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CC BY-NC-ND 4.0 · Ibnosina Journal of Medicine and Biomedical Sciences
DOI: 10.1055/s-0044-1787110
Original Article

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

Fatih Başak 
1   Department of General Surgery, University of Health Sciences, Umraniye Education and Research Hospital, Istanbul, Turkey
,
Yahya Kemal Çalışkan
2   Department of General Surgery, University of Health Sciences, Kanuni Education and Research Hospital, Istanbul, Turkey
,
Yıldız Büyükdereli Atadağ 
3   Department of Family Medicine, Family Medicine, Abdulkadir Yüksel State Hospital, Şahinbey, Gaziantep, Turkey
› Author Affiliations Funding None.
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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 conformed to the ethical standards of the institutional and national research committee and the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards. No prior ethical approval is required for this retrospective cohort study due to the nature of the data collection and consent process. 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.


Supplementary Material



Publication History

Article published online:
04 June 2024

© 2024. The Libyan Biotechnology Research Center. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • 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
    CrossrefPubMedGoogle Scholar
  • 2 Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann Oncol 2005; 16 (03) 481-488
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 7 Tilg H, Adolph TE, Gerner RR, Moschen AR. The intestinal microbiota in colorectal cancer. Cancer Cell 2018; 33 (06) 954-964
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Winawer SJ, Fletcher RH, Miller L. et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997; 112 (02) 594-642
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 18 Kavalukas S. Colonoscopy versus FIT-fecal DNA for colon cancer screening. Accessed April 11, 2024 at: https://www.facs.org
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar