International Journal of Colorectal Disease

, Volume 25, Issue 11, pp 1343–1351

The comparison of the clinical manifestations and risk factors of colorectal cancer and adenomas: results from a colonoscopy-based study in southern Chinese

  • Liyun Huang
  • Xinying Wang
  • Wei Gong
  • Yinglong Huang
  • Bo Jiang
Original Article
  • 212 Downloads

Abstract

Background and aims

Colorectal cancer (CRC) is one of the most common gastrointestinal tumors in the world. This study aimed to compare the clinical manifestations and risk factors of CRC and adenomas in native patients of Guangzhou.

Methods

Patients who underwent colonoscopy for the first time at Nanfang Hospital between July 2008 and July 2009 were recruited. Data on demographic information, main clinical manifestations, results of endoscopies and pathology, and possible risk factors of colorectal tumor were collected. Chi-square test and logistic regression were used to compare the clinical characteristics and risk factors for CRC and adenomas.

Results

Hematochezia and body weight loss were more frequent in proximal and distal CRC groups, respectively (P ≤ 0.05). Older age [odds ratio (OR), 1.079; 95% confidence interval (CI), 1.065–1.093], smoking status (OR, 1.712; 95% CI, 1.158–2.531), BMI = 18.5–24.9 and ≥ 25.0 (OR, 2.384; 95% CI, 1.250–4.549; OR, 2.162; 95% CI, 1.044–4.478, respectively) were significant risk factors for advanced adenoma, while female (OR, 0.638; 95% CI, 0.429–0.949) and using aspirin (OR, 0.188; 95% CI, 0.042–0.845) were significant protective factors. Hyperlipemia (OR, 0.109; 95% CI, 0.013–0.886) was identified as a protective factor for proximal CRC. Smoking (OR, 1.717; 95% CI, 1.093–2.696), drinking (OR, 1.817; 95% CI, 1.145–2.883), DM history (OR, 2.204; 95% CI, 1.044–4.652) were identified as independent risk factors for distal CRC, and using aspirin (OR, 0.190; 95% CI, 0.043–0.840) was a protective factor. Drinking (OR, 3.288; 95% CI, 1.546–6.994; OR, 1.862; 95% CI, 1.037–3.343, respectively) was an independent risk factor for both poorly to moderately differentiated CRC and well-differentiated CRC. Besides, DM (OR, 3.761; 95% CI, 1.615–8.762) and hypertension (OR, 0.384; 95% CI, 0.178–0.828) were identified as independent risk factor and protective factor for well-differentiated CRC, respectively.

Conclusions

Hematochezia and body weight loss were representative manifestations for distal and proximal CRC, respectively. For southern Chinese the most important influential factors for colorectal tumor are age, smoking, drinking, nutritional state, DM, hypertension, and the use of aspirin.

Keywords

Colorectal cancer Adenomas Clinical manifestations Risk factors Protective factors 

