Surgical Pathology of Colorectal Cancer in Filipinos: Implications for Clinical Practice Leoncio L Kaw Jr, MD, Corazon K Punzalan, MD, Armando C Crisostomo, MD, FPCS, Mark W Bowyer, MD, FACS, David C Wherry, MD, FACS BACKGROUND: A number of studies published in the Philippine literature have demonstrated certain peculiar clinicopathologic characteristics of colorectal cancer among Filipinos. This study presents the latest data and analyzes their implications for clinical practice. STUDY DESIGN: The pathology reports of all patients who underwent operation for colorectal cancer at the Philippine General Hospital over a period of 7 years were reviewed. RESULTS: One thousand two hundred seventy-seven patients were included. The male to female ratio was almost 1:1. The majority of patients were in the sixth and seventh decades of life, with a mean age of 55.3 years. Patients 40 years of age and younger made up 17% of the total. The site of cancer in order of frequency was rectum (49.8%), left colon (27.9%), and right colon (21.4%). Cancers of the right colon were more common in women, and rectal cancers were more frequent in men. Seventy-six percent of the tumors were well to moderately differentiated adenocarci- nomas, and 6.7% were poorly differentiated. Mucinous and signet ring carcinomas were found in 11% and 1% of cases, respectively. Forty-four percent of patients had localized disease at the time of operation, 54% had regional disease, and 2% had disseminated disease. Associated predisposing conditions noted were polyps (4.7%), schistosomiasis (3%), and tuberculosis (1.5%). CONCLUSIONS: Colorectal cancer in Filipinos exhibits a number of unique clinicopathologic features, such as a higher proportion of early age of onset tumors, more advanced stage at presentation, an asso- ciation with chronic granulomatous diseases, and relatively rare occurrence with polyps. This might suggest the possibility of a different pathway for tumor development of colorectal cancer in this population of patients. Also, current screening guidelines advocated for the Western population might not be appropriate for Filipinos. (J Am Coll Surg 2002;195:188–195. © 2002 by the American College of Surgeons) In the United States, colorectal cancer (CRC) is the third most common malignancy affecting men and women and the second leading cause (after lung cancer) of can- cer deaths. Approximately 135,400 new cases were esti- mated to occur in the year 2001, with 56,700 disease- related deaths expected. 1 Likewise, in the Philippines, the colon and rectum are the leading sites of malignancy of the gastrointestinal tract. Colon and rectal cancer combined ranked fourth in cancer incidence in 1998, representing 7.1% of all cancer cases in the country. 2 Although CRC incidence in the United States has been declining an average of 1.6% per year since 1985, 1 the trend in the Philippines appears to be an increase since 1993. 2,3 Whether this is a true increase in incidence or a result of improved surveillance and detection is not known. A number of reports published in the Philippines have demonstrated certain peculiar clinicopathologic characteristics of CRC among Filipinos, most particu- larly a higher proportion of early age of onset tumors, more advanced stage at presentation, and a possible as- sociation with chronic granulomatous diseases such as schistosomiasis and tuberculosis. 4-6 These observations might not only indicate a difference in the tumor biol- ogy of CRC in this unique population of patients, but No competing interests declared. Received September 19, 2001; Revised January 9, 2002; Accepted February 19, 2002. From the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD (Kaw, Bowyer, Wherry) and Division of Colorectal Surgery, University of the Philippines, Philippine General Hospi- tal, Manila, The Philippines (Punzalan, Crisostomo). Correspondence address: David C Wherry, MD, FACS, Department of Sur- gery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814. 188 © 2002 by the American College of Surgeons ISSN 1072-7515/02/$21.00 Published by Elsevier Science Inc. PII S1072-7515(02)01186-9