer is more common in older people. Most cases are in people over the age of 50.
• If a close relative has had colorectal cancer (there is some genetic factor). This is really first degree relatives at an early age.
• If you have familial adenomatous polyposis or hereditary non-polyposis colorectal cancer. These are rare inherited disorders.
• If you have ulcerative colitis (a condition of the colon) for more than 8-10 years.
• Obesity.
• Lifestyle factors: little exercise, eating a lot of red meat, drinking a lot of alcohol, smoking.
Source: www.patient.co.uk, WCISU
What are the symptoms of colorectal cancer?
When a colorectal cancer first develops and is small it usually causes no symptoms. As it grows, the symptoms that develop can vary, depending
on the site of the tumour. The most common symptoms to first develop are:
• Bleeding from the tumour. You may see blood mixed up with your faeces (stools or motions). Sometimes the blood can make the faeces
turn a very dark colour. The bleeding is not usually severe and in many cases the bleeding is not noticed as it is just a small 'trickle' which
is mixed with the faeces. However, small amounts of bleeding that occur regularly can lead to anaemia which can make you tired and
pale.
• Passing mucus with the faeces.
• A change from your usual 'bowel habit'. This means you may pass faeces more or less often than usual.
• Bouts of diarrhoea.
• A feeling of not fully emptying the rectum after passing faeces.
• Abdominal pains.
As the tumour grows in the colon or rectum, symptoms may become worse and can include:
• The same symptoms as above, but more severe.
• You may feel generally unwell, tired, or lose weight.
• If the cancer becomes very large, it can cause a blockage (obstruction) of the colon. This causes severe abdominal pain and other
symptoms such as vomiting.
• Sometimes the cancer makes a hole in the wall of the colon or rectum (perforation). If this occurs the faeces can leak into the abdomen.
This causes severe pain.
If the cancer spreads to other parts of the body, various other symptoms can develop.
All the above symptoms can be due to other conditions, so tests are needed to confirm colorectal cancer.
Source: www.patient.co.uk
Diagnosing bowel cancer
This section tells you about the tests that are used to diagnose colorectal cancer, and the other tests you may have if colorectal cancer is
diagnosed.
Bowel cancer tests
This part tells you about tests for bowel cancer (also called colon cancer or colorectal cancer). There is information on:
• Seeing your GP
• Tests at the hospital including sigmoidoscopy, barium enema and colonoscopy
• CEA blood test
• Other blood tests
• Further tests
Source: www.cancerresearchuk.org
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Diagnosing bowel cancer continued …
Seeing your GP
Usually you begin by seeing your family doctor who will ask you about your general health and examine you and do some tests. Your GP may then
refer you to hospital for any further tests or X-rays.
At the hospital
The bowel cancer specialist will ask about your medical history and your symptoms and will probably want to examine your back passage
(rectum). The examination may be slightly uncomfortable, but should not be painful. You may have this done in the clinic with a
sigmoidoscopy. You will have to arrange an appointment to have the rest of your bowel examined with a barium enema or colonoscopy.
CEA blood test
CEA stands for 'carcinoembryonic antigen'. It is a marker that shows up in some cancers, including colorectal cancers. A marker is a chemical
produced by a cancer which can be picked up in the blood. It will go up when the disease is active and fall when treatment is working. It may go up
if the cancer comes back. Some doctors are now taking a blood sample to get a baseline reading of CEA when patients are diagnosed.
Other blood tests
A full blood count includes a check for anaemia. Anaemia is commonly a feature of colorectal cancer. Blood tests are also done to check if your
liver and kidneys are working normally.
Further tests
Your may have tests to check to see if the cancer has spread. These include a chest X-ray to rule out spread to the lungs. This is one of the areas
where colorectal cancer can spread to. You may also have an ultrasound scan of your stomach (abdomen) to check that the cancer has not spread
to the liver.
