Colorectal Cancer (CRC) is recognized as a major global health challenge due to its high prevalence, associated morbidity and mortality and the substantial burden it places on healthcare systems worldwide. It stands as the third most common cancer in men and the second most common in women globally (1). Approximately 60% of cases are diagnosed in developed regions, underscoring the role of lifestyle, environmental exposures and healthcare infrastructure in influencing disease prevalence (1).

Incidence rates exhibit striking geographic variability, with the highest rates reported in Australia, New Zealand and Western Europe and the lowest in Africa (except Southern Africa) and South-Central Asia (1). Within populations, significant differences are observed based on race and ethnicity. For example, Ashkenazi Jews demonstrate an increased predisposition to CRC and in the United States, African-Americans experience higher incidence and mortality rates compared to Caucasians (4).

In India, the age-standardized incidence rate for CRC remains relatively low at 7.2 per 100,000 for males and 5.1 per 100,000 for females (5). However, the absolute burden of disease is substantial due to the country’s large population. Alarmingly, the five-year survival rate for CRC patients in India remains below 40%, among the lowest globally (6). Moreover, evidence from the CONCORD-2 study suggests that survival outcomes for rectal cancer patients in India are deteriorating in certain registries (6), likely reflecting diagnostic and therapeutic inadequacies.

The lifetime risk of developing CRC in Western populations is approximately 5–6% (3), with most cases occurring after the age of 50 (3). Although traditionally considered a disease of the elderly, recent studies reveal a troubling rise in incidence among younger adults, a trend particularly notable in both developed and developing countries (6).

CRC is a heterogeneous disease influenced by a complex interplay of genetic, environmental and lifestyle factors (7). High intake of red and processed meats, smoking, obesity, physical inactivity and alcohol consumption are recognized modifiable risk factors (7), whereas diets rich in fiber, fruits and vegetables, along with regular physical activity, confer a protective effect (19).

Genetic predispositions, such as Lynch syndrome and familial adenomatous polyposis, account for approximately 10% of all CRC cases (6). Molecular characteristics also differ by tumor location, with right-sided (proximal) and left-sided (distal) tumors exhibiting distinct genetic alterations and clinical behaviors (8).

The clinical presentation of CRC varies depending on tumor location. Symptoms such as rectal bleeding, altered bowel habits, abdominal pain, anemia and weight loss are common but nonspecific, often delaying diagnosis (9). About 15% of CRC cases present as surgical emergencies with obstruction or perforation (10), conditions associated with poorer outcomes.

Given the evolving epidemiology and clinicopathological characteristics of CRC in India, a deeper understanding of the patient profile is essential. This study aims to evaluate the clinicopathological features of colorectal cancer patients presenting to a tertiary care center in North India, with the goal of informing future strategies for early detection, management and improving survival outcomes.

The primary aim of this study was to evaluate the clinicopathological profile of Colorectal Cancer (CRC) patients presenting to a tertiary care center in North India. Specific objectives included analyzing the demographic characteristics, symptomatology, tumor location, histopathological subtypes and stage at diagnosis. Additionally, the study sought to assess the relationship between risk factors such as smoking, alcohol use, dietary habits, comorbidities and tumor presentation patterns. This prospective observational study was conducted at the Department of General Surgery, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, over a period of one year. A total of 50 patients diagnosed with colorectal carcinoma based on clinical evaluation, radiological investigations, colonoscopic findings and histopathological confirmation were included. Patients presenting with other gastrointestinal malignancies were excluded from the study. Data were collected systematically using a predesigned structured proforma encompassing variables such as age, sex, lifestyle factors, family history, presenting symptoms, tumor characteristics and treatment modalities. Histopathological analysis was performed on all resected specimens to determine tumor type, grade and pathological staging according to the TNM classification. Statistical analysis was carried out using SPSS software, with descriptive and inferential statistics applied to explore significant clinicopathological correlations.

This prospective study included a total of 50 patients diagnosed with colorectal carcinoma. The demographic distribution revealed a male predominance, with 64% males and 36% females. The majority of patients (40%) were in the 51–60-year age group. Lifestyle factors revealed that 42% of patients were smokers, 34% consumed alcohol and a significant proportion (70%) followed a non-vegetarian diet. A positive family history of colorectal cancer was noted in 6% of patients. Comorbidities such as hypertension and diabetes mellitus were present in 24% of cases (Table 1).

