See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/324654851

A Moroccan Colorectal Cancer Database

Conference Paper · April 2018

CITATIONS READS
0 279

11 authors, including:

Noureddine Boukhatem Laila Bouguenouch

Université Mohammed Premier Centre Hospitalier Universitaire Hassan II
39 PUBLICATIONS   371 CITATIONS    29 PUBLICATIONS   46 CITATIONS   

SEE PROFILE SEE PROFILE

Saaïd Amzazi Hassan Ghazal

84 PUBLICATIONS   779 CITATIONS    34 PUBLICATIONS   686 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Molecular screening of Congenital Heart Disease in Moroccan population View project

Argania Genetics View project

All content following this page was uploaded by Noureddine Boukhatem on 20 April 2018.

The user has requested enhancement of the downloaded file.

 ISSN 2321 -9017
Volume 5, No.3, April - May 2017
Imane AllaliInternational
et al., International Journal
Journal of Bio-Medical Informatics and
of Bio-Medical e-Health, 5(3), April
Informatics and– e-Health
May 2017, 10- 14
Available Online at http://www.warse.org/IJBMIeH/static/pdf/file/ijbmieh01532017.pdf

A Moroccan Colorectal Cancer Database

Imane Allali1,2, Souad Chaqsare4, Noureddine Boukhatem2, Leila Bouguenouch5, Jihane Querrach6, Mohamed Sekal7,
Mohammed Adnane Tazi8, Abdelouahed Er-Raki9, Karim Ouldim5, Saaïd Amzazi1, Hassan Ghazal2,3*
1
Laboratory of Biochemistry & Immunology, Faculty of Sciences, University Mohammed V, Rabat, Morocco
2
Laboratory of Physiology and Genetics, Faculty of Sciences of Oujda, University Mohammed Premier, Oujda, Morocco
3
Polydisciplinary Faculty of Nador, University Mohammed Premier, Nador, Morocco
4
National Institute of Hygiene, Rabat, Morocco
5
Department of Molecular Genetics, University hospital Hassan II, Fez, Morocco
6
Department of Gastroenterology, University hospital Hassan II, Fez, Morocco
7
Department of Pathology, University hospital Hassan II, Fez, Morocco
8
National School of Public Health, Rabat, Morocco
9
National Institute of Oncology, Rabat, Morocco

ABSTRACT CRC in the Moroccan population. Accurate and extensive

Colorectal cancer is one of the most common cancers in
Morocco; the number of patients has been increasing over the
last decade with the increase being attributed to different
changes in the lifestyle. Here, we proposed to build a
database for colorectal cancer of Moroccan patients for the
purpose to capture all the data that may play a major role in
cancer research and for a better managing of healthcare. This
colorectal cancer database includes detailed information
about family history, risk factors, eating habits and other
information related to diagnoses and clinical notes. Patients
with colorectal cancer were recorded between 2009 and 2013
from the National Institute of Oncology in Rabat and the
Hospital University Center Hassan II in Fez. Data were
collected from 525 patients; they were aged between 16–90
years, with 26.3% of colorectal cancer patients were ranging
from 50 to 59 years. We observed that 46.1% of cancers were
localized in the rectum, 31.1% of complaining symptoms
were rectal bleeding and the most used treatment was surgery
(62.2%). It is expected that this database will contribute to
generating great information about colorectal cancer, provide
important information for epidemiological studies and
support colorectal cancer research in Morocco.
data on CRC patients are very important for the
understanding of cancer etiology, clinical decisions and
epidemiological studies.
The purpose of this study is to create a colorectal cancer
database that will be regional and national benchmarks for
colorectal cancer care in Morocco. The CRC database
includes detailed information about family history, risk
factors, information related to diagnoses and clinical notes.
This database is very useful for the analysis of the efficacy of
diagnostic and therapeutic procedures and for the evaluation
of clinical outcomes in real healthcare system that are
essential for decision making in the management and the
treatment. Additionally, our aim is that this database is
expected to contribute to generating great information about
colorectal cancer, to provide reliable records, to have easy
data access with a better scientific reproducibility and
interoperability between institutions in order to support
colorectal cancer research in Morocco.
2. MATERIALS AND METHODS
2.1. Database

Keywords: Database, Colorectal cancer, Morocco.
1. INTRODUCTION
Colorectal cancer (CRC) is the third leading cause of
cancer related deaths in Morocco among cancers that affect
both men and women behind breast and lung cancer [1-3].
The number of patients has been increasing over the last
decade, the incidence was 10.4 per 100,000 individual in
2008 compared to 6.0 in 2005 according to the Cancer
Registry of Rabat [2]. According to the same cancer registry,
it estimated that 2,701 new cases must be diagnosed with
CRC in 2008 in Morocco and 4,096 new cases are expected
to be diagnosed in 2020 [2].
In spite of increased colorectal cancer patients, little is
known about the factors that may influence the incidence of
10
The colorectal cancer database is a data integration
platform and knowledge discovery system for the oncology
and scientific research. It includes detailed information about
family history, risk factors, eating habits and other
information related to diagnoses and clinical notes as
histopathology reports, radiotherapy and chemotherapy
treatment data, administrative details such as route of
admission and access to imaging information which will
enable accurate cancer staging (Supplementary Figure 1).
CRC database uses MySQL (My Structured Query
Language) database management system to store the data.
The PHP (Hypertext Preprocessor) and the HTML
(HyperText Markup Language) programming language are
used for retrieval and recording of data. For data safety,
passwords were required to access the database to guarantee
Imane Allali et al., International Journal of Bio-Medical Informatics and e-Health, 5(3), April – May 2017, 10- 14
the use of the data only by authorized researchers and ID’s No 16 ( 3.1 )
numbers were attributed to patients to avoid data duplication. Undefined 334 ( 63.6 )
2.2. Population and data collection
The study population (n=525) comprised all men and Zone of Origin Region
women who had a histological confirmation of cancer in the Tangier – Tetouan – Al 39 ( 7.4 )
colon or in the rectum in the University Hospital Center Hoceima 7 ( 1.3 )
Hassan II of Fez and in the National Institute of Oncology of Oriental 225 ( 42.9 )
Rabat from January 2009 to December 2013. These two Fez – Meknes 60 ( 11.5 )
institutions represent two of the largest university hospital Rabat – Sale – Kenitra 10 ( 1.9 )
centers in Morocco; they host mainly patients from four Beni Mellal – Khenifra 6 ( 1.1 )
major regions (Tangier-Tetouan-Al Houceima, Oriental, Fez- Casablanca – Settat 5 ( 1.0 )
Meknes and Rabat-Sale-Kenitra), the percentage of Marrakesh – Safi 7 ( 1.3 )
population in these four regions is approximately 47.1% Draa – Tafilalt 1 ( 0.2 )
compared to the whole population of Morocco according to Souss – Massa 0 ( 0.0 )
the high commissariat of planning [4]. Each patient’s medical Guelmim – Oued Noun 0 ( 0.0 )
records were reviewed to collect the clinical characteristics, Laayoune – Sakia El Hamra 0 ( 0.0 )
laboratory results and pathological reports. The analyzed Dakhla – Oued Eddahab 165 ( 31.4 )
variables were age, gender, symptoms, location of the tumor, Undefined
histological type and type of treatment.
2.3. Statistical analysis Table 1. Demographic and clinical characteristics of the studied subjects
Descriptive analyses of patient demographic
characteristics were carried out. Simple statistical analyses The mean age for female is 55.0 years and for male 56.1
were used to look for the mean, standard deviation of the data years (Figure 1). Most of the cases have between 50-59 years
according to the nature and the distribution of the data. The for both female and male. The percentage of young patients
data were represented in percentage and absolute numbers under 40 years is 14.6% of cases. The number of patient with
either in graphs or tables. colorectal cancer increases steadily with age for both sexes.
3. RESULTS
3.1. Demographic and Clinical Characteristics of
Patients
A total of 525 patients were identified with colorectal
cancer and were included in this study; 325 patients from the
University Hospital Center of Fez and 200 patients from the
National Institute of Oncology of Rabat from January 2009 to
December 2013. The baseline demographics and clinical
characteristics of these patients are listed in (Table 1). The
percentage of female with CRC is 50.7% compared to 49.3%
for male.
Characteristics Colorectal Cancer (CRC)
n = 525
(%)
Age Range
15-19 3 ( 0.5 )
20-29 20 ( 3.8 )
30-39 54 ( 10.3 )
40-49 88 ( 16.8 ) Figure 1. The number of patients per age ranges shown as
50-59 138 ( 26.3 ) female (red) and men (blue)
60-69 109 ( 20.8 )
70-79 84 ( 16.0 ) 3.2. Histological type
80-90 24 ( 4.6 ) According to Figure 2, for female, 179 cases (69.4%) of
Undefined 5 ( 0.9 ) colorectal cancers are Adenocarcinoma with no other
specification (NOS), followed by 45 (17.4%) Leiberkuhnien
Adenocarcinoma, 22 (8.5%) other adenocarcinomas and 12
Gender
Female 266 ( 50.7 ) cases (4.7%) of Carcinoma. For male, we observed similar
Male 259 ( 49.3 ) histological type; we found that 177 (71.7%)of the cases
were diagnosed with Adenocarcinoma NOS followed by 42
(17.0%) Leiberkuhnien Adenocarcinoma, 17 (6.9%), other
Familial History of
adenocarcinomas and 11 cases (4.4%) of Carcinoma.
Colorectal Cancer
Yes 175 ( 33.3 )

