Exploring the Association between Benign Anorectal Conditions and Colorectal Cancer from the Analysis of Lower Gastrointestinal Endoscopies

Abstract

Objective Patients experiencing hemorrhoids or fissures may overlook other gastrointestinal (GI) symptoms, assuming that they are linked solely to their existing condition. However, colon cancer, often asymptomatic, can coincide with benign pathologies detected during colonoscopy. This study investigates the prevalence of colorectal cancer (CRC) in patients undergoing lower GI endoscopy for hemorrhoids and elucidates the correlation between cancer and benign pathologies identified during colonoscopy. Highlighting its potential to reveal hidden cancers emphasizes the critical role of colonoscopy in comprehensive health care.

Methods The primary objective was to thoroughly investigate the prevalence of CRC in patients who underwent lower GI endoscopy for hemorrhoids. A comprehensive analysis was conducted using a dataset spanning 7 years of lower GI endoscopy. The main focus of this investigation was to determine the incidence of cancer. Additionally, a meticulous examination of accompanying benign diagnoses was performed to provide a comprehensive evaluation.

Results The study cohort, comprising 6,268 patients, revealed a noteworthy coexistence of malignancies with common conditions. The revelation was of paramount significance that the total number of malignant cases within this cohort was 440. Polyps emerged as the most frequently observed condition, constituting 55.2% (n = 243) of the cases. Diverticulosis was present in 6.6% (n: 29) of cases, while ulcerative colitis was detected in 8% (n: 2) of cases. Hemorrhoids were identified in 20.7% (n: 91) of cases. The findings indicated a substantial association between these common conditions and malignancy. Specifically, it was discovered that approximately 1 in 22 individuals with hemorrhoids, 1 in 52 individuals with fissures, and 1 in 5.7 individuals with polyps were diagnosed with malignancy.

Conclusion This study highlights the pivotal role of colonoscopy in uncovering hidden cancers, especially in patients with hemorrhoids. The findings emphasize the significance of doctors and patients prioritizing colonoscopy, as it allows for early detection and intervention for potential malignancies, even in the presence of hemorrhoids.

Keywords

colonoscopy - hemorrhoids - benign pathologies - malignant pathology - clinical implications

Authors' Contributions

FB worked on Conceptualization, Methodology, Software, Writing. YKÇ, YBA looked into Visualization, Investigation, Supervision. Software, Validation, Writing- Reviewing and Editing. All authors contributed to study design.

Compliance with Ethical Principles

This retrospective chart review study with human participants adhered to the ethical standards of the institutional research committee and the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards. All patients and/or their patients and/or guardians signed a general consent form allowing anonymous use of data for education, research, and quality improvement. The authors confirmed that the data were collected anonymously.

Publikationsverlauf

Artikel online veröffentlicht:
04. Juni 2024

• References

• 1 Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 2000; 343 (03) 162-168
• 2 Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann Oncol 2005; 16 (03) 481-488
• 3 Minoli G, Meucci G, Bortoli A. et al. The ASGE guidelines for the appropriate use of colonoscopy in an open access system. Gastrointest Endosc 2000; 52 (01) 39-44
• 4 Winawer S, Fletcher R, Rex D. et al; Gastrointestinal Consortium Panel. Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology 2003; 124 (02) 544-560
• 5 Singh H, Turner D, Xue L, Targownik LE, Bernstein CN. Risk of developing colorectal cancer following a negative colonoscopy examination: evidence for a 10-year interval between colonoscopies. JAMA 2006; 295 (20) 2366-2373
• 6 Muthusami S, Ramachandran IK, Babu KN. et al. Role of inflammation in the development of colorectal cancer. Endocr Metab Immune Disord Drug Targets 2021; 21 (01) 77-90
• 7 Tilg H, Adolph TE, Gerner RR, Moschen AR. The intestinal microbiota in colorectal cancer. Cancer Cell 2018; 33 (06) 954-964
• 8 Mowat C, Cole A, Windsor A. et al; IBD Section of the British Society of Gastroenterology. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011; 60 (05) 571-607
• 9 Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2009: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin 2009; 59 (01) 27-41
• 10 Smith RA, Cokkinides V, Eyre HJ. American Cancer Society. American Cancer Society guidelines for the early detection of cancer, 2003. CA Cancer J Clin 2003; 53 (01) 27-43
• 11 Davidson KW, Barry MJ, Mangione CM. et al; US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement: US Preventive Services Task Force recommendation statement. JAMA 2021; 325 (19) 1965-1977
• 12 Winawer SJ, Fletcher RH, Miller L. et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997; 112 (02) 594-642
• 13 Cappell MS. Reducing the incidence and mortality of colon cancer: mass screening and colonoscopic polypectomy. Gastroenterol Clin North Am 2008; 37 (01) 129-160
• 14 Brenner H, Stock C, Hoffmeister M. Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies. BMJ 2014; 348: g2467
• 15 Ren HG, Luu HN, Cai H. et al. Oral health and risk of colorectal cancer: results from three cohort studies and a meta-analysis. Ann Oncol 2016; 27 (07) 1329-1336
• 16 Lech G, Słotwiński R, Słodkowski M, Krasnodębski IW. Colorectal cancer tumour markers and biomarkers: recent therapeutic advances. World J Gastroenterol 2016; 22 (05) 1745-1755
• 17 Marano L, Pellino G, Kontovounisios C, Celentano V, Frasson M. Translational research in colorectal cancer: current status and future perspectives of multimodal treatment approach. Gastroenterol Res Pract 2019; 2019: 2010259
• 18 Kavalukas S. Colonoscopy versus FIT-fecal DNA for colon cancer screening. Accessed April 11, 2024 at: https://www.facs.org
• 19 Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143 (03) 844-857