Colorectal carcinoma (CRC) is a major global health burden. It is the third most commonly diagnosed cancer and the second leading cause of cancer-related death worldwide, with an estimated 1.9 million new cases and about 935,000 deaths in 2020 (1). Global incidence is projected to exceed 3 million new cases annually by 2040 (2). The burden has historically been highest in industrialised countries. It is now rising quickly in transitioning economies, driven by westernised diets, physical inactivity, obesity, smoking, alcohol use and an ageing population (3). India has traditionally reported lower age-standardised rates of CRC than Western countries, but the disease is becoming more common. Data from the National Cancer Registry Programme show a growing share of gastrointestinal malignancies among Indian patients (4). Hospital-based series from India describe a patient profile that differs from Western cohorts. Patients tend to be younger, present at more advanced stages, and have a higher proportion of rectal tumours (5). Late presentation, limited screening and delayed referral all contribute to poorer outcomes. An important concern worldwide is the rising incidence of early-onset CRC, which affects adults below 50 years of age. Population-based registry analyses from several countries show increasing incidence in young adults, with a notable rise in rectal cancers (6,7). Younger patients often present with more advanced disease and more aggressive histology, which underlines the need for region-specific data. CRC develops through multiple molecular pathways, including chromosomal instability, microsatellite instability and the CpG island methylator phenotype, usually following the adenoma-carcinoma sequence. Established risk factors include age, male sex, a family history of CRC, hereditary syndromes such as Lynch syndrome and familial adenomatous polyposis, inflammatory bowel disease, and a diet high in red and processed meat (8). Patients typically present with rectal bleeding, altered bowel habits, abdominal pain, anaemia or unexplained weight loss. Symptoms often depend on tumour location, so right-sided lesions present differently from left-sided or rectal lesions, and the nonspecific symptoms can delay diagnosis. The clinicopathological profile of CRC includes age and sex distribution, presenting symptoms, tumour site, histological type, grade of differentiation and stage at diagnosis. These features matter for prognosis and for planning treatment. Adenocarcinoma is the predominant histological type, while mucinous and signet-ring cell variants are associated with a worse prognosis. The WHO classification of digestive system tumours is widely used for histopathological typing and grading (9). The AJCC TNM staging system remains the cornerstone for assessing prognosis and guiding therapy (10). Screening programmes can reduce CRC incidence and mortality by detecting early cancers and precancerous polyps (11). In many parts of India, however, organised screening is lacking, and most patients present only when symptomatic. Local hospital-based data are therefore valuable for understanding how the disease behaves in a specific population, identifying patterns of presentation, and informing early detection and referral strategies. This study aims to describe the clinicopathological profile of patients with colorectal carcinoma presenting to our hospital, including demographic characteristics, clinical presentation, tumour location, histopathological type and grade, and stage at diagnosis.

This was a hospital-based, descriptive, cross-sectional study was conducted in the Department of General Surgery, Institute of Medical Sciences, Institutional Ethical approval was obtained for the study. Written informed consent was obtained from all the participants included in the study after explaining the nature of study in vernacular language. Inclusion criteria 1. Patients aged 18 years and above with histopathologically confirmed primary adenocarcinoma or another primary malignant epithelial tumour of the colon or rectum 2. Patients who gave written informed consent Exclusion criteria 1. Recurrent or metastatic malignancy to the colorectum from another primary site 2. Anal canal carcinoma and appendiceal tumours 3. Patients with incomplete clinical or histopathological records 4. Patients who had received neoadjuvant chemotherapy or radiotherapy before the biopsy or resection specimen was taken, where this would affect histological grading The study included 40 patients with histopathologically confirmed colorectal carcinoma who presented to the hospital during the study period. Consecutive sampling was used: every eligible patient was enrolled until the sample of 40 cases was reached. Data collection: A pre-designed, structured proforma was used to record data for each patient from a detailed history, clinical examination, hospital records and histopathology reports. The following variables were collected. Demographic details: age, sex, place of residence, occupation, dietary habits (vegetarian or mixed), and personal habits such as smoking, tobacco chewing and alcohol use. Clinical details: presenting symptoms (rectal bleeding, change in bowel habits, abdominal pain, weight loss, anaemia, abdominal mass, intestinal obstruction), duration of symptoms, family history of colorectal or other cancers, and history of inflammatory bowel disease or polyps. Investigations: haemoglobin, serum carcinoembryonic antigen (CEA) where available, colonoscopy findings, and contrast-enhanced CT of the abdomen and pelvis for staging. Tumour location: the tumour site was recorded from colonoscopy, imaging and operative findings. It was classified as right colon (caecum to hepatic flexure and proximal transverse colon), left colon (distal transverse colon to sigmoid colon) or rectum. Histopathological evaluation: Biopsy and resection specimens were fixed in 10% neutral buffered formalin, processed routinely, and stained with haematoxylin and eosin. A pathologist reviewed all slides. Tumours were classified by histological type and grade of differentiation according to the WHO classification of tumours of the digestive system (9). Adenocarcinomas were graded as well, moderately or poorly differentiated. Mucinous and signet-ring cell variants were recorded separately. In resection specimens, the depth of invasion, lymph node status, lymphovascular and perineural invasion, and surgical margin status were also recorded. Staging: Tumours were staged using the AJCC TNM classification, 8th edition (10). Pathological staging was used for resected cases, and clinical and radiological staging for patients who did not undergo resection. Statistical analysis: Data were entered into Microsoft Excel and analysed using SPSS version [26] (IBM Corp., Armonk, NY, USA). Categorical variables were expressed as frequencies and percentages. Continuous variables were expressed as mean ± standard deviation (SD), or median with interquartile range if the distribution was skewed. The association between categorical variables, such as tumour site, histological grade and stage, was tested with the chi-square test or Fisher's exact test where expected cell counts were less than 5. Given the small sample size, these associations were treated as exploratory. A p-value of less than 0.05 was considered statistically significant.