11
Imane Allali et al., International Journal of Bio-Medical Informatics and e-Health, 5(3), April – May 2017, 10- 14
Characteristics Right Left Rectum
Colon* Colon**
n = 68 n = 91 n = 243
N (%) N (%) N (%)
Gender (%)
Female 37 (54.4) 50 (54.9) 122 (50.2)
Male 31 (45.6) 41 (45.1) 121 (49.8)

Age (mean ± SD) 55.6 ± 11.8 54.8 ± 13.8 54.8 ± 15.5

Female 55.8 ± 11.6 53.9 ± 13.5 53.5 ± 14.4
Male 55.5 ± 12.2 56.0 ± 14.2 56.1 ± 16.5

Age Range (N,

%) 7 (10.3) 12 (13.2) 44 (18.1)
40> 10 (14.7) 17 (18.7) 42 (17.3)
40-49 21 (30.9) 26 (28.6) 63 (25.9)
Figure 2. Distribution of colorectal cancer histological type by sex
group A. Female and B. Male 50-59 20 (29.4) 21 (23.1) 40 (16.5)
60-69 7 (10.3) 9 (9.8) 40 (16.5)
70-79 3 (4.4) 6 (6.6) 14 (5.7)
3.3. Site of Colorectal Cancer 80-90
The site of colorectal cancer is shown in Figure 3. For
402 patients for whom data were available, about 60.3% of Symptoms (%)
tumors were localized in the rectum especially low rectum Rectal bleeding 1 (1.5) 17 (18.7) 80 (32.9)
Abdominal pain 23 (33.8) 18 (19.8) 30 (12.3)
with 16.9% and 14.2% in the recto-sigmoid junction for both
Physical tiredness 13 (19.1) 13 (14.3) 39 (16.0)
sexes, 23.2% of tumors were localized in distal colon (left-
Diarrhea 7 (10.3) 9 (9.9) 26 (10.7)
sided) (17.7% of patients had a tumor in the sigmoid and Constipation 9 (13.2) 14 (15.4) 16 (6.6)
5.5% in the descending colon) whereas 16.5% of tumors Others 5 (7.4) 3 (3.3) 41 (16.9)
were locally found in the proximal colon (right-sided) (11.2% Undefined 10 (14.7) 17 (18.6) 11 (4.5)
in the cecum followed by 3.8% in the transverse colon and
1.5% in the ascending colon). The age of patients was *Right-sided Colon: Proximal Colon, **Left-sided Colon: Distal
slightly higher in the right side of the colon (Table 2). A Colon
relatively higher proportion of patients with CRC were Table 2. Comparison of clinical characteristics between right-sided,
observed for both male and female at 50-59 years. When we left-sided colon and the rectum
compared the distal colon (left-sided) and the proximal colon
(right-sided), we found that the number of patients were 3.4. Symptom of Colorectal Cancer
higher at 50 years or younger in the distal colon (D=31.9% vs The frequent symptoms that we have reported are rectal
P=25%) while the number of patients were higher at 50 years bleeding (31.1%), abdominal pain (16.7%) and physical
or older in the proximal colon (D=68.1% vs P=75%). tiredness (12.3%) (Figure 4). Moreover, we compared the
symptoms observed in the patients with right-sided colon
with those with left-sided colon and rectum (Table 2). We
observed that rectal bleeding symptom was higher in rectum
(32.9%) followed by left-sided colon (18.7%), however,
abdominal pain, physical tiredness and constipation were
more observed in patients with right-sided colon cancer. The
proportion complaining symptoms associated with diarrhea
was observed to be similar in right and left sided colon and in
the rectum.