References

  1. 1.
    Lu JB, Sun XB, Dai DX, Zhu SK, Chang QL, Liu SZ, Duan WJ (2003) Epidemiology of gastroenterologic cancer in Henan Province, China. World J Gastroenterol 9:2400–2403PubMedGoogle Scholar
  2. 2.
    Xu AG, Jiang B, Yu ZJ, Zhong XH, Gan AH, Liu JH, Luo QY, Xiong LS (2007) Epidemiology investigation of colorectal cancer on community group in Guangdong province. Zhonghua Yi Xue Za Zhi 87:1950–1953PubMedGoogle Scholar
  3. 3.
    Leslie A, Carey FA, Pratt NR, Steele RJ (2002) The colorectal adenoma-carcinoma sequence. Br J Surg 89:845–860CrossRefPubMedGoogle Scholar
  4. 4.
    Vernon SW (1997) Participation in colorectal cancer screening: a review. J Natl Cancer Inst 89:1406–1422CrossRefPubMedGoogle Scholar
  5. 5.
    Drossman DA, Brandt LJ, Sears C, Li Z, Nat J, Bozymski EM (1996) A preliminary study of patients' concerns related to GI endoscopy. Am J Gastroenterol 91:287–291PubMedGoogle Scholar
  6. 6.
    Oh SW, Kim YH, Choi YS, Chang DK, Son HJ, Rhee PL, Kim JJ, Rhee JC, Yun SH, Lee WY, Chun HK, Kim DH, Shim SG (2008) The comparison of the risk factors and clinical manifestations of proximal and distal colorectal cancer. Dis Colon Rectum 51:56–61CrossRefPubMedGoogle Scholar
  7. 7.
    Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395CrossRefPubMedGoogle Scholar
  8. 8.
    Hagstromer M, Oja P, Sjostrom M (2006) The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr 9:755–762CrossRefPubMedGoogle Scholar
  9. 9.
    Qu NN, Li KJ (2004) Study on the reliability and validity of international physical activity questionnaire (Chinese Vision, IPAQ). Zhonghua Liu Xing Bing Xue Za Zhi 25:265–268PubMedGoogle Scholar
  10. 10.
    Deng HB, Macfarlane DJ, Thomas GN, Lao XQ, Jiang CQ, Cheng KK, Lam TH (2008) Reliability and validity of the IPAQ-Chinese: the Guangzhou Biobank Cohort study. Med Sci Sports Exerc 40:303–307CrossRefPubMedGoogle Scholar
  11. 11.
    Lieberman DA, Weiss DG, Harford WV, Ahnen DJ, Provenzale D, Sontag SJ, Schnell TG, Chejfec G, Campbell DR, Kidao J, Bond JH, Nelson DB, Triadafilopoulos G, Ramirez FC, Collins JF, Johnston TK, McQuaid KR, Garewal H, Sampliner RE, Esquivel R, Robertson D (2007) Five-year colon surveillance after screening colonoscopy. Gastroenterology 133:1077–1085CrossRefPubMedGoogle Scholar
  12. 12.
    Bowman TS, Gaziano JM, Buring JE, Sesso HD (2007) A prospective study of cigarette smoking and risk of incident hypertension in women. J Am Coll Cardiol 50:2085–2092CrossRefPubMedGoogle Scholar
  13. 13.
    Jacobson JS, Neugut AI, Murray T, Garbowski GC, Forde KA, Treat MR, Waye JD, Santos J, Ahsan H (1994) Cigarette smoking and other behavioral risk factors for recurrence of colorectal adenomatous polyps (New York City, NY, USA). Cancer Causes Control 5:215–220CrossRefPubMedGoogle Scholar
  14. 14.
    Lee WC, Neugut AI, Garbowski GC, Forde KA, Treat MR, Waye JD, Fenoglio-Preiser C (1993) Cigarettes, alcohol, coffee, and caffeine as risk factors for colorectal adenomatous polyps. Ann Epidemiol 3:239–244CrossRefPubMedGoogle Scholar
  15. 15.
    Nagata C, Shimizu H, Kametani M, Takeyama N, Ohnuma T, Matsushita S (1999) Cigarette smoking, alcohol use, and colorectal adenoma in Japanese men and women. Dis Colon Rectum 42:337–342CrossRefPubMedGoogle Scholar
  16. 16.
    Abrams JA, Terry MB, Neugut AI (2008) Cigarette smoking and the colorectal adenoma-carcinoma sequence. Gastroenterology 134:617–619CrossRefPubMedGoogle Scholar
  17. 17.
    Akhter M, Nishino Y, Nakaya N, Kurashima K, Sato Y, Kuriyama S, Tsubono Y, Tsuji I (2007) Cigarette smoking and the risk of colorectal cancer among men: a prospective study in Japan. Eur J Cancer Prev 16:102–107CrossRefPubMedGoogle Scholar
  18. 18.
    Anderson JC, Attam R, Alpern Z, Messina CR, Hubbard P, Grimson R, Ells PF, Brand DL (2003) Prevalence of colorectal neoplasia in smokers. Am J Gastroenterol 98:2777–2783CrossRefPubMedGoogle Scholar
  19. 19.