Examining the bowel
Your doctor may arrange for you to have one or more of these tests. They include:
• Sigmoidoscopy (or proctoscopy)
• Colonoscopy
• Barium enema
• Virtual colonoscopy or CT colonography
Sigmoidoscopy and proctoscopy
The doctor uses these tests to look inside the rectum (proctoscopy), or the rectum and lower part of the large bowel (sigmoidoscopy). While you lie
on your side, the doctor puts a thin tube into your rectum and up into the large bowel. The bowel is inflated with air and there is a light inside the
tube so the doctor can see if anything is wrong. The doctor can take a biopsy (sample of tissue) if necessary. The biopsies go to the lab, where a
tissue specialist examines them under a microscope.
You have this test in the outpatients department. Because this test is quite quick and usually painless, it isn't usual to need any anaesthetic, or
anything to make you drowsy. You should be able to go home as soon as the test is over. You may notice a small amount of blood in your stool
after the biopsy.
Colonoscopy
This test looks at the whole of the inside of the large bowel. It is done in outpatients and takes about an hour.
For this test the bowel has to be empty. You will be given a list of things to do to help prepare the bowel for the test. These are likely to include:
• Stopping iron tablets
• Not eating solid food for 2 days before the test
• Drinking plenty of clear fluids
• Taking laxatives
Source: www.cancerresearchuk.org
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Diagnosing bowel cancer continued …
You will probably have medicine to make you drowsy just before the test. This is called a sedative.
Colonoscopy is nearly always done with sedation and painkillers because it would be uncomfortable for you
without. It may be possible to have a colonoscopy without a sedative, if you have particular reasons for wanting to.
You would need to talk to your doctor beforehand about this.
Your doctor will ask you to lie on your side. The doctor will pass a flexible tube into your rectum and up into your
bowel. As the tube bends easily, it can pass around the curves in the bowel so your doctor can examine the whole
length of it. The light inside the tube helps the doctor to see any problem areas or swelling.
Photographs and biopsies of the lining of the bowel can be taken during the test. A colonoscopy can be
uncomfortable but the sedative should help you to feel more relaxed.
You should be able to go home a couple of hours after the test. You shouldn't drive for a few hours after the sedative. If you have had a sedative,
you should have someone with you to take you home. Ideally they should stay overnight just to make sure everything is all right.
Barium enema
This is an X-ray of the large bowel. For this test you have to have an empty bowel. You will be:
• Given laxatives to take the day before
• Asked to drink lots of fluids the day before
• Asked not to eat solid food on the day before the test
• Asked not to eat and drink anything on the morning of the test
Before the test, you may have a bowel washout, although this isn't done so often now as the laxatives they give you work very well. A bowel
washout is a bit like having an enema. A tube is passed into your rectum and water is passed through the tube. The water then drains out of the
tube again into a bowl or bucket. As the water drains out, it washes out the inside of the bowel.
Barium is a white liquid which shows up on X-rays. A mixture of barium and water is passed into the rectum in the same way as the bowel washout.
But you will be asked to try to hold the liquid in the rectum this time until all the X-rays have been taken.
The barium passes through the bowel and shows up any lumps or swellings. The doctor can watch on an X-ray screen.
The test can be uncomfortable and tiring. It is best to have someone to take you home afterwards.
After the test:
• You may be constipated
• Your first couple of stools will be white
You may want to ask the doctor for a mild laxative to take home with you after the test. Your stools will return to normal after the barium is out of
your system.
Virtual colonoscopy
This is a new type of test. It is also called CT colonography. Instead of having the colonoscope put inside your bowel, you may be able to have a
computer simulated examination. As it is a new type of test not all radiologists are trained and experienced in using it yet.
The preparation is the same as for barium enema - laxatives and plenty of fluids to clear out your bowel. The test is done with a CT scanner. So
you have this test in the CT scanning department. You can have it as an outpatient.
Just before the test, the doctor will put a small tube into your back passage to pump air or carbon dioxide inside. This helps to open up the bowel,
which gives a better result from the scan. You then have two CT scans done. One when you are lying on your back and one with you lying on your
front. A computer matches up the two scans and makes a 'virtual' scan of the inside of your bowel. This will show up any growths on your bowel
wall. You may still have to have a colonoscopy if a biopsy is needed.
CT colonography is sometimes used instead of a barium enema to examine the bowel. Clinical trials are comparing it to standard tests to see if it is
as good at helping to diagnose bowel cancer.
