Gastro-Intestinal Cancer among Iraqi Patients

The incidence of gastro-intestinal cancers among Iraqis is reviewed from 1973-2021 in different Iraqi provinces. The incidence rates are also illustrated in relation to age, sex, site of cancer and year of registration. Incidence rate differs widely in relation to locality, age, sex and race. Many factors have been considered as Iraq exposed to the Iraq-Iran war, gulf war and the usage of uranium weapon in the south part of Iraq. In addition, oil wheel fire in gulf war in south of Basrah, as well as the pollution caused by cars and generators for electricity production that expected to have an effect on the increased cancer rate in Iraq. Impaired physiological and immunological functions with advanced age might have an effect on the increased rate of cancer. The highest incidence observed in colon and stomach. Thus, a national control program is vital for diagnosis and treatment for this disease.

Gastric carcinoma remains an obvious problem in the world despite records of decreasing incidence in United Kingdom and United States with a high incidence include Japan, Chile and parts of South Africa [2][3][4][5][6].In Iraq, gastric cancer is the 9 th common and the 2 nd commonest gastrointestinal malignancy after colorectal carcinoma [7][8][9][10].
In Iraq, gastro-intestinal cancer accounted for 10.16% of total registered cases [11].According to BCRG data for the years 2005-2008, cancer of the stomach ranked the 10 th in all population and in males and 9th in females [12].Colon-rectum cancer ranked 5 th among males and 8 th among females in Basrah over the period 2005-2008 [12].
Worldwide, around 80 million patients with colon cancer are diagnosed each year, which constitute about 10% of all reported cancers [13].It is the most commonly diagnosed cancer in North America, Western Europe, and Australia, with a high mortality rate among males and females [14][15][16].Worldwide, gastro-intestinal cancer is the 3 rd most commonly diagnosed malignancy after lung and breast cancer [17].Age has an influence on the incidence of colorectal cancer.Thus, cancer is a big health problem in Iraq as far as number of cases, cost of treatment and the mortality are concerned.The present review aimed to determine the analysis of gastro-intestinal cancers data according to age, year of registration and cancer site over time.

Introduction
Gastro-intestinal cancers are distributed worldwide.They are responsible for millions of morbidity and mortality.Thus, it is a public health problem in many parts of the world.In addition, gastro-intestinal cancer might be undetectable and unrecorded in many countries due to differences in the availability of screening programs and risk factors.Many types of cancer are very aggressive, diagnosed very late and might metastasis has developed making the chances for cures are doubtful.Despite great efforts to improve survival of patients with cancer through different modalities of Gastro-intestinal cancer became a major cause of death with an increasing worldwide especially in well developed countries.The increase in life expectancy in most countries together with changes in life style are expected to lead to cancer development.The

Results and Discussion
The incidence rates of gastro-intestinal cancer are reviewed among Iraqi patients in different Iraqi provinces from 1973-2021.The incidence is varying from one province to another (Table 1 and Table 2).patients without [25].Excess body weight and diet may also increase colorectal cancer risk [18,26].Cigarette smoking and Shisha pipe may be differentially associated with colorectal cancers [27].
The highest incidence observed in this review is colon and stomach cancers (Table 2).Colorectal cancer is rarely diagnosed before the age of 40.The incidence of this malignancy increases dramatically between 45 and 50 years of age, with 90% of cases occurring after the age of 50 years; consequently, deaths from colorectal cancer begin to increase slowly in the 5th decade of life [28,29] (Table 2).In contrast, it has been noticed in Baghdad province the colorectal cancer does not only affect older people, but young people as well (28.6%)[27].An old study in Iraq (1980) observed that availability of palliative stomas may be contributed to late detection and advanced disease.
The cause is not explained till now but many factors have been considered as Iraq exposed to the Iraq-Iran war, gulf war and the usage of uranium weapon in the south part of Iraq.In addition, oil wheel fire in gulf war in south of Basrah, as well as the pollution caused by cars and generators for electricity production might have an effect on the increased cancer rate in Iraq.Most cases of colorectal cancer appears to be related to environmental factors, as fast-food with high fat consumption is related to a higher incidence of CRC, in comparison to low fat diet rich in fruits and vegetables [18][19][20][21][22][23][24].Patients with gastrointestinal cancer and Type 2 diabetes mellitus have a higher risk of mortality than  [31].The rate of colorectal cancer in this study is much higher compared to a study conducted in Basra-Iraq, where the incidence of the disease was 6.5/100,000 populations [32].
Although gastric cancer is rare before the age of 40 years, a study in Baghdad has noticed that 22% of patients were below the age of 40 [33].This is probably due to higher incidence of Helicobacter pylori.Gastric cancer presents most commonly in the 5th and 6th decades of life [34].The peak age group was 60-70 years and was similar to previous studies in Iraq [7][8][9][10].
In respect to male: female frequency the male was more commonly affected than female [33,35,36], which was similar to many countries in the world [2][3][4].Never the less, few studies have reported the incidence is more among females rather than males [37][38][39].

Conclusions
Colorectal cancer is most common among older people of both sexes, yet it also occurs in younger people as well.The highest incidence observed was colon and stomach.It is an important disease and remains challenge to the surgeons and since the early diagnosis of gastro-intestinal cancer is vital in the treatment and prognosis of the disease.
Implementing a national control program should include a primary health care, health education, wellbalanced diet, environmental sanitation and health education to stress the important of the hazard of risk factors.

Table 1 :
Distribution of gastro-intestinal cancer in relation to province, years of registration, age and sex.

Table 2 :
Incidence of gastro-intestinal cancers and their types in the Iraqi provinces.