Clinicopathologic Features Of Colorectal Cancer At RSUD Dr. H. Chasan Boesoirie Ternate 2018-2023

According to the International Agency for Research on Cancer (IARC)


Introduction
Adenocarcinoma is the most common type of colorectal cancer in the gastrointestinal tract compared to other variants such as, mucinous adenocarcinoma, signet ring cell carcinoma, medullary carcinoma, serrated adenocarcinoma, micropapillary adenocarcinoma, and adenosquamous carcinoma (1) (2).
According to the International Agency for Research on Cancer (IARC), colorectal cancer or colon cancer includes cancer of the colon and rectum (International Agency for Research on Cancer, 2019).Colorectal cancer is the 3rd most common cancer and the 4th most common cause of death related to cancer.Most colorectal cancer cases are detected in western countries with the incidence increasing year by year.The probability of having colorectal cancer is about 4%-5% (4).
Worldwide, as many as 1,065,960 men and 865,630 women are affected by colorectal cancer, making a total of 1,931,590 people (10% of all cases of cancer incidence in the world), while cases of death caused by colorectal cancer worldwide amounted to 935,173 people (9.4% of all cases of death caused by cancer) so that CRC occupies the second position with the most cases of death.Colorectal cancer deaths by gender were 515,637 men and 419,536 women (5).Colorectal cancer in Indonesia occupies the fourth position of the overall addition of new cases of cancer diagnosed in 2020 with a total of 34,189 people, 21,764 male patients and 12,425 female patients (5) Clinical symptoms felt by colorectal cancer patients such as changes in defecation patterns, hematochezia, anemia, abdominal pain, masses at the site of malignancy, nausea, vomiting, ascites, hepatomegaly, and lymphadenopathy help in confirming the diagnosis of colorectal cancer, and these complaints can predict the location of the cancer, for example complaints such as hematochezia and defecation disorders indicate the possibility of malignancy on the left side while symptoms of anemia indicate on the right side while changes in defecation patterns are more common in rectal cancer.(6).Based on the WHO classification, colorectal cancer variations are divided into several types including adenocarcinoma, mucinous adenocarcinoma, signet ring cell carcinoma, medullary carcinoma, serrated adenocarcinoma, micropapillary adenocarcinoma, and adenosquamous carcinoma (1).Colorectal cancer has several types and forms that have been mentioned before, one of which is adenocarcinoma which is the type of malignancy in the colon that most often occurs in the digestive tract (2).
The degree of differentiation is also something that affects the prognosis of colorectal cancer.

Methods
This study is an observational descriptive study with a cross-sectional approach.The population in this study were all patients diagnosed with colorectal cancer at Dr. H. Chasan Boesoirie Ternate Hospital in the period January 2018-November 2023 who suit the inclusion and exclusion criteria in medical records obtained as many as 29 samples and taken using total sampling technique.The secondary data collection process will be taken from medical records in the Medical Record Room and Anatomical Pathology Laboratory of Dr. H. Chasan Boesoirie Ternate Hospital.The data obtained will be analyzed statistically.The analysis that will be carried out is univariate analysis using IBM SPSS 29 software.The data included age, gender, clinical symptoms, cancer location, histopathology type, and degree of differentiation.

