Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  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 9:2400–2403

    PubMed  Google Scholar 

  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 87:1950–1953

    PubMed  Google Scholar 

  3. Leslie A, Carey FA, Pratt NR, Steele RJ (2002) The colorectal adenoma-carcinoma sequence. Br J Surg 89:845–860

    Article  CAS  PubMed  Google Scholar 

  4. Vernon SW (1997) Participation in colorectal cancer screening: a review. J Natl Cancer Inst 89:1406–1422

    Article  CAS  PubMed  Google Scholar 

  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 91:287–291

    CAS  PubMed  Google Scholar 

  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 51:56–61

    Article  PubMed  Google Scholar 

  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 35:1381–1395

    Article  PubMed  Google Scholar 

  8. Hagstromer M, Oja P, Sjostrom M (2006) The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr 9:755–762

    Article  PubMed  Google Scholar 

  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 25:265–268

    PubMed  Google Scholar 

  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 40:303–307

    Article  PubMed  Google Scholar 

  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 133:1077–1085

    Article  PubMed  Google Scholar 

  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 50:2085–2092

    Article  CAS  PubMed  Google Scholar 

  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 5:215–220

    Article  CAS  PubMed  Google Scholar 

  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 3:239–244

    Article  CAS  PubMed  Google Scholar 

  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 42:337–342

    Article  CAS  PubMed  Google Scholar 

  16. Abrams JA, Terry MB, Neugut AI (2008) Cigarette smoking and the colorectal adenoma-carcinoma sequence. Gastroenterology 134:617–619

    Article  PubMed  Google Scholar 

  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 16:102–107

    Article  PubMed  Google Scholar 

  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 98:2777–2783

    Article  PubMed  Google Scholar 

  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 99:1729–1735

    Article  PubMed  Google Scholar 

  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 119:630–635

    Article  CAS  PubMed  Google Scholar 

  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 348:883–890

    Article  CAS  PubMed  Google Scholar 

  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 294:914–923

    Article  CAS  PubMed  Google Scholar 

  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 294:47–55

    Article  CAS  PubMed  Google Scholar 

  24. Flossmann E, Rothwell PM (2007) Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies. Lancet 369:1603–1613

    Article  CAS  PubMed  Google Scholar 

  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 107:1183–1188

    CAS  PubMed  Google Scholar 

  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 11:622–629

    PubMed  Google Scholar 

  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 39:50–57

    Article  CAS  PubMed  Google Scholar 

  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 147:670–680

    CAS  PubMed  Google Scholar 

  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 90:805–811

    CAS  PubMed  Google Scholar 

  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 16:526–531

    Article  PubMed  Google Scholar 

  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 7:253–263

    Article  CAS  PubMed  Google Scholar 

  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 78:1187–1194

    Article  CAS  PubMed  Google Scholar 

  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 7:661–666

    CAS  PubMed  Google Scholar 

  34. Sung JJ, Lau JY, Goh KL, Leung WK (2005) Increasing incidence of colorectal cancer in Asia: implications for screening. Lancet Oncol 6:871–876

    Article  PubMed  Google Scholar 

  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 90:2157–2166

    CAS  PubMed  Google Scholar 

  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 352:2061–2068

    Article  CAS  PubMed  Google Scholar 

  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 15:2391–2397

    Article  PubMed  Google Scholar 

  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) 32:304–314

    Article  CAS  Google Scholar 

  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 334:82–87

    Article  CAS  PubMed  Google Scholar 

  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 77:174–179

    CAS  PubMed  Google Scholar 

  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 14:879–887

    Article  CAS  PubMed  Google Scholar 

  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 1:96–102

    Article  PubMed  Google Scholar 

  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 32:33–38

    Article  PubMed  Google Scholar 

  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 10:937–941

    CAS  PubMed  Google Scholar 

  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 11:385–391

    PubMed  Google Scholar 

  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 298:1412–1419

    Article  CAS  PubMed  Google Scholar 

  47. Ahmed RL, Schmitz KH, Anderson KE, Rosamond WD, Folsom AR (2006) The metabolic syndrome and risk of incident colorectal cancer. Cancer 107:28–36

    Article  PubMed  Google Scholar 

  48. Pais R, Silaghi H, Silaghi AC, Rusu ML, Dumitrascu DL (2009) Metabolic syndrome and risk of subsequent colorectal cancer. World J Gastroenterol 15:5141–5148

    Article  CAS  PubMed  Google Scholar 

  49. Lipkin M, Reddy B, Newmark H, Lamprecht SA (1999) Dietary factors in human colorectal cancer. Annu Rev Nutr 19:545–586

    Article  CAS  PubMed  Google Scholar 

  50. Giovannucci E, Willett WC (1994) Dietary factors and risk of colon cancer. Ann Med 26:443–452

    Article  CAS  PubMed  Google Scholar 

  51. Slattery ML, Boucher KM, Caan BJ, Potter JD, Ma KN (1998) Eating patterns and risk of colon cancer. Am J Epidemiol 148:4–16

    CAS  PubMed  Google Scholar 

  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 361:1496–1501

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank all the endoscopists in the Department of Gastroenterology, Nanfang Hospital for their support to our study and their help in obtaining study specific data. We also acknowledge the enormous contribution made by members of the Pathology Laboratory of the Department of Gastroenterology in Nanfang Hospital. This study was supported by Science and Technology Planning Project of Guangdong Province (2009B030801213).

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China

    Liyun Huang, Xinying Wang, Wei Gong, Yinglong Huang & Bo Jiang

Authors
  1. Liyun Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xinying Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yinglong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bo Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bo Jiang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huang, L., Wang, X., Gong, W. et al. The comparison of the clinical manifestations and risk factors of colorectal cancer and adenomas: results from a colonoscopy-based study in southern Chinese. Int J Colorectal Dis 25, 1343–1351 (2010). https://doi.org/10.1007/s00384-010-1030-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-010-1030-6

Keywords

Search

Navigation