If there are changes to be done, let me know ASAP. Good luck.
Background of the Problem
One of the most common types of cancer in the world is colorectal cancer. Per the
GLOBOCAN global statistics of 2012, colorectal cancer is the second most common cancer in
women and third most common in men. This realization comes at a time when the number of
new cases reported in 2012 alone reached 1,400,000. It closely follows that developed
nations account for the majority of the cases in the world by 55%. As an example, Australia
and New Zealand reportedly had the highest age standardized rates estimated to be 44.8 per
100000 in men and 32.2 per 100000 women. The lowest prevalence was in Western Africa
with age-standardized rates estimated to be 4.5 per 100,000 for men and 3.8 per 100,000
women. As it is with the global prevalence, this cancer type is the third most common and the
third leading cause of cancer mortality for both genders. Per the 2012 statistics alone, the
colorectal cancer accounted for more than 8.5% of all cancer deaths in the world. This figure
translates to 694,000 deaths. Perhaps most notably is the fact that most of these deaths occurred
in developing countries despite the low prevalence of the disease in these contexts
In the Kingdom of Saudi Arabia, the incidence of CC has increased significantly since
the first report of the Saudi Cancer Registry in 1994 . According to Alharbi ⌈3⌉, the incidence
of CC in the Kingdom of Saudi Arabia ( KSA ) is akin to that of developed countries such as
the United States per the 1994-2003 statistics. In essence, it is the third most common cancer
type among women and the most common among men in KSA. In 2013 alone, statistics from
the cancer incidence report of KSA revealed that CC accounted for 11.9% of all cancer cases
in the world, which is tantamount to 1387 people⌈3⌉. Out of this figure, 46, 9% were women
while 53.1% were men. To this end, CC is the second most prevalent cancer type in KSA when
standardizing the age of the population. As it stands, the age-standardized rate for CC for
women in KSA is 10.1 per 100000 people and 11.7 per 100000 people for men. It is also
interesting to note that most of the people at risk of this cancer type comprise the older and
aged people. The geographical location is also a risk factor for CC in KSA as evidenced by the
variation in the age-standardized rate for the disease⌈3⌉.
To this end, policies relating to the screening of CC are called -for. Aljumah and
Aljebreen ⌈5⌉, in examining the policy of screening for the disease in KSA, noted that all
countries ought to develop and implement control programs for cancers per recommendations
by the World Health Assembly and the World Health Organization. Among other requirements,
such policies ought to be in writing to facilitate review and consultation with a wide range of
stakeholders. It closely follows that proper endorsement from the Ministry of Health is called for to ensure that there is sufficient political input as far as resource allocation are concerned.
The involvement of the ministry could also ensure that the prevention and treatment of
colorectal cancer are high priority actions, per the recommending bodies⌈5⌉.
Considering the rise in the incidence of CC in the KSA and the global emphasis for a
national CC in the world, this paper aims to investigate the survival and mortality of CC cases
in KSA in 2011-2015. This investigation is part of a broader aim to increase awareness of the
disease and to influence policy interventions. After this introductory section, the next parts of
Chapter 1 will comprise the statement of the problem and the significance of the study
respectively. This chapter forms an important linkage to the review of the literature chapter.
The KSA continues to witness unprecedented changes amid the socio-economic
improvements attributable to the oil-driven wealth. These noteworthy lifestyle dynamics visà-vis nutritional and epidemiological changes necessitate inquiry into colorectal cancer, with a
focus on recent epidemiology helping illuminate the patterns and health burden associated with
colorectal cancer in the country. As it stands, CC is a source of concern in KSA as with other
parts of the world. Aljumah and Aljebreen ⌈5⌉ observe that the Ministry of Health in KSA is
yet to adopt relevant policies for the screening of colorectal cancer. It is likely that these issues
collectively or individually influence the survival and mortality rates of CC significantly.
Therefore, it is not only indispensable but also timely to examine survival and mortality rates
associated with CC in KSA. Perhaps such data could serve as a crucial first step in determining
whether these issues influence the survival and mortality rates of the disease.
Significance of the Problem
This study is invaluable for both policy and practice in various ways. By understanding
the survival and mortality of CC, policymakers could find it prudent to implement appropriate
screening interventions for the disease. As it stands, evidence shows that the Ministry of Health
of KSA is yet to implement such policies. In addition to its significance to policymakers, the
study could also influence healthcare settings and practitioners in KSA in various ways. For
instance, it would prompt healthcare administrators to implement appropriate treatment
interventions for disease to improve patient outcomes. It would also be incumbent on these
institutions to invest in the most effective technologies and personnel to improve health
outcomes for their patients. Overall, the data obtained from this study would go a long way in
bridging the gap between knowledge and awareness in these respective areas.
The main objective of this study is to assess the survival and mortality rate of CC between 2011
Estimate the gender- and age-specific survived rates and mortality from 2011 to
Estimate the distribution and magnitude of CC from 2011 to 2015.