Source: www.cancerresearchuk.org
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Diagnosing bowel cancer continued …
Scans for bowel cancer
This section has information about the scans you may have when you are having tests for bowel cancer.
There is information on:
• Ultrasound of the stomach (abdomen)
• Ultrasound of the back passage
• CT scan
• MRI scan
Ultrasound scan
This test uses sound waves to build up a picture of the inside of your body. You will be asked to lie on your back. A gel is spread onto your
abdomen. A small microphone will be passed over your abdomen. The microphone picks up echoes and sends the signals to a computer which
converts them into a picture.
The doctor may want to use this test to look at your liver. The liver is one of the areas colorectal cancer can spread to.
Rectal ultrasound scan
This is a type of ultrasound scan which is used to find out more about rectal cancer. It is usually used after the cancer has been diagnosed to find
out more about:
• The size of the tumour
• Whether the tumour has spread
This information helps your doctor decide how to treat your cancer. To do the scan, the ultrasound probe has to be placed inside the rectum. This
can be uncomfortable, but the scan only takes a few minutes at most.
CT scan (CAT scan)
This is a type of X-ray that takes pictures from different angles. The pictures are fed into a computer and form a detailed picture of the inside of your
body. The scan can show the area where the cancer is. The doctor can also use the scan to check whether the cancer has spread anywhere else.
Before the scan you may be asked:
• Not to eat or drink for four hours
• To drink a special liquid a few hours before
• To drink more of the liquid in the X-ray department
Just before the scan, the doctor may put more liquid into your rectum. This makes the scan picture clearer.
MRI scan
This scan uses magnetism to build up a picture. An MRI scan can give more detail than CT.
MRI scans are increasingly used for rectal cancers for this reason. Your doctor may want you to have this test with an 'endo anal coil'.
This is a small magnetic coil that goes inside your back passage during the scan. It is uncomfortable but gives a very accurate result.
You may want to ask your doctor beforehand how long you will need to have the coil in, so that you know what to expect.
Source: www.cancerresearchuk.org
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What are the treatment options for colorectal cancer?
Treatment options that may be considered include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on
various factors such as the stage of the cancer (how large the cancer is and whether it has spread), and your general health.
You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible
side effects, and other details about the various possible treatment options for your type of cancer.
You should also discuss with your specialist the aims of treatment. For example:
• Treatment may aim to cure the cancer. Some colorectal cancers can be cured, particularly if they are treated in the early
stages of the disease. (Doctors tend to use the word 'remission' rather than the word 'cured'. Remission means there is no
evidence of cancer following treatment. If you are 'in remission', you may be cured. However, in some cases a cancer returns
months or years later. This is why some doctors are reluctant to use the word cured.)
• Treatment may aim to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or
spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.
• Treatment may aim to ease symptom. If a cure is not possible, treatments may be used to reduce the size of a cancer which
may ease symptoms such as pain. If a cancer is advanced then you may require treatments such as nutritional supplements,
painkillers, or other techniques to help keep you free of pain or other symptoms.
Surgery
It is often possible to surgically remove the primary tumour. Removing the tumour may be curative if the cancer is in an early stage. The common
operation is to cut through the intestine above and below the tumour. The affected section is then removed and, if possible, the two cut ends of
intestine are sewn together.
• Sometimes a temporary stoma is done to allow the joined ends to heal without faeces passing through. The stoma is often
reversed in a second operation a few months later when the joined ends of the intestine are well healed.
• If the tumour is low down in the rectum, then the rectum and anus need to be removed. You would then need a permanent
colostomy.
A colostomy is where an opening (hole) is made through the wall of the abdomen. A section of colon is then cut and the edges are attached to the
opening in the abdominal wall. This is called a stoma and it allows faeces to pass out from the colon into a disposable bag which is stuck over the
stoma.
Even if the cancer is advanced and a cure is not possible, surgery may still have a place to ease symptoms. For example, a stent can be inserted to
ease a blocked colon. A stent is a thin metal tube which is placed through a narrowed or blocked section of colon. It can then be opened wide and
remains in the colon to prevent a further blockage.
Chemotherapy and radiotherapy
One or other of these treatments may be advised depending on the site and stage of the cancer.
• Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells, or stops them from multiplying.
• Radiotherapy is a treatment which uses high energy beams of radiation which are focussed on cancerous tissue. This kills
cancer cells, or stops cancer cells from multiplying. It is most commonly used for colorectal cancer when the tumour is in the
rectum.
When chemotherapy or radiotherapy are used in addition to surgery it is known as 'adjuvent chemotherapy' or 'adjuvent radiotherapy'. For example,
following surgery you may be given a course of chemotherapy or radiotherapy. This aims to kill any cancer cells which may have spread away from
the primary tumour site. Sometimes, adjuvant chemotherapy or radiotherapy is given before surgery to shrink a large tumour so that the operation
to remove the tumour is easier for a surgeon to do, and is more likely to be successful.
Source: www.patient.co.uk, WCISU
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Staging of large bowel cancer
The stage of a cancer describes its size and whether it has spread beyond its original area of the body. Knowing the extent of the cancer helps the
doctors to decide on the most appropriate treatment. Often, the exact stage of a bowel cancer can only be known after it has been removed by
surgery.
Generally, cancer of the large bowel is divided into four stages: small and localised (stage A); spread into surrounding structures (stages B and C);
or spread to other parts of the body (stage D). If the cancer has spread to distant parts of the body, this is known as secondary cancer (or
metastatic cancer).
Doctors often use a staging system created by a pathologist called Dukes to describe large bowel cancer.
The Dukes staging system
• Dukes A The cancer is contained within the bowel wall.
• Dukes B The cancer has spread through the muscle of the bowel wall, but the lymph nodes are not affected.
• Dukes C The cancer has spread to one or more of the lymph nodes close to the bowel. Lymph nodes are usually the first place the
cancer spreads to.
• Dukes D The cancer has spread to another part of the body such as the liver or the lungs (secondary cancer).
TNM staging system
The Dukes system is gradually being replaced by the TNM staging system.
• T describes the size of the tumour and if it has spread into the bowel wall.
• N describes whether the cancer has spread to the lymph nodes.
• M describes whether the cancer has spread to another part of the body, such as the liver or the lungs (secondary or metastatic cancer).
Although this system is more complex, it can give more precise information about the tumour stage than the Dukes method.
If the cancer comes back after initial treatment it is known as recurrent cancer.
Source: www.cancerbacup.org.uk
What is the prognosis (outlook)?
Without treatment, a colorectal cancer is likely to get larger, and spread to other parts of the body. However, in many cases it grows slowly and may
remain confined to the lining of the colon or rectum for some months before growing through the wall of the colon or rectum, or spreading. You
have a good chance of a cure if you are diagnosed and treated when the cancer is in an early stage.
If the cancer is diagnosed when it has grown through the wall of the colon or rectum, or spread to other parts of the body, there is less chance of a
cure. However, treatment can often slow down the progression of the cancer.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very
general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of
cancer is likely to respond to treatment.
Source: www.patient.co.uk
Prevention
To reduce the risk of developing colorectal cancer, you should eat a healthy, balanced diet including plenty of fresh fruit and vegetables. It is
recommended that you cut down the amount of red meat you eat to around one or two portions a week. Red meat is any meat that is red before
you cook it, such as beef, pork and lamb.
You should also eat lots of fibre in your diet. The type of fibre found in foods such as wholemeal bread and rice, and whole grain cereals will make it
easier for you to digest food, and lower your risk of developing colorectal cancer.
It is also important to take regular exercise, maintain a healthy weight and avoid alcohol and smoking.
Source: www.nhsdirect.nhs.uk
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* Please note the following information is for Colon cancer in Wales only *
Summary
Cancer of the colon was the 3rd most common cancer in both males and females in Wales during 1992-2006, with an average of 1258 new
registrations per annum. The cumulative incidence rates (0-74 yrs) of colon cancer are 2.7% in males and 1.9% in females.
