Introduction: Colorectal cancer is one of the most common and lethal cancer worldwide, and it exhibits differences in incidence, pathogenesis, molecular pathways, and outcome depending on the location of the tumour. Colorectal cancer is a disease strongly influenced by gender, mortality rates in males considerably higher than females
Aim: To determine the gender disparities in the incidence of Colorectal cancer
Methods: All patients managed with colorectal cancer from January 2015 through December 2019 were retrospectively identified from the referral database created by the colorectal specialist nurses in the colorectal service. 
Inclusion: All patients diagnosed with colorectal cancer                                                     
Exclusion: Tumour in the Appendix, Anal canal, small bowel, metastatic tumours of unknown primary                                                                                                                           
Results: 976 patients were diagnosed with bowel cancer percentages of studied participant were Male 52.60% and Female 47.40%. The mean age of 74.14 years. Sixty six (66) 6.76% patients were excluded from the study. The location of colon cancer is also changing. The incidence rate of Right  side colon cancer in women was much higher than that in men 1.20:1, and on Left side colon cancer including rectum was much higher in men than that in women this was especially exhibited in cases of rectal cancer, for which the male to female ratio was increased to 1.54:1 whereas the male to female ratio of left colon cancer 1.26:1 The incidence rates were increasing in all groups over time, especially in the 50 -79 years group. Incidence of colorectal cancer was greater for cancers of the left side of colon than right colon (62.41% vs 37.58%).
Conclusion: There are not significant sex differences in access to and effectiveness of Colorectal cancer treatment. Screening provides effective opportunity to prevent Colorectal cancer. Gender-specific guidelines for screening, treatment, and prevention protocols for colorectal cancer can be established to decrease the mortality and increase the quality of life.

Colorectal cancer is the third most commonly diagnosed cancer in the world and is a major health problem, incidence and mortality rates vary markedly around the world. Globally, Colorectal cancer is the second most common cause of cancer death causing almost one million deaths. The incidence of Colorectal cancer is more among men than women and 3–4 times more common in developed than in developing nations. Worldwide Age-standardised incidence rates per 100,000 of Colorectal cancer in both sexes is 19.7, in males is 23.6, and in females is 16.31 While the age-standardised incidence rate among men is 30.1/100,000, in high human development index nations (Canada, the United Kingdom (UK), Denmark, and Singapore), it is 8.4, in low human development index nations (the same statistics for women are 20.9 and 5.9, respectively).2 With increasing age, the proportion of proximal Colorectal cancer gradually increased in women, whereas that of rectal cancer gradually decreased. Most colorectal cancers (CRC) arise from adenomatous colon polyps that progress from small (<8 mm) to large (⋝8 mm) polyps, then to dysplasia and carcinoma. Colo rectal cancer is a disease that has both biological sex differences and socio-cultural gender components.3-10 Detecting colorectal cancer is challenging patients may present with slight symptoms or asymptomatic. A diagnosis of colorectal cancer results either from an evaluation of a patient symptoms, or as a result of screening. When colorectal cancer or its precursor lesion is diagnosed early, its 5-year relative survival rate is very high, however advanced colorectal cancer reduces the quality of life of patients. Sex differences recommend more targeted interventions might expedite prevention and early diagnosis in both gender. There are not significant sex differences in access to and effectiveness of Colorectal cancer treatment. Therefore, novel methods that would allow the early diagnosis of colorectal cancer are chosen. Greater awareness of how sex and gender impact on Colorectal cancer may therefore lead to new insights into how improvements in prevention, early diagnosis, treatment and survival can be made.

All patients managed with colorectal cancer at the Luton and Dunstable University Hospital UK from January 2015 through December 2019 were retrospectively identified from the referral database created by the colorectal specialist nurses in the colorectal service. Data were retrieved by detailed review of the hospital case notes, ICE / Evolve (Computer database for investigations and correspondence) including endoscopy; radiographic imaging; operative course and cancer follow up. The following parameters were recorded: age, gender, and source of referral, presentation, stage of the disease, MDT discussion, intervention, and outcome. Tumour locations were classified as the right colon (i.e. caecum, ascending colon, hepatic flexure, transverse colon, and the left colon (i.e. spleenic flexure, descending colon, sigmoid, Recto sigmoid, and rectum. 
Inclusion: All patients diagnosed with colorectal cancer
Exclusion: Tumour in the Appendix, Anal canal, small bowel, metastatic tumours of unknown primary

Data were analyzed using the Statistical Package for Social Sciences (SPSS, version 26). Mean values were compared using the Student t test (Table 1).

 Univariate analysis of categorical variables was performed by the chi-square test (Table 2). 

Pearson’s chi squared test was used for comparing two proportions (Table 3). 

An OR with corresponding 95% confidence interval >1 implied a positive association where as an OR with corresponding 95% confidence interval <1>

The results are mainly illustrated by descriptive statistics. (Table 5)

Table 6

In the study period 976 patients were diagnosed with bowel cancer percentages of studied participant were Male 52.60% and Female 47.40%. (figure 1) 

Figure 1: Characteristics and incidence

The mean age of 74.14 years (range, 25 to 101). 6.76% patients were excluded from the study on the account of Tumours in the Appendix, Anal canal, Small bowel and metastatic tumor of unknown primary. (Figure 2).   

Figure 3

The location of colon cancer is also changing, (Figure 3). The incidence rate of Right side colon cancer in women was much higher than that in men 1.20:1, and on Left side colon cancer including rectum was much higher in men than that in women this was especially exhibited in cases of rectal cancer, for which the male to female ratio was increased to 1.54:1 whereas the male to female ratio of left colon cancer 1.26:1 (Table 1,2 ). In the univariate analysis, tumour location was associated with age in both men and women. The shift of tumour location to the proximal colon with increasing age was more prominent 5.38% aged < 50 years had rightsided colorectal cancer, compared with 65.05% of those aged 50 –79 years. while Age group 80-99 years incidence 28.90% and over age group 100 years 0.65%. In a multivariate analysis, right-sided colorectal cancer was the only independent variable that correlated with age. The rectal cancer incidence increased from 20.75% in 2015 to 21.88% in 2018. The most significant increase was noted 22.64% in 2017. High male to female rate ratios were found in 2017,1.35:1 and 2018, 1.32:1. The proportion of distal colon cancer was increasing annually, rising to 22.88% in 2018. The proportion of Colorectal cancer in women increase from 7.58% in 2015 to 10.43% in 20190. (Table 3) All studied cases were classified into four groups according to the age at diagnosis. The incidence rates were increasing in all groups over time, especially in the 50 -79 years group. 69.89% patients underwent surgical intervention. 24.50% patients deemed unsuitable for resection surgery were treated with best supportive care palliatively.(Table 4,5,6) In the Right colon subset of patients there was a total of 37.58% patients 189 Female and 153 Male, In 33.29% patients with Left Colon cancer there were 169 Male and 134 Female. Of 29.12% Rectal cancer patients there were 161 Male and 104 Female. 32.08 % patients died during the study period. Incidence of colorectal cancer was greater for cancers of the left side of colon than right colon (62.41% vs 37.58%).