    Paskett ED, Reeves KW, Rohan TE, Allison MA, Williams CD, Messina CR, Whitlock E, Sato A, Hunt JR (2007) Association between cigarette smoking and colorectal cancer in the Women's Health Initiative. J Natl Cancer Inst 99:1729–1735CrossRefPubMedGoogle Scholar
  20. 20.
    Verla-Tebit E, Lilla C, Hoffmeister M, Brenner H, Chang-Claude J (2006) Cigarette smoking and colorectal cancer risk in Germany: a population-based case-control study. Int J Cancer 119:630–635CrossRefPubMedGoogle Scholar
  21. 21.
    Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, Petrelli N, Pipas JM, Karp DD, Loprinzi CL, Steinbach G, Schilsky R (2003) A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 348:883–890CrossRefPubMedGoogle Scholar
  22. 22.
    Chan AT, Giovannucci EL, Meyerhardt JA, Schernhammer ES, Curhan GC, Fuchs CS (2005) Long-term use of aspirin and nonsteroidal anti-inflammatory drugs and risk of colorectal cancer. JAMA 294:914–923CrossRefPubMedGoogle Scholar
  23. 23.
    Cook NR, Lee IM, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE (2005) Low-dose aspirin in the primary prevention of cancer: the Women's Health Study: a randomized controlled trial. JAMA 294:47–55CrossRefPubMedGoogle Scholar
  24. 24.
    Flossmann E, Rothwell PM (2007) Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies. Lancet 369:1603–1613CrossRefPubMedGoogle Scholar
  25. 25.
    Eberhart CE, Coffey RJ, Radhika A, Giardiello FM, Ferrenbach S, DuBois RN (1994) Up-regulation of cyclooxygenase 2 gene expression in human colorectal adenomas and adenocarcinomas. Gastroenterology 107:1183–1188PubMedGoogle Scholar
  26. 26.
    Terry MB, Neugut AI, Bostick RM, Sandler RS, Haile RW, Jacobson JS, Fenoglio-Preiser CM, Potter JD (2002) Risk factors for advanced colorectal adenomas: a pooled analysis. Cancer Epidemiol Biomarkers Prev 11:622–629PubMedGoogle Scholar
  27. 27.
    Boutron-Ruault MC, Senesse P, Meance S, Belghiti C, Faivre J (2001) Energy intake, body mass index, physical activity, and the colorectal adenoma-carcinoma sequence. Nutr Cancer 39:50–57CrossRefPubMedGoogle Scholar
  28. 28.
    Bird CL, Frankl HD, Lee ER, Haile RW (1998) Obesity, weight gain, large weight changes, and adenomatous polyps of the left colon and rectum. Am J Epidemiol 147:670–680PubMedGoogle Scholar
  29. 29.
    Kono S, Handa K, Hayabuchi H, Kiyohara C, Inoue H, Marugame T, Shinomiya S, Hamada H, Onuma K, Koga H (1999) Obesity, weight gain and risk of colon adenomas in Japanese men. Jpn J Cancer Res 90:805–811PubMedGoogle Scholar
  30. 30.
    Sedjo RL, Byers T, Levin TR, Haffner SM, Saad MF, Tooze JA Jr, D'Agostino RB (2007) Change in body size and the risk of colorectal adenomas. Cancer Epidemiol Biomarkers Prev 16:526–531CrossRefPubMedGoogle Scholar
  31. 31.
    Giovannucci E, Colditz GA, Stampfer MJ, Willett WC (1996) Physical activity, obesity, and risk of colorectal adenoma in women (United States). Cancer Causes Control 7:253–263CrossRefPubMedGoogle Scholar
  32. 32.
    Tamura K, Ishiguro S, Munakata A, Yoshida Y, Nakaji S, Sugawara K (1996) Annual changes in colorectal carcinoma incidence in Japan. Analysis of survey data on incidence in Aomori Prefecture. Cancer 78:1187–1194CrossRefPubMedGoogle Scholar
  33. 33.
    Ji BT, Devesa SS, Chow WH, Jin F, Gao YT (1998) Colorectal cancer incidence trends by subsite in urban Shanghai, 1972–1994. Cancer Epidemiol Biomarkers Prev 7:661–666PubMedGoogle Scholar
  34. 34.
    Sung JJ, Lau JY, Goh KL, Leung WK (2005) Increasing incidence of colorectal cancer in Asia: implications for screening. Lancet Oncol 6:871–876CrossRefPubMedGoogle Scholar
  35. 35.
    Yang L, Parkin DM, Li LD, Chen YD, Bray F (2004) Estimation and projection of the national profile of cancer mortality in China: 1991–2005. Br J Cancer 90:2157–2166PubMedGoogle Scholar
  36. 36.
    Schoenfeld P, Cash B, Flood A, Dobhan R, Eastone J, Coyle W, Kikendall JW, Kim HM, Weiss DG, Emory T, Schatzkin A, Lieberman D (2005) Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 352:2061–2068CrossRefPubMedGoogle Scholar
  37. 37.