Research Results
The Table 2. show the distribution of colorectal cancer patients with male gender was obtained as many as 16 samples (55.2%) and 13 samples (44.8%) of women.Thus it is known that the most samples for gender variables are male and the least are female.Table 5. show the distribution of colorectal cancer patients based on histopathology type with adenocarcinoma form was obtained as many as 25 samples (86.2%) and adenocarcinoma mucinous form as many as 4 samples (13.8%).Thus it is known that the most samples for histopathology type variables for colorectal cancer are adenocarcinoma.Table 6.show the distribution of colorectal cancer patients based on the degree of differentiation was found to be well differentiated as many as 22 samples (72.9%), moderately differentiated as many as 5 samples (17.2%), and poorly differentiated as many as 2 samples (6.9%).Thus it is known that the most samples for the degree of differentiation of colorectal cancer are well differentiated and the least in poorly differentiated.
Denpasar.This study shows that the most common clinical symptom in colorectal cancer is bloody stools with 101 samples from 204 patients (29.9%) (14).
The most common clinical symptom was bloody stools.This can be caused by colorectal tumors that can cause obstruction so that the tumor can block the lumen of the colon or rectum.This obstruction can cause irritation of the colonic and rectal mucosa and prevent feces from leaving, thus often causing complaints in the form of changes in defecation, especially bleeding (15).
Based on the results of this study, the location of the most colorectal cancer is in the rectum, namely 15 samples (51.7%).These results are in line with research conducted at Cut Meutia Aceh Hospital in 2017-2020, it was found that the location of the most colorectal cancer was in the rectum with a total of 26 samples (41.9%) (16).These results are also supported by other studies conducted by Rahaf Almuhanna and friends in Saudi Arabia, where the most common location of colorectal cancer is in the rectum with 177 samples (30.8%) (17).The results of this study are also in line with research conducted at the Bandung Islamic Hospital, where the most common location of colorectal cancer is in the rectum, with 37 samples (61%) (18).
The location of colorectal cancer can be divided into 2 parts, the right side (caecum, ascending colon, and transverse colon) and the left side (descending colon, sigmoid colon, and rectum) which is limited by the splenic flexure (19).This result is also supported by the theory that based on the location of the onset of the rectum accounted for 49.66% (20).One of the influential factors is diet, certain types of food such as low fiber, high protein and fat, will make fecal transit time longer.This can trigger colorectal cancer, especially in the rectum area because the rectum functions as a place of transit and defecation (18).
Based on the results of the study, the most histopathology type in colorectal cancer was adenocarcinoma, which was 25 samples (86.2%) and the rest were musinus adenocarcinoma by 4 samples (13.8%).These results are in line with research conducted at Cut Meutia Aceh Hospital, where the most histopathology type was Adenocarcinoma in 55 samples (88.7%) and Musinus Adenocarcinoma in 3 samples (4.8%) (16).The results of this study are also supported by research conducted at Arifin Achmad Hospital in Riau Province with the same results where the most histopathological type was Adenocarcinoma with 197 samples (67.8%) and followed by Musinus Adenocarcinoma type as many as 16 samples (5,3%) (Romus and Nisa, 2021).
The degree of differentiation itself is the appearance of the tumor based on how abnormal the tumor cells and tumor tissue look under a microscope.In colorectal cancer, the degree of differentiation is generally divided into well differentiated, moderately differentiated, and poorly differentiated.(Amin,Edge and Greene, 2017; Fleming et al., 2012).Based on the background described and seeing the number of colorectal cancer patients in Indonesia, researchers are interested in conducting research with the aim of knowing the clinicopathological features of colorectal cancer at RSUD Dr. H. Chasan Boesoirie Ternate in 2018-2023, based on parameters such as age, gender, histopathology type, degree of differentiation, clinical symptoms, and cancer location.
. While colorectal cancer in North Maluku, especially at RSUD Dr. H. Chasan Boesoirie Ternate for the 2018-2023 period, the exact number is not

Table 1 . Overview of Colorectal Cancer Patients Based on Age
clinicopathological features of colorectal cancer at Dr. H. Chasan Boesoire Hospital in 2018-2023 based on age, gender, clinical symptoms, tumor location, histopathology type, and degree of differentiation by recording the medical records of 29 colorectal cancer patients.The description is detailed in the following table:

Table 1 .
show the distribution table of colorectal cancer patients starting from the age range 21-30 years as many as 2 samples (6.9%), age range 31-40 years as many as 4 samples (13.8%), age range 41-50 years as many as 8 samples (27.6%), age range 51-60 years as many as 10 samples (34.5%), and age range 61-70 years as many as 5 samples (17.2%).Thus it is known that the largest number of samples for age variables is in patients with an age range of 51-60 years and the least in the age range of 21-30 years.