Colorectal cancer is one of the most common and lethal cancer worldwide, and it exhibits differences in incidence, pathogenesis, molecular pathways, and outcome depending on the location of the tumour. Colorectal cancer is a disease strongly influenced by gender, mortality rates in males considerably higher than females. There is scarcity to appreciative whether sex differences exist along the pathway from presentation to survival. Most colorectal cancers arise from adenomatous colon polyps that progress from small (<8 mm) to large (⋝8 mm) polyps, then to dysplasia and carcinoma. Bowel cancer can affect anyone of any age, in the United Kingdom, age-standardised incidence have remained constant, but incidence rates in aged 20–39 have increased in the last 25 years.11 Age-standardised incidence rates of bowel cancer for females in the UK remained stable between 1993-1995 and 2015- 2017, and for males, bowel cancer age-standardised incidence rates in the UK decreased by 3?tween 1993-1995 and 2015-2017. In the UK between 2005-2007 and 2015-2017, bowel cancer age-standardised incidence rates for males and females combined decreased by 4%. In males age-standardised incidence rates decreased by 6%., and in females rates decreased by 2%. Generally prevalence of colon cancer is higher in males than in females. This increased liability of men to develop colorectal may be due to a number of genetic and gender related (developmental) factors.12-15 Men are more likely to have a diet rich in processed and red meat,16 be more alcohol consumers,17 and more prone to smoke.18 Men also have a more tendency to deposit visceral fat19 which is related with increased risk of developing colorectal cancer.20- 22 Conversely, female gender is more associated with BRAF V600E mutation, CpG island methylator phenotype (CIMP)-high, hypermethylation, microsatellite instability,23 which are more liable to result in the sessile serrated polyps. Females are furthermore found to have higher frequency of KRAS mutations in codon 12 than males, that again are linked with more advanced adenomas.24 Published Studies have shown that Women, are more constant with relationships and appeared more familiar about colorectal cancer screening, and better able to expressive views on screening.25,26,27-30 Men reported less clear interactions, less knowledgeable and often kept decision making processes vague and emotionally distanced. In the UK bowel cancer is the 3rd most common cancer In both sexes. In males (13% of all new male cancer cases) and in females, (10% of all new female cancer cases). A comparable or greater proportion of patients with Right colon cancer are female, and the median age of patients with Right colon cancer at diagnosis is higher compared to patients with Left colon cancer.31-33 56 % of bowel cancer cases in the UK are in males, and 56% are in females. This is in contrast to our study, in our study there were 52.74% Male and 47.25?male. In current study Bowel cancer incidence is strongly related to age, with the highest incidence rates being in older people. Agespecific incidence rates rise steeply from around age 50-79. The highest rates are in the 70 to 79 age group for females and males, while Age group 80-99 years incidence 28.90% and over age group 100 years 0.65%. In our study the proportion of cancer in the distal colon and rectum is considerably lower among women than among men this is similar to other published studies (Stewart et al, 1983; Bonithon-Kopp and Benhamiche, 1999; McCashland et al, 2001). Many studies have reported that oncologic outcomes of colon cancer are different according to the tumour location. Most studies have reported poorer oncologic outcomes in patients with Right colon cancer compared with patients with Left colon cancer.34-38 However, our study have reported that the prognosis of Right colon cancer is better than that of Left colon cancer this is similar to other published studies.39,40 Five-year survival for bowel cancer shows an unusual pattern with age: survival overall decreases with increasing age.41 In 1990 report on prognostic effect of primary tumour localisation on clinical outcome was first reported.42 In a FIRE-1 trial, Right colon cancer patients had a considerably shorter progression-free survival and overall survival compared with Left colon cancer.43 This is similar to our study, Overall 5-year survival in our study for right-sided tumours was 24.94%. In comparison, survival rates were 42.96% for patients with left-sided tumours. In our study 15.10% had complications after surgery (Fig. 6) and age is not a predictor of post-operative complications. Increased circulating levels of oestrogens and progestin subsequent to exogenous exposure through contraceptives or hormone replacement therapy (HRT) in post-menopausal, have shown to lower risk of colorectal cancer in women, possibly by preventing the loss of oestrogen receptor beta signalling in the colonic mucosa (Rennert, 2017; Barzi et al., 2013). Similarly, reduced testosterone levels as a result of androgen deprivation therapy, androgen receptor polymorphisms or obesity associates with increased cancer risk in men (Rennert, 2017; Lin et al., 2013). Gender differences have been also observed in body fat storage/distribution and lifestyle (Vari et al., 2016; Bredella, 2017). One of the strengths of our study is that the sample size is not small, Patients admitted as an emergency and scheduled for elective surgery for confirmed colorectal cancer were included and long follow-up period. The limitations of this study is single center, retrospective. The choice of treatment is based on several factors, including conditions of the patient stage at presentation, and the location of tumour. Surgery remains the core in curative treatment for colorectal cancer. Age on its own would not be taken as for less aggressive therapy; Careful assessment of the patient taking into consideration comorbidities, functional status and patient wishes are essential in decision making and choosing appropriate management plan. Management of comorbidities preceding surgery may impact postoperative outcome. Colon cancer is a common and highly treatable cancer. Advances in screening and treatment have led to better outcomes for patients. Greater awareness of how gender impact on colorectal cancer may have led to innovative comprehensions in what way to prevent, early diagnosis, treatment and survival can be made.

Screening provides effective opportunity to prevent Colorectal cancer. Conversely, there are no gender-specific guidelines or screening tools. Gender-specific guidelines for screening, treatment, and prevention protocols for colorectal cancer can be established to decrease the mortality and increase the quality of life. There are not significant sex differences in access to and effectiveness of Colorectal cancer treatment.