Countries experiencing rapid socioeconomic changes are witnessing a significant rise in
lifestyle-related health outcomes amid a decline in infectious-related ones. The World Cancer
Research Fund (2019) notes that colorectal cancer (CC) constitutes one the clearest marker of
the nutritional and epidemiologic transition accompanying these changes. The rising incid ence
in the world -- becoming the third most common cancer globally -- underscores the need for
research [12 ,20]. As the Kingdom of Saudi Arabia (KSA) experiences significant
transformation (associated with oil-driven wealth) discernible lifestyle changes with nutritional
and epidemiologic changes require research on CC, helping to illuminate preventable
interventions and the health burden.
Therefore, we reviewed colorectal cancer in KSA plus provided an analytic assessment to
juxtapose the global and regional burdens and discussed risk factors; demographic, geographic,
and clinical determinants plus protective interventions to improve survival rates.
CC is a carcinoma of the large intestine; one originating and affecting the colon or rectum .
Cancers affecting the colon or rectum are grouped under the umbrella of colorectal cancer
because of many shared features. CC starts as growth on the colon or rectum’s inner lining,
producing polyps. However, not all polyps become cancerous, with ad enomatous polyps
sometimes changing into cancer while the more common hyperplastic and inflammatory
polyps are not pre-cancerous .
Cancer forming in a polyp may grow over time from the innermost lining into the wall of the
colon or rectum. The cancer cells can then grow into blood vessels and lymph vessels, allowing
them to travel to proximal lymph nodes or distant body parts. The stage of colorectal cancer
refers to the extent of spread of the cancer, translating to the depth of growth into the wall as
well as spread beyond the colon or rectum .
Colorectal adenocarcinoma is by far the most common type, with others being less common or
even rare. Adenocarcinomas, constituting 95% of colorectal cancers, grow in epithelial cells of
the colon or rectum and may be mucinous or signet ring cell adenocarcinomas depending on
constitution or appearance . Carcinoid tumors (associated with intestinal hormone-making
cells), gastrointestinal stromal tumors (starting from the interstitial cells of Cajal), lymphomas
(affecting immune system cells), and sarcomas (starting in blood vessels, muscle layers, and
other connective tissues) are less common types of CC .
CC is a leading causes of mortality and morbidity worldwide; it ranks third most commonly
diagnosed cancer among males and the second among females while accounting for 9% of all
cancer cases globally . CC is the fourth leading cause of cancer death globally, accounting
for 1.4 million new cancer cases and 700,000 deaths annually. This represents 8% of all cancer
deaths [9, 13] Projections based on temporal profiles and demographics demonstrate that the
global burden of colorectal cancer may increase, rising by 60% to more than 2.2 million new
cases of colorectal cancer alongside 1.1 million deaths by 2030 .
The burden of CC varies around the world; > 2/3 of the incidence and 60% of its mortality in
countries with a high or very high human development index . However, incidence has been
rising in the developing world, associated with changes in lifestyle and nutrition . At the
same time, incidence around the world varies by gender, being substantially higher among
men. This gender variability remains concerning, with commentators citing complex
interactions between sex-specific risk factor exposures, protective effects associated with
endogenous and exogenous hormones, and gender-specific differences found in screening
practices . Ultimately, global review reveals colorectal cancer as a significant health burden
with geographic and gender differences. Research will inform urgent interventions and
determine the design and implementation of interventions.
Colorectal Cancer in the Middle East
The global burden of CC has wide regional variations. In the Middle East, the data reported for
incidence and mortality are lower than those for developed countries (Fig 1). The incidence
has increased significantly over the past decade . However, while an increase in colorectal
carcinoma incidence rates has been observed in the Middle East, trend s vary among different
countries in the region. Alhurry et al.  report worrying surges in incidence in Kuwait, as well
as the Jordan River and Gaza Strip, followed by Syria, Turkey, and Lebanon in terms of
incidence rates. Meanwhile, the rest of the Middle East countries have low to mild risk of
colorectal cancer, with the southern countries in the Middle East, such as Oman and Yemen,
having some of the lowest risk of CC around the world. In similar fashion to global gender
variability, male preponderance is observed in the burden of CC in most countries in the Middle
East, with reports indicating a higher proportion of men to women with CC .
Figure 1: Comparison of colorectal cancer incidence rates in a number of Middle East
countries, juxtaposed against some developed countries .
Scholars have explored the explanations for the aforementioned rise in colorectal
cancer in the Middle East. Arafa and Farhat  cite a number of drivers, including lifestyle
changes, food consumption trends, and obesity amid the replacement of consumption of
traditional foods with Western-style foods and ready-made preparations. As the same time,
while many high income countries have rolled out population based screening programs that
help address incidence and mortality, such programs are absent in many countries in the Middle
East. The lack of screening p...