A total of 40 patients with histopathologically confirmed colorectal carcinoma were included. The mean age was 56.8 ± 12.4 years (median 58 years, range 32–78). The 50–59-year group was the largest (12 patients, 30.0%), followed by the 60–69-year group (11 patients, 27.5%). Eleven patients (27.5%) were below 50 years of age, and 6 (15.0%) were 70 years or older. There were 24 men (60.0%) and 16 women (40.0%), a male-to-female ratio of 1.5:1. Most patients lived in rural areas (23 patients, 57.5%). The commonest occupation was farmer or labourer (13 patients, 32.5%), followed by homemaker (9 patients, 22.5%). Twenty-six patients (65.0%) followed a mixed diet and 14 (35.0%) were vegetarian. Twelve patients (30.0%) were smokers, 11 (27.5%) chewed tobacco, and 8 (20.0%) consumed alcohol. A family history of colorectal cancer was present in 3 patients (7.5%) (Table 1).

The commonest presenting symptom was rectal bleeding (25 patients, 62.5%), followed by change in bowel habits (22 patients, 55.0%), abdominal pain (19 patients, 47.5%) and weight loss (17 patients, 42.5%). Anaemia was a presenting feature in 14 patients (35.0%), an abdominal mass in 8 (20.0%), and intestinal obstruction in 6 (15.0%). Many patients had more than one symptom. The duration of symptoms was less than 3 months in 13 patients (32.5%), 3–6 months in 17 (42.5%), and more than 6 months in 10 (25.0%) (Table 2).

The mean haemoglobin was 10.3 ± 2.0 g/dL, and 26 patients (65.0%) had a haemoglobin below 12 g/dL. Serum CEA was available for 30 patients (75.0%) and was elevated (>5 ng/mL) in 16 of them (53.3%). On colonoscopy, an ulceroproliferative mass was the commonest finding (30 patients, 75.0%), followed by stricture (6 patients, 15.0%) and polypoid lesion (4 patients, 10.0%). The tumour was located in the left colon in 15 patients (37.5%), the rectum in 13 (32.5%) and the right colon in 12 (30.0%) (Table 3)

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Adenocarcinoma, not otherwise specified, was the predominant histological type (33 patients, 82.5%). Mucinous adenocarcinoma was seen in 5 patients (12.5%) and signet-ring cell carcinoma in 2 (5.0%). Twenty-one tumours (52.5%) were moderately differentiated, 12 (30.0%) were poorly differentiated and 7 (17.5%) were well differentiated. Twenty-nine patients (72.5%) underwent resection and 11 (27.5%) did not. Among the resected cases, most tumours were T3 (16 patients, 55.2%), followed by T4 (6 patients, 20.7%), T2 (5 patients, 17.2%) and T1 (2 patients, 6.9%). Nodal metastasis was present in 17 of the 29 resected cases (58.6%): 10 (34.5%) were N1 and 7 (24.1%) were N2, while 12 (41.4%) were node negative. The median number of lymph nodes harvested was 12 (interquartile range 9–16). Lymphovascular invasion was present in 9 resected cases (31.0%), perineural invasion in 6 (20.7%), and the surgical margin was positive in 4 (13.8%) (Table 4).

According to the AJCC 8th edition, 4 patients (10.0%) were in stage I, 11 (27.5%) in stage II, 17 (42.5%) in stage III and 8 (20.0%) in stage IV. Stage III was the commonest, and 25 patients (62.5%) presented with stage III or IV disease (Table 5).

Poorly differentiated tumours were proportionally more frequent in the rectum (5 of 13, 38.5%) and right colon (4 of 12, 33.3%) than in the left colon (3 of 15, 20.0%), but this difference was not significant (Fisher's exact test, p = 0.78) (Table 6).