Figure 3. The number of tumors located in the colon and the rectum

12
Imane Allali et al., International Journal of Bio-Medical Informatics and e-Health, 5(3), April – May 2017, 10- 14
*Syndrome such as familial adenomatous polyposis (FAP) or
hereditary non-polyposis colon cancer (HNPCC), also known as
Lynch syndrome.
Figure 4. Type of symptoms found in patients diagnosed
with colorectal cancer
3.5. Treatments
The first treatment envisaged in the case of colorectal
cancer is surgery in 62.2% of cases, followed by a
combination of surgery and chemotherapy with 14.0% then a
treatment with a combination of chemotherapy and radiation
therapy with 7.7% and 7.4% for a treatment based only on
chemotherapy. Radiation therapy and a combination of
surgery and radiotherapy are less frequent with 5.4% and
3.3% respectively.
4. DISCUSSION
With an estimated of 2,701 new cases that must be
diagnosed with CRC in 2008 in Morocco [2], colorectal
cancer creates interest to researchers and health authorities,
therefore a population database is an ideal tool for the
evaluation of actual needs for the management of colorectal
cancer, especially for calculating the incidence, which is an
important indicator of the impact of the disease on public
health.
This Colorectal cancer database represents one of the
largest data set collected from the National Institute of
Oncology in Rabat and from the University Hospital Center
Hassan II of Fez; those two institutions cover large areas in
Morocco[4]. Over this last decade, the number of patients of
colorectal cancer in Morocco is increasing [1-3, 5]. Risk
factors for the development of CRC include different factors
such as environmental factors, inflammatory bowel disease,
age, smoking, alcohol, diet and genetic factors [6-11]. The
risk of developing colorectal cancer is usually low before the
age of 40 years [12], in our study, only 14.6% of cases are
under 40 years for both sexes, but the risk increases sharply
with age, most people diagnosed were between their fifties
and seventies [13]. In our study, 62.5% of female and 64.8%
of male were diagnosed between 50 and 79 years. More than
90% of CRC histological type was adenocarcinomas for both
sexes; it is the more common histological type in colorectal
cancer [14, 15]. Most of the CRC were localized in the
rectum with 60.3%; our results are in agreement with
13
previous epidemiological studies where they revealed a
predilection of the rectum in CRC in both sexes [16-18].
Recently, many studies were interested to study the clinical
and biological differences between right and left sided colon
in the colorectal cancer [19, 20]. In our case, we found that
distal colon cancer (left-sided) is more frequent in younger
people while proximal colon cancer (right-sided) increases
with age for both sexes which is in accordance with previous
studies where they reported a dominant presence of proximal
colon cancer in older people and distal colon cancer in
younger people [19, 20]. Additionally, the most observed
symptoms were rectal bleeding with 31.1%, which is the
mainly complained symptom from CRC patients [21, 22].
In this study, we aimed to create a Moroccan database
for colorectal cancer patients. We believe that it is extremely
important and helpful to have a detailed database in hospitals
or in oncological centers for a better management and care
and to know the epidemiological profile of the population.
Having a reliable database is a great way for storing patients
records, sharing those records easily between institutions and
physicians and helpful in decision-making for instance in the
type of treatments or in the risk of factors. This database is
not perfect, we had some limitations in the process of data
collecting not all the patients have all the detailed
information but it is a good start to make a model for a
database that can be improve with time especially there is
critical issue in the process of data collection and with such
as an experience we could achieve our goal to have an
accurate and complete data about CRC from the National
Institute of Oncology in Rabat and the University Hospital
Center Hassan II of Fez as a first step and then to be extended
to the all University Hospital Centers and Oncological
Centers in Morocco in order to have a much better
understanding of the CRC in Morocco, to provide
information and to facilitate access for oncologists and
physicians to the patients records for a better analysis.
5. CONCLUSION
The development of such as colorectal cancer database is
