Change in the incidence and anatomic distribution of colorectal adenoma and cancer over a period of 20 years – A single center experience

Tamara Alempijevic; Vladimir Nikolic; Simon Zec; Aleksandar Veljkovic; Aleksandra Sokic-Milutinovic; Aleksandra Pavlovic-Markovic; Vera Matovic; Dusan Dj Popovic; Tomica Milosavljevic

doi:10.2298/VSP160409207A

Tamara Alempijevic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Vladimir Nikolic Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Simon Zec Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Aleksandar Veljkovic Faculty of Mathematics, University of Belgrade, Serbia
Aleksandra Sokic-Milutinovic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Aleksandra Pavlovic-Markovic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Vera Matovic Emergency Center, Clinical Center of Serbia, Serbia
Dusan Dj Popovic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Tomica Milosavljevic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP160409207A

Keywords: colorectal neoplasms;, adenoma;, carcinoma;, diagnosis;, incidence

Abstract

Background/Aim. In recent years, many studies have demonstrated a proximal shift in the distribution of adenomas and colorectal cancers. The aim of this study was to investigate whether there are differences in the incidence and anatomical distribution of adenomas and colorectal cancers spanning a 20 year time gap. Methods. We performed a retrospective observational study of colorectal adenomas and cancers diagnosed during total colonoscopy in a high volume tertiary care facility in two 1-year periods of time – 1990 and 2010. Results. During the analyzed period, 4,048 colonoscopies were performed, 1,148 were performed in 1990 and 2,900 were done in 2010. The study included 466 patients with adenomas and 121 patients with colorectal cancers. Frequency of proximal adenoma changed from 16.5% to 32.7% (p < 0.001). By analyzing colonoscopies in 2010, an increase in the incidence of adenomas compared to 1990 was noticed. The number of adenomas sized 0–5 mm rose from 32.8% to 56.9% (p < 0.001). Frequency of colon carcinoma changed from 5.3% to 2.0% (p < 0.001). Incidence of cancers in the proximal colon rose from 21.3% to 48.4% (p = 0.002). A higher incidence of cancers in the proximal colon and a lower incidence of distal cancers were observed, while no difference was observed in the incidence of rectal cancers. Conclusion. Presence of proximal colon adenoma and cancer is higher, while the overall incidence of colon cancer is lower. This finding should be taken into account when planning the screening for colorectal cancer.

Author Biographies

Tamara Alempijevic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Vladimir Nikolic, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Simon Zec, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Aleksandar Veljkovic, Faculty of Mathematics, University of Belgrade, Serbia

Aleksandra Sokic-Milutinovic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Aleksandra Pavlovic-Markovic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Vera Matovic, Emergency Center, Clinical Center of Serbia, Serbia

Dusan Dj Popovic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Tomica Milosavljevic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

References

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136(5): E359-86.

Leslie A, Carey FA, Pratt NR, Steele RJ. The colorectal adenoma-cancer sequence. Br J Surg 2002; 89(7): 845-60.

Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet 2014; 383(9927): 1490-502.

Hart AR, Kennedy HJ. Preventing bowel cancer: an insight for clinicians. Ther Adv Med Oncol 2011; 3(6): 269-77.

Martinez ME, Baron JA, Lieberman DA, Schatzkin A, Lanza E, Winawer SJ, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology 2009; 136(3): 832-41.

Park DH, Kim HS, Kim WH, Kim TI, Kim YH, Park DI, et al. Clinicopathologic characteristics and malignant potential of colorectal flat neoplasia compared with that of polypoid neoplasia. Dis Colon Rectum 2008; 51(1): 43-9; discussion 49.

Yamaji Y, Mitsushima T, Ikuma H, Watabe H, Okamoto M, Kawabe T, et al. Incidence and recurrence rates of colorectal adenomas estimated by annually repeated colonoscopies on asymptomatic Japanese. Gut 2004; 53(4): 568-72.

de Oliveira AMF, Anapaz V, Lourenco L, Lourenc L¸ Grac CR, Folgado SA, et al. Is there a proximal shift in the distribution of colorectal adenomas? United European Gastroenterol J 2015;3(4):353-7.

Iida Y, Kawai K, Tsuno NH, Ishihara S, Yamaguchi H, Sunami E, et al. Proximal shift of colorectal cancer along with aging. Clin Colorectal Cancer 2014; 13(4): 213-8.

Visovan, II, Tantau M, Ciobanu L, Pascu O, Tantau A. Increasing prevalence of right-sided colonic adenomas in a high-volume endoscopy department in Romania: implications for colorectal cancer screening. J Gastrointestin Liver Dis 2014; 23(2): 147-51.

Seydaoglu G, Ozer B, Arpaci N, Parsak CK, Eray IC. Trends in colorectal cancer by subsite, age, and gender over a 15-year period in Adana, Turkey: 1993-2008. Turk J Gastroenterol 2013; 24(6): 521-31.

Parente F, Bargiggia S, Boemo C, Vailati C, Bonoldi E, Ardizzoia A, et al. Anatomic distribution of cancers and colorectal adenomas according to age and sex and relationship between proximal and distal neoplasms in an i-FOBT-positive average-risk Italian screening cohort. Int J Colorectal Dis 2014; 29(1): 57-64.

Caldarella A, Crocetti E, Messerini L, Paci E. Trends in colorectal incidence by anatomic subsite from 1985 to 2005: a population-based study. Int J Colorectal Dis 2013; 28(5): 637-41.

Chen HM, Weng YR, Jiang B, Sheng JQ, Zheng P, Yu CG, et al. Epidemiological study of colorectal adenoma and cancer in symptomatic patients in China between 1990 and 2009. J Dig Dis 2011; 12(5): 371-8.

Fenoglio L, Castagna E, Comino A, Luchino C, Senore C, Migliore E, et al. A shift from distal to proximal neoplasia in the colon: a decade of polyps and CRC in Italy. BMC Gastroenterol 2010;10:139.

Mensink PB, Kolkman JJ, Van Baarlen J, Kleibeuker JH. Change in anatomic distribution and incidence of colorectal cancer over a period of 15 years: clinical considerations. Dis Colon Rectum 2002; 45(10): 1393-6.

Takada H, Ohsawa T, Iwamoto S, Iwamoto S, Yoshida R, Nakano M, Imada S, et al. Changing site distribution of colorectal cancer in Japan. Dis Colon Rectum 2002; 45(9): 1249-54.

Cucino C, Buchner AM, Sonnenberg A. Continued rightward shift of colorectal cancer. Dis Colon Rectum 2002; 45(8): 1035-40.

Kim YG, Jang BI, Kim DH, Moon HJ, Oh HJ, Kim TN, et al. A Matched Case-Control Study Using the Propensity Score on Differences in the Characteristics of Colorectal Polyps between Younger and Older Koreans: Proximal Shift in the Distribution of Colorectal Polyps among Older Koreans. Gut Liver 2010; 4(4): 481-7.

Rabeneck L, Davila JA, El-Serag HB. Is there a true "shift" to the right colon in the incidence of colorectal cancer? Am J Gastroenterol 2003; 98(6): 1400-9.

Lieberman DA, Weiss DG. One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. N Engl J Med 2001; 345(8): 555-60.

Podolsky DK. Going the distance--the case for true colorectal-cancer screening. N Engl J Med 2000; 343(3): 207-8.

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127(12): 2893-917.

Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR; United States Multi-Society Task Force on Colorectal Cancer. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143(3): 844-57.

Sobhani I, Amiot A, Le Baleur Y, Levy M, Auriault ML, Van Nhieu JT, et al. Microbial dysbiosis and colon carcinogenesis: could colon cancer be considered a bacteria-related disease? Therap Adv Gastroenterol 2013; 6(3): 215-29.

Keku TO, Dulal S, Deveaux A, Jovov B, Han X. The gastrointestinal microbiota and colorectal cancer. Am J Physiol Gastrointest Liver Physiol 2015; 308(5): G351-63.

Jobin C. Colorectal cancer: looking for answers in the microbiota. Cancer Discov 2013; 3(4): 384-7.

McCoy AN, Araujo-Perez F, Azcarate-Peril A, Yeh JJ, Sandler RS, Keku TO. Fusobacterium is associated with colorectal adenomas. PLoS One 2013; 8(1): e53653.

Geng J, Fan H, Tang X, Zhai H, Zhang Z. Diversified pattern of the human colorectal cancer microbiome. Gut Pathog 2013; 5(1): 2.

Zeller G, Tap J, Voigt AY, Sunagawa S, Kultima JR, Costea PI, et al. Potential of fecal microbiota for early-stage detection of colorectal cancer. Mol Syst Biol 2014; 10: 766.

Compare D, Nardone G. The bacteria-hypothesis of colorectal cancer: pathogenetic and therapeutic implications. Transl Gastrointest Cancer 2014; 3(1): 44-53.

Hjartaker A, Aagnes B, Robsahm TE, Langseth H, Bray F, Larsen IK. Subsite-specific dietary risk factors for colorectal cancer: a review of cohort studies. J Oncol 2013; 2013: 703854.

Gervaz P, Bucher P, Morel P. Two colons-two cancers: paradigm shift and clinical implications. J Surg Oncol 2004; 88(4): 261-6.

Dejea CM, Wick EC, Hechenbleikner EM, White JR, Mark Welch JL, Rossetti BJ, et al. Microbiota organization is a distinct feature of proximal colorectal cancers. Proc Natl Acad Sci U S A 2014; 111(51): 18321-6.

Alempijevic T, Milutinovic AS, Markovic AP, Krstić R, Popović D, Djuranović S, et al. Frequency and clinical caracteristics of colorectal adenoma and cancer in women. Acta Chir Iugosl 2011; 58(4): 51-4.

Corley DA, Levin TR, Doubeni CA. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370(26): 2541.

Deaconescu V, Simion L, Alecu M, Ionescu S, Mastalier B, Straja ND. Surgical treatment in stenosing rectal cancer. Chirurgia (Bucur) 2014; 109(6): 794-9.