Regarding tumor characteristics, rectal tumors were the most frequent, accounting for 54% of cases, followed by left-sided colon tumors (30%) and right-sided colon tumors (16%). Histopathological evaluation revealed that moderately differentiated adenocarcinoma was the predominant subtype (58%), followed by well-differentiated adenocarcinoma (24%). Poorly differentiated adenocarcinoma was identified in 10% of cases, while mucinous and signet ring variants constituted 8% of the study population (Table 2).

Staging analysis demonstrated that the majority of patients presented with advanced disease, with 44% diagnosed at stage III and 24% at stage IV. Only 32% were diagnosed at stage II. Emergency presentations were not uncommon; 20% of patients presented with acute intestinal obstruction and 8% with perforation. Surgical management revealed that curative resection was feasible in 68% of patients, while 32% underwent palliative procedures, including diversion colostomy (Table 3).

Table 1: Demographic and Clinical Profile

Table 2: Tumor Characteristics

Table 3: Staging and Outcomes

Colorectal Cancer (CRC) remains a significant global health burden and its incidence is rising steadily in both developed and developing countries. The demographic and clinical profile in our study closely mirrors established patterns, but with distinct features relevant to the Indian subcontinent.

The male predominance observed in this study (male-to-female ratio of 1.8:1) aligns with global and regional studies, where CRC is consistently more common among males [1]. Risk factors such as smoking and alcohol consumption were significantly present in our cohort, noted in 42% and 34% of patients respectively, emphasizing the contributory role of modifiable lifestyle factors in colorectal carcinogenesis [2]. A high prevalence of non-vegetarian diet (70%) was also noted, consistent with previous studies linking increased consumption of red and processed meat with higher CRC risk [3].

In terms of tumor location, the rectum was the most commonly involved site (54%), which is congruent with prior Indian and Asian studies where rectal cancers are disproportionately higher compared to Western populations [4]. Left-sided colonic tumors were more frequent than right-sided ones, suggesting different biological and genetic pathways influencing tumor development [5].

Histologically, moderately differentiated adenocarcinoma was the predominant subtype (58%), which is consistent with global pathology trends [6]. However, poorly differentiated and mucinous/signet ring variants, although less common, warrant special attention due to their association with aggressive behavior and poorer prognosis [7].

A significant finding was that the majority of patients presented at advanced stages-44% at stage III and 24% at stage IV. This late presentation is a recurring challenge in India and other low-middle-income countries, attributed to lack of awareness, inadequate screening programs, socioeconomic barriers and reliance on symptomatic diagnosis [8]. Emergency presentations, including obstruction (20%) and perforation (8%), further complicated management and are associated with increased perioperative morbidity and mortality [9].

Surgical intervention remains the cornerstone of CRC management. Curative resections were possible in 68% of cases, while palliative procedures, such as diversion colostomies, were required in 32% of patients, mostly those presenting with unresectable metastatic disease or severe obstruction [10]. The relatively high rate of palliative interventions highlights the urgent need for earlier detection strategies.

Comparing these findings with similar studies emphasizes a pressing need for the implementation of effective CRC screening programs in India [11]. Opportunistic screening, increased public awareness and structured referral systems can significantly downstage the disease at presentation and improve long-term survival [12]. Furthermore, multidisciplinary management approaches, including the integration of surgical, oncological and palliative care services, are critical to optimize outcomes for patients diagnosed at late stages.

Overall, the present study reinforces the emerging epidemiological trend of CRC in India towards a younger age of onset, predominant rectal location, advanced disease stage at presentation and significant association with lifestyle risk factors. Tailored public health interventions and research into local genetic and environmental contributors are necessary to address this growing burden effectively.

Colorectal cancer in the present study exhibited a notable male predominance, with the rectum being the most common site of involvement. Most patients presented at an advanced stage, often requiring palliative interventions. Lifestyle factors such as smoking, alcohol consumption and non-vegetarian diet were significant contributors. The findings underscore the need for greater public awareness, early detection initiatives and improved access to timely healthcare. Implementation of structured screening programs could potentially lead to earlier diagnosis and better clinical outcomes.

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