Average registrations per annum (1992-2006)
Relative Frequency
Rank
Mean age at diagnosis (years)
Cumulative Rate (0-64 years)
Cumulative Rate (0-74 years)
Percentage Annual Change in EASR (incidence)
Percentage Annual Change in EASR (mortality)
Percentage Death Certificate Only
Average deaths per annum (1992-2006)
Mortality:Incidence Ratio (1992-2006)
Males
Females
640
8.2%
3rd
70.7
1.0%
2.7%
-0.2%
-2.3%**
5.0%
337
52.7%
618
8.1%
3rd
73.3
0.8%
1.9%
-1.0*
-3.2%**
7.1%
337
54.5%
*
**
Significant at 5% level
Significant at 1% level
2000
400
1800
360
1600
320
1400
280
1200
240
1000
200
800
160
600
120
400
80
200
40
0
Age Specific rate per 100,000 population
Number of cases
Number of incident cases and age-specific rates, 1992-2006
0
Under 5
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Age Group
Male Cases
Fem ale Cases
Male ASR
Female ASR
Prevalence Statistics (at 31st December 2006) in Wales
Males
Up to 1 year
>1 to 5 years
>5 to 10 years
>10 to 20 years
Total up to 20 years
Number
Rate per 100,000
% prev in pop
% in each time interval
586
1501
1303
1210
4600
40.56
103.89
90.19
83.75
318.39
0.04
0.10
0.09
0.08
0.32
12.74
32.63
28.33
26.30
100.00
Number
Rate per 100,000
% prev in pop
% in each time interval
487
1265
1187
1386
4325
32.02
83.16
78.04
91.12
284.33
0.03
0.08
0.08
0.09
0.28
11.26
29.25
27.45
32.05
100.00
Females
Up to 1 year
>1 to 5 years
>5 to 10 years
>10 to 20 years
Total up to 20 years
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Trends in Incidence 1992-2006
Males
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Total
Crude Rate
EASR
WASR
1992
0
0
0
0
1
0
6
0
3
17
19
46
54
99
130
103
64
51
593
42.59
36.15
23.38
1993
0
0
0
0
2
1
3
1
10
13
19
33
58
114
124
99
80
63
620
44.41
37.18
24.05
1994
0
0
0
0
0
1
0
3
3
11
22
41
62
109
132
95
82
40
601
42.97
35.31
23.00
1995
0
0
0
0
0
1
2
3
8
10
27
32
55
95
127
97
87
48
592
42.28
34.43
22.32
1996
0
0
0
0
0
1
2
3
10
12
18
49
71
115
112
97
69
52
611
43.61
36.08
23.84
1997
0
0
0
0
1
0
3
3
5
12
27
49
77
99
116
101
77
58
628
44.73
36.69
24.10
1998
0
0
0
0
0
1
3
3
9
17
30
41
69
111
117
119
76
51
647
45.98
37.00
24.43
1999
0
0
0
1
1
0
0
6
7
14
36
41
72
102
134
111
80
63
668
47.46
38.03
25.03
2000
0
0
0
0
0
1
6
3
6
12
24
53
59
95
121
139
83
62
664
47.16
36.82
23.81
2001
0
0
0
0
2
2
2
6
7
9
33
48
61
91
125
112
80
63
641
45.50
35.49
23.28
2002
0
0
0
0
0
0
1
3
10
10
31
39
61
88
111
118
85
45
602
42.58
32.32
21.13
2003
0
0
0
1
1
0
0
2
4
9
26
51
64
122
129
111
95
64
679
47.63
36.02
23.52
2004
0
0
0
0
1
0
3
2
4
14
25
43
75
96
108
127
113
56
667
46.50
34.32
22.30
2005
0
0
0
0
1
2
2
4
10
7
21
55
65
99
113
118
99
73
669
46.53
34.20
22.24
2006
0
0
0
0
2
3
5
5
15
17
26
49
76
105
114
130
114
61
722
49.97
36.68
24.33
1992
0
0
0
1
1
0
0
1
9
18
25