    Sturmer T, Buring JE, Lee IM, Gaziano JM, Glynn RJ (2006) Metabolic abnormalities and risk for colorectal cancer in the physicians' health study. Cancer Epidemiol Biomarkers Prev 15:2391–2397CrossRefPubMedGoogle Scholar
  38. 38.
    Stocks T, Lukanova A, Johansson M, Rinaldi S, Palmqvist R, Hallmans G, Kaaks R, Stattin P (2008) Components of the metabolic syndrome and colorectal cancer risk; a prospective study. Int J Obes (Lond) 32:304–314CrossRefGoogle Scholar
  39. 39.
    Winawer SJ, Zauber AG, Gerdes H, O'Brien MJ, Gottlieb LS, Sternberg SS, Bond JH, Waye JD, Schapiro M, Panish JF et al (1996) Risk of colorectal cancer in the families of patients with adenomatous polyps. National Polyp Study Workgroup. N Engl J Med 334:82–87CrossRefPubMedGoogle Scholar
  40. 40.
    Negri E, Braga C, La Vecchia C, Franceschi S, Filiberti R, Montella M, Falcini F, Conti E, Talamini R (1998) Family history of cancer and risk of colorectal cancer in Italy. Br J Cancer 77:174–179PubMedGoogle Scholar
  41. 41.
    Slattery ML, Levin TR, Ma K, Goldgar D, Holubkov R, Edwards S (2003) Family history and colorectal cancer: predictors of risk. Cancer Causes Control 14:879–887CrossRefPubMedGoogle Scholar
  42. 42.
    Lynch KL, Ahnen DJ, Byers T, Weiss DG, Lieberman DA (2003) First-degree relatives of patients with advanced colorectal adenomas have an increased prevalence of colorectal cancer. Clin Gastroenterol Hepatol 1:96–102CrossRefPubMedGoogle Scholar
  43. 43.
    Imperiale TF, Kahi CJ, Stuart JS, Qi R, Born LJ, Glowinski EA, Rex DK (2008) Risk factors for advanced sporadic colorectal neoplasia in persons younger than age 50. Cancer Detect Prev 32:33–38CrossRefPubMedGoogle Scholar
  44. 44.
    Trevisan M, Liu J, Muti P, Misciagna G, Menotti A, Fucci F (2001) Markers of insulin resistance and colorectal cancer mortality. Cancer Epidemiol Biomarkers Prev 10:937–941PubMedGoogle Scholar
  45. 45.
    Colangelo LA, Gapstur SM, Gann PH, Dyer AR, Liu K (2002) Colorectal cancer mortality and factors related to the insulin resistance syndrome. Cancer Epidemiol Biomarkers Prev 11:385–391PubMedGoogle Scholar
  46. 46.
    Chan AO, Jim MH, Lam KF, Morris JS, Siu DC, Tong T, Ng FH, Wong SY, Hui WM, Chan CK, Lai KC, Cheung TK, Chan P, Wong G, Yuen MF, Lau YK, Lee S, Szeto ML, Wong BC, Lam SK (2007) Prevalence of colorectal neoplasm among patients with newly diagnosed coronary artery disease. JAMA 298:1412–1419CrossRefPubMedGoogle Scholar
  47. 47.
    Ahmed RL, Schmitz KH, Anderson KE, Rosamond WD, Folsom AR (2006) The metabolic syndrome and risk of incident colorectal cancer. Cancer 107:28–36CrossRefPubMedGoogle Scholar
  48. 48.
    Pais R, Silaghi H, Silaghi AC, Rusu ML, Dumitrascu DL (2009) Metabolic syndrome and risk of subsequent colorectal cancer. World J Gastroenterol 15:5141–5148CrossRefPubMedGoogle Scholar
  49. 49.
    Lipkin M, Reddy B, Newmark H, Lamprecht SA (1999) Dietary factors in human colorectal cancer. Annu Rev Nutr 19:545–586CrossRefPubMedGoogle Scholar
  50. 50.
    Giovannucci E, Willett WC (1994) Dietary factors and risk of colon cancer. Ann Med 26:443–452CrossRefPubMedGoogle Scholar
  51. 51.
    Slattery ML, Boucher KM, Caan BJ, Potter JD, Ma KN (1998) Eating patterns and risk of colon cancer. Am J Epidemiol 148:4–16PubMedGoogle Scholar
  52. 52.
    Bingham SA, Day NE, Luben R, Ferrari P, Slimani N, Norat T, Clavel-Chapelon F, Kesse E, Nieters A, Boeing H, Tjonneland A, Overvad K, Martinez C, Dorronsoro M, Gonzalez CA, Key TJ, Trichopoulou A, Naska A, Vineis P, Tumino R, Krogh V, Bueno-de-Mesquita HB, Peeters PH, Berglund G, Hallmans G, Lund E, Skeie G, Kaaks R, Riboli E (2003) Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study. Lancet 361:1496–1501CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Liyun Huang
    • 1
  • Xinying Wang
    • 1
  • Wei Gong
    • 1
  • Yinglong Huang
    • 1
  • Bo Jiang
    • 1
  1. 1.Department of Gastroenterology, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople’s Republic of China

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