the necessary first step in the comprehension of a disease to
improve scientific research and clinical practice. Colorectal
cancer researchers across Morocco will have access to
detailed clinical data including genetics characteristics, eating
habits, clinical notes and treatment, which will speed up work
to understand and to prevent the disease in the future
especially with the advent in the gut microbiome research
and personalized medicine, they will fundamentally
revolutionize the way we diagnose and treat cancer.
Acknowledgments
We would like to thank Prof. Mohammed El Abkari and
Prof. Sidi Adil Ibrahimi (Department of Gastroenterology),
Prof. Hinde El Fatemi (Department of Pathology) from the
University Hospital Hassan II of Fez and Prof. Noureddine
Benjaafar (Department of Radiotherapy) from National
Institute of Oncology in Rabat and Mrs. Hayat Sedrati from
the National School of Public Health in Rabat for their
support.
Imane Allali et al., International Journal of Bio-Medical Informatics and e-Health, 5(3), April – May 2017, 10- 14
17. O'Connell, J.B., et al., Rates of colon and rectal
cancers are increasing in young adults. Am Surg.,
REFERENCES 2003. 69(10): p. 866-72.
1. Register-Casablanca, Register of Cancers of 18. Meyer, J.E., et al., Increasing incidence of rectal
Casablanca (2005-2006-2007). Edition 2012. cancer in patients aged younger than 40 years: an
2. Register-Rabat, Incidence of Cancers in Rabat analysis of the surveillance, epidemiology, and end
(2006-2008). Cancer Registry of Rabat. Edition results database. Cancer, 2010. 116(18): p. 4354-9.
June 2012. 2012. 19. Nawa, T., et al., Differences between right- and left-
3. Register of Cancers of Casablanca (2008-2012). sided colon cancer in patient characteristics, cancer
Edition 2016. morphology and histology. J Gastroenterol Hepatol.,
4. Regions_Morocco, High commissariat of planning 2008. 23(3): p. 418-23.
in Morocco. Edition 2014. 20. Iacopetta, B., Are there two sides to colorectal
5. Bouchbika, Z., et al., Cancer incidence in Morocco: cancer? Int. J. Cancer, 2002(101): p. 403-8.
report from Casablanca registry 2005-2007. Pan 21. Campbell, P.T., et al., Prospective study reveals
Afr Med J, 2013. 16: p. 31. associations between colorectal cancer and type 2
6. Bernstein, C.N., et al., Cancer risk in patients with diabetes mellitus or insulin use in men.
inflammatory bowel disease: a population-based Gastroenterology, 2010. 139(4): p. 1138-46.
study. Cancer, 2001. 91(4): p. 854-62. 22. Astin, M., et al., The diagnostic value of symptoms
7. Hannan, L.M., E.J. Jacobs, and M.J. Thun, The for colorectal cancer in primary care: a systematic
Association between Cigarette Smoking and Risk of review. Br J Gen Pract., 2011. 61(586): p. 231-43.
Colorectal Cancer in a Large Prospective Cohort
from the United States. Cancer Epidemiol Supplementary Material Legends
Biomarkers Prev., 2009. 18(12): p. 3362-7.
8. Ferrari, P., et al., Lifetime and baseline alcohol Figure 1. The conceptual model of the Moroccan database, it
intake and risk of colon and rectal cancers in the shows entities and their attributes
European prospective investigation into cancer and
nutrition (EPIC). Int J Cancer, 2007. 121(9): p.
2065-72.
9. Fung, T.T. and L.S. Brown, Dietary Patterns and
the Risk of Colorectal Cancer. Curr Nutr Rep.,
2013. 2(1): p. 48-55.
10. Kunzmann, A.T., et al., Fruit and vegetable intakes
and risk of colorectal cancer and incident and
recurrent adenomas in the PLCO cancer screening
trial. Int J Cancer, 2016. 138(8): p. 1851-61.
11. Sharma, S. and S.J. O'Keefe, Environmental
influences on the high mortality from colorectal
cancer in African Americans. Postgrad Med J, 2007.
83(983): p. 583-9.
12. Chiang, J.M., et al., Favorable influence of age on
tumor characteristics of sporadic colorectal
adenocarcinoma: patients 30 years of age or
younger may be a distinct patient group. Dis Colon
Rectum, 2003. 46: p. 904-910.
13. Pinsky, P.F. and R.E. Schoen, Colorectal Cancer
Incidence by Age Among Patients Undergoing
Surveillance Colonoscopy. JAMA Intern Med.,
2015. 175(5): p. 858-860.
14. Hugen, N., et al., Metastatic pattern in colorectal
cancer is strongly influenced by histological
subtype. Ann Oncol, 2014. 25(3): p. 651-657.
15. Fleming, M., et al., Colorectal carcinoma:
Pathologic aspects. J Gastrointest Oncol., 2012.
3(3): p. 153-173.
16. Stigliano, V., et al., Early-onset colorectal cancer: A
sporadic or inherited disease? World J
Gastroenterol., 2014. 20(35): p. 12420-12430.

14

View publication stats