38
54
87
107
106
108
127
682
45.92
28.86
19.04
1993
0
0
0
0
0
1
0
3
5
14
20
37
55
83
97
97
105
99
616
41.41
26.02
17.18
1994
0
0
0
0
0
0
0
5
9
12
22
36
53
86
96
96
115
104
634
42.58
26.63
17.57
1995
0
0
0
0
0
1
2
6
5
12
22
32
46
69
109
107
86
112
609
40.92
25.29
16.61
1996
0
0
0
0
0
3
1
1
8
16
27
37
41
67
84
120
114
124
643
43.15
26.11
17.02
1997
0
0
0
0
0
0
2
3
3
6
18
30
52
73
102
120
119
114
642
43.06
25.33
16.38
1998
0
0
0
0
0
1
3
5
8
15
21
39
49
59
98
128
100
90
616
41.28
25.48
16.81
1999
0
0
0
0
0
3
4
1
12
6
36
33
47
69
110
132
88
127
668
44.74
27.28
17.94
2000
0
0
0
1
0
0
1
5
6
8
33
35
40
66
87
116
87
107
592
39.50
24.15
15.83
2001
0
0
0
1
0
1
2
4
5
16
20
33
39
69
81
120
76
103
570
37.96
23.29
15.39
2002
0
0
0
0
0
0
3
2
10
13
25
34
47
53
81
107
107
110
592
39.22
23.46
15.37
2003
0
0
0
1
1
0
3
3
8
12
11
34
47
52
86
95
106
110
569
37.62
22.08
14.50
2004
0
0
0
0
0
0
0
6
8
15
28
36
48
65
95
118
116
88
623
41.04
24.89
16.36
2005
0
0
0
0
2
1
2
5
7
6
30
30
37
74
81
99
100
96
570
37.48
22.65
14.94
2006
0
0
0
0
0
0
1
6
7
16
31
48
62
69
93
107
98
109
647
42.53
26.27
17.45
Females
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Total
Crude Rate
EASR
WASR
WELSH CANCER INTELLIGENCE AND SURVEILLANCE UNIT
www.wcisu.wales.nhs.uk
COLORECTAL CANCER FACTSHEET
* Please note the following information is for Rectal cancer in Wales only *
Summary
In total there were about 720 new registrations of rectal cancer per annum in the period 1992-2006. For males this cancer site is ranked 5th and 6th
for females, representing 5.6% of cancers in males and 3.6% of cancers in females.
Average registrations per annum (1992-2006)
Relative Frequency
Rank
Mean age at diagnosis (years)
Cumulative Rate (0-64 years)
Cumulative Rate (0-74 years)
Percentage Annual Change in EASR (incidence)
Percentage Annual Change in EASR (mortality)
Percentage Death Certificate Only
Average deaths per annum (1992-2006)
Mortality:Incidence Ratio (1992-2006)
Males
Females
439
5.6%
5th
69.0
0.8%
2.0%
-0.7%*
-1.6%**
2.7%
183
41.7%
279
3.6%
6th
71.8
0.4%
0.9%
-0.6%*
-2.1%**
4.4%
115
41.3%
*
**
Significant at 5% level
Significant at 1% level
Number of incident cases and age-specific rates, 1992-2006
1400
200
180
1200
Number of cases
140
120
800
100
600
80
60
400
Age Specific rate per 100,000 population
160
1000
40
200
20
0
0
Under 5
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Age Group
Male Cases
Fem ale Cases
Male ASR
Female ASR
Prevalence Statistics (at 31st December 2006) in Wales
Males
Up to 1 year
>1 to 5 years
>5 to 10 years
>10 to 20 years
Total up to 20 years
Number
Rate per 100,000
% prev in pop
% in each time interval
401
1042
893
973
3309
27.76
72.12
61.81
67.35
229.03
0.03
0.07
0.06
0.07
0.23
12.12
31.49
26.99
29.40
100.00
Number
