Colorectal Cancer In New Jersey
1979-1997

Colorectal Cancer Sub-Sites

Incidence and Incidence Rates by Sub-sites - 1979-1997

Colorectal cancer includes cancers of both the colon and the rectum. For the purpose of this analysis, the colon is divided into two regions: the proximal colon (including the cecum, appendix, ascending colon, hepatic flexure, transverse colon and splenic flexure), and the distal colon (including the descending colon, sigmoid colon, and large intestine, not otherwise specified (NOS)). The rectum is comprised of the rectum and the rectosigmoid junction. (See Figure 8.) It is important to characterize colorectal cancer by subsite because risk factors, incidence, stage at diagnosis, and mortality differ among subsites. The incidence trends of the three colorectal cancer subsites differed. Proximal colon cancer incidence rates increased between1979 and1985, then leveled off. Distal colon cancer incidence rates decreased steadily between 1979 and 1997, and rectal cancer incidence rates increased from 1979 to 1985, then steadily decreased.

White women and black men and women had about the same proportions of proximal, distal, and rectal cancer. White men, however, had a higher proportion of rectal cancer and a lower proportion of proximal colon cancer than did the other gender and race groups. (See Table 11.)

Figure 8
Diagram Of The Colon And Rectum
Source: Centers for Disease Control and Prevention, 2000.



Table 11
Colorectal Cancer Incidence
By Subsite, New Jersey - 1979-1997*

SITE White Black
Male Female Male Female
Number Rate % Number Rate % Number Rate % Number Rate %
Colon 33,229 41.7 69.1 35,248 30.0 74.3 2,807 38.8 69.6 3,380 31.6 78.4
Proximal Colon 14,836 21.8 30.9 17,198 16.7 36.2 1,377 22.2 35.8 1,654 18.0 38.4
Cecum 5,478 8.2 11.4 6,859 6.6 14.5 479 7.7 12.5 608 6.7 14.1
Appendix 192 0.3 0.4 220 0.3 0.5 22 0.3 0.6 27 0.3 0.6
Ascending Colon 4,366 6.5 9.1 5,075 5.0 10.7 397 6.5 10.3 452 5.0 10.5
Hepatic Flexure 1,164 1.7 2.4 1,128 1.1 2.4 117 1.9 3.4 109 1.2 2.5
Transverse Colon 2,460 3.7 5.1 2,940 2.9 6.2 206 3.4 5.4 314 3.5 7.3
Splenic Flexure 1,176 1.8 2.4 976 1.0 2.3 156 2.6 4.1 144 1.6 3.3
Distal Colon 18,393 20.0 38.2 18,050 13.4 38.0 1,430 16.6 37.2 1,726 13.5 40.1
Descending Colon 2,512 3.7 5.2 2,224 2.3 4.7 244 4.0 6.4 321 3.6 7.4
Sigmoid Colon 10,945 16.3 22.8 10,357 11.0 21.8 776 12.6 20.2 902 10.0 20.9
Large Intestine, NOS 4,936 7.4 10.3 5,469 5.4 11.5 410 6.6 10.7 503 5.6 11.7
Rectum 14,858 22.1 30.9 12,203 13.0 25.7 1,035 16.4 26.9 929 10.2 21.6
Rectosigmoid Junction 5,440 8.1 11.3 4,663 5.0 9.8 360 5.7 9.4 345 3.8 8.0
Rectum 9,418 14.0 19.6 7,540 8.0 16.0 675 10.7 17.6 584 6.4 13.6
Total Colorectal 48,087 63.8 100.0 47,451 43.0 100.0 3,842 55.2 100.0 4,309 41.8 100.0

* Incidence rates - per 100,000 population, age-adjusted to the 1970 U.S. standard population. Does not include in situ colorectal cancer cases.

Incidence and Incidence Rates by Subsite and Race and Gender

For the years 1979 through 1997 combined, incidence rates were highest for cancers of the proximal colon in all the race and gender groups except white males. Prior to 1984, however, distal colon cancer incidence rates were higher than rates for the other two subsites in all four groups. Over the nineteen year period, the incidence rates of proximal colon cancer increased among all the race and gender groups and distal colon cancer declined among all the race and gender groups. Rectal cancer decreased among white men and women, but increased among black men and women. (See Figures 9 through 12 and Tables 29 through 32 in Appendix II.)

Figure 9
Colorectal Cancer Incidence Rates
By Subsite, White Males, New Jersey - 1979-1997*

*Age-adjusted to the 1970 U.S. standard population.


Figure 10
Colorectal Cancer Incidence Rates
By Subsite, White Females, New Jersey - 1979-1997*

*Age-adjusted to the 1970 U.S. standard population.


Figure 11
Colorectal Cancer Incidence Rates
By Subsite, Black Males, New Jersey - 1979-1997*

*Age-adjusted to the 1970 U.S. standard population.


Figure 12
Colorectal Cancer Incidence Rates
By Subsite, Black Females, New Jersey - 1979-1997*

*Age-adjusted to the 1970 U.S. standard population.


Age-Specific Incidence Rates by Subsite

For the years 1979 through 1997 combined, the incidence rates generally increased with increasing age for all three subsites for all gender and race groups. Distal colon cancer had the highest incidence rates in the younger age groups, but proximal colon cancer incidence rates were greater than the other two subsites in the oldest age groups. (See Figures 13 though 16 and Tables 33 through 36 in Appendix II.)


Figure 13
Age-Specific Colorectal Cancer Incidence Rates
By Subsite, White Males, New Jersey - 1979-1997




Figure 14
Age-Specific Colorectal Cancer Incidence Rates
By Subsite, White Females, New Jersey - 1979-1997*




Figure 15
Age-Specific Colorectal Cancer Incidence Rates
By Subsite, Black Males, New Jersey - 1979-1997




Figure 16
Age-Specific Colorectal Cancer Incidence Rates
By Subsite, Black Females, New Jersey - 1979-1997




Subsite Stage at Diagnosis - 1985-1997

Between the years of 1985 and 1997, the percent of proximal and distal colon cancers diagnosed in the earlier stages (in situ and localized) generally increased for all gender and race groups. For men of both races and white women, the percent of cases diagnosed at the in situ and localized stages increased for colon cancer but decreased for rectal cancer. Black women were diagnosed in the early stages at increasingly higher percentages for both colon and rectal cancer between 1985 and 1997. Black men and white women showed the greatest increases in early stage diagnoses for proximal and distal colon cancers. (See Figures 17 through 20 and Tables 37 through 48 in Appendix II).


Figure 17
Colorectal Cancer Percent Early Stage At Diagnosis
By Subsite, White Males, New Jersey - 1985-1997*


*in situ and localized stages


Figure 18
Colorectal Cancer Percent Early Stage At Diagnosis
By Subsite, White Females, New Jersey - 1985-1997*


*in situ and localized stages


Figure 19
Colorectal Cancer Percent Early Stage At Diagnosis
By Subsite, Black Males, New Jersey - 1985-1997*


*in situ and localized stages


Figure 20
Colorectal Cancer Percent Early Stage At Diagnosis
By Subsite, Black Females, New Jersey - 1985-1997*


*in situ and localized stages.


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