Stage IV disease was more frequent in rectal tumours (4 of 13, 30.8%) than in right-sided (2 of 12, 16.7%) or left-sided tumours (2 of 15, 13.3%). Stage III or IV disease was found in 10 of 13 rectal tumours (76.9%), 7 of 12 right colon tumours (58.3%) and 8 of 15 left colon tumours (53.3%). The overall association between tumour site and stage was not statistically significant (p = 0.69) (Table 7).

Higher grade tumours tended to present at a more advanced stage. Eleven of the 12 poorly differentiated tumours (91.7%) were stage III or IV, and 5 (41.7%) were stage IV. In comparison, 11 of 21 moderately differentiated tumours (52.4%) and 2 of 7 well-differentiated tumours (28.6%) were stage III or IV, and no well-differentiated tumour was stage IV. This association did not reach statistical significance (Fisher's exact test, p = 0.09) (Table 8).

This hospital-based study describes the clinicopathological profile of 40 patients with colorectal carcinoma. The mean age was 56.8 years, and 27.5% of patients were younger than 50 years. In Western populations the median age at diagnosis is about 66 years (13). Our finding agrees with Indian series that report a younger age profile (5), and with the global rise in early-onset disease (6,7). There was a male predominance (60%), as in most registries, where men have a higher incidence and are diagnosed at a later stage (14). Smoking (30%), tobacco chewing (27.5%) and alcohol use (20%) were common. Smoking and alcohol are both established risk factors (15,16), and 65% of patients ate a mixed diet, in keeping with the dietary risk factors described earlier (8). A family history of colorectal cancer was present in only 7.5%. A family history is associated with a moderately higher risk (17), but most of our cases appear to be sporadic. Rectal bleeding (62.5%) and change in bowel habits (55.0%) were the commonest symptoms. This is similar to the classic symptom patterns described for colorectal cancer, which are nonspecific and vary with tumour site (18). About two-thirds of our patients (67.5%) had symptoms for more than three months before diagnosis, which suggests delayed presentation or referral. Anaemia was frequent: 65% had a haemoglobin below 12 g/dL. Serum CEA was elevated in 53.3% of those tested. CEA is more useful for prognosis and follow-up than for diagnosis, because its sensitivity is limited in early disease (19). The tumours were distributed fairly evenly between the left colon (37.5%), rectum (32.5%) and right colon (30.0%). Left-sided and rectal lesions together made up 70% of cases. Tumour sidedness matters clinically because right- and left-sided cancers differ in their biology and prognosis (20). Adenocarcinoma was the predominant type (82.5%). Mucinous adenocarcinoma (12.5%) and signet-ring cell carcinoma (5.0%) are less common variants. Both have been associated with a different tumour biology and a worse prognosis than conventional adenocarcinoma (21,22). The proportion of signet-ring cell carcinoma in our series is higher than is usually reported, but with only two cases this may reflect chance. Most tumours were moderately differentiated (52.5%), a common finding (23). Most patients presented with advanced disease: 42.5% had stage III and 20.0% stage IV, so 62.5% were stage III or IV. This probably reflects the lack of organised screening, which reduces incidence and mortality by detecting early lesions (11). Among resected cases, 58.6% had nodal metastasis and the median lymph node yield was 12. This meets the commonly recommended minimum, and adequate node sampling is linked to better staging accuracy and survival (24). We found no significant association between tumour site and histological grade (p = 0.78) or stage (p = 0.69). Poorly differentiated tumours tended to present at a more advanced stage (p = 0.09), which fits the known link between grade and stage (23). Rectal tumours showed a numerically higher proportion of stage IV disease. Because of the small sample these findings are exploratory only. This study has limitations. It is a single-centre, cross-sectional study with 40 patients, which limits statistical power and generalisability. It did not assess molecular markers such as microsatellite instability or follow patients for survival. Larger multicentre studies with long-term follow-up are needed. Overall, colorectal carcinoma in this cohort affected relatively young patients, presented late, and showed a predominance of moderately differentiated adenocarcinoma. Greater awareness, earlier referral and organised screening could improve stage at diagnosis.

In this hospital-based study of 40 patients, colorectal carcinoma affected relatively young patients, with a mean age of 56.8 years and more than a quarter below 50 years. There was a male predominance. Rectal bleeding and change in bowel habits were the commonest symptoms, and most patients had symptoms for over three months before diagnosis. Tumours were distributed across the left colon, rectum and right colon, and moderately differentiated adenocarcinoma was the commonest type. Most patients (62.5%) presented at stage III or IV. These findings point to delayed presentation and support greater symptom awareness, earlier referral and organised screening. Larger multicentre studies are needed to confirm them.

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