Rate per 100,000
% prev in pop
% in each time interval
234
669
617
757
2277
15.38
43.98
40.56
49.77
149.69
0.02
0.04
0.04
0.05
0.15
10.28
29.38
27.10
33.25
100.00
Females
Up to 1 year
>1 to 5 years
>5 to 10 years
>10 to 20 years
Total up to 20 years
WELSH CANCER INTELLIGENCE AND SURVEILLANCE UNIT
www.wcisu.wales.nhs.uk
COLORECTAL CANCER FACTSHEET
Trends in Incidence 1992-2006
Males
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Total
Crude Rate
EASR
WASR
1992
0
0
0
0
0
0
1
5
5
19
35
45
57
67
90
75
45
24
468
33.61
29.32
19.59
1993
0
0
0
0
0
0
0
2
3
13
22
38
63
85
68
40
29
21
384
27.51
23.93
16.40
1994
0
0
0
0
0
1
2
1
2
9
15
47
48
83
84
53
44
21
410
29.31
24.69
16.50
1995
0
0
0
0
0
1
0
4
6
9
21
45
52
70
78
50
46
26
408
29.14
24.73
16.60
1996
0
0
0
0
0
0
3
1
1
17
28
32
63
83
74
62
40
32
436
31.12
26.29
17.74
1997
0
0
0
0
0
1
3
5
4
12
25
38
58
75
89
75
50
28
463
32.98
27.16
18.20
1998
0
0
0
0
0
1
0
2
5
10
18
38
65
57
84
79
47
27
433
30.77
24.97
16.63
1999
0
0
0
0
0
0
2
2
8
17
29
30
60
69
80
93
43
27
460
32.68
26.38
17.70
2000
0
0
0
0
0
0
2
0
7
9
29
35
68
64
81
77
52
22
446
31.67
25.29
16.99
2001
0
0
0
0
0
1
0
2
6
11
26
35
54
69
82
75
44
24
429
30.45
24.09
16.21
2002
0
0
0
0
0
0
0
2
2
7
29
36
52
71
85
78
40
34
436
30.84
24.09
15.96
2003
0
0
0
0
0
0
1
7
4
11
19
45
60
74
70
72
49
25
437
30.65
23.82
16.07
2004
0
0
0
0
0
0
0
0
6
8
21
45
47
62
83
78
60
34
444
30.96
23.29
15.24
2005
0
0
0
0
1
0
0
1
11
15
18
35
64
80
68
81
58
33
465
32.34
24.39
16.40
2006
0
0
0
0
0
1
0
2
4
17
22
38
56
80
78
85
65
22
470
32.53
24.20
16.22
1992
0
0
0
0
1
0
0
2
4
5
17
18
32
37
37
47
44
48
292
19.66
13.01
8.70
1993
0
0
0
0
0
1
1
2
5
8
11
17
24
40
46
48
38
42
283
19.03
12.43
8.35
1994
0
0
0
0
0
1
0
1
4
8
6
18
21
41
49
42
37
40
268
18.00
11.55
7.73
1995
0
0
0
0
0
0
2
2
5
5
7
21
30
40
36
39
30
46
263
17.67
11.78
7.98
1996
0
0
0
0
0
0
1
3
2
15
8
22
15
45
37
43
56
46
293
19.66
12.39
8.26
1997
0
0
0
0
0
0
1
1
4
9
14
21
26
41
43
57
39
42
298
19.99
13.05
8.75
1998
0
0
0
0
0
1
0
0
7
4
13
19
25
43
37
53
38
39
279
18.69
12.12
8.15
1999
0
0
0
0
0
0
2
3
2
11
14
9
26
35
47
51
34
48
282
18.89
11.97
8.08
2000
0
0
0
0
0
0
1
3
3
9
10
23
21
34
32
48
42
45
271
18.08
11.50
7.67
2001
0
0
0
0
0
0
0
2
0
8
7
20
18
36
49
49
39
43
271
18.05
11.19
7.38
2002
0
0
0
0
0
1
2
5
4
4
16
16
33
27
38
43
43
40
272
18.02
11.64
7.92
2003
0
0
0
0
0
0
1
3
6
6
15
27
33
34
26
44
41
49
285
18.84
12.19
8.24
2004
0
0
0
0
2
0
1
2
4
7
16
19
32
31
28
35
55
37
269
17.72
11.27
7.70
2005
0
0
0
0
1
0
0
2
5
9
12
20
26
37
41
41
41
42
277
18.21
11.61
7.86
2006
0
0
0
0
0
0
2
2
6
9
14
18
32
31
38
40
43
42
277
18.21
11.61
7.89
Females
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Total
Crude Rate
EASR
WASR
WELSH CANCER INTELLIGENCE AND SURVEILLANCE UNIT
www.wcisu.wales.nhs.uk