The Association of Cholelithiasis and Colorectal Cancer

Open access

Abstract

Background: In the literature there are a number of studies that suggest a possible correlation between cholelithiasis/cholecystectomy and colorectal cancer. The exposure of the colon mucosa to the action of bile acids that potentially have a carcinogenic effect due to the change in anatomy after cholecystectomy, seems to be the explanation of this association. The purpose of this paper was to search for such a correlation in our study group. Methods: We performed a retrospective cross-sectional study, analyzing the patients admitted to the First Surgical Clinic of the County Emergency Clinical Hospital Tîrgu Mureș, between January 1st, 2005 - December 31st, 2010. Analyzing the medical records, operation protocols and histopathological results, we paid attention to demographics, location of neoplasia, the time elapsed since the cholecystectomy to the discovery of neoplasia, histological types, trying to perform correlations between these parameters and the lithiasic factor. Results: Out of the 534 patients admitted and operated with the diagnosis of colorectal cancer, 15.6% (n = 83) showed a history of gallbladder stone affection. Most patients came from urban areas, the average age was 67.2 (range 39-88 years), females were more affected. The most common locations were: the sigmoid colon (26.5%), rectum (36.3%) and the most common histological form was moderately differentiated adenocarcinoma. Conclusions: Similar to other studies, our work suggests a slight increase in the incidence of colorectal cancer in patients that underwent a cholecystectomy, without drawing a firm conclusion. We deem it necessary to see if diet changes of the Romanian population affect this relationship

1. Bernstein C, Holubec H, Bhattacharyya AK, et al. Carcinogenicity of deoxycholate, a secondary bile acid. Arch Toxicol. 2011;85(8):863-71.

2. Goerg KJ, Nell G, Rummel W. Effect of deoxycholate on the perfused rat colon. Concentration dependence of the effect on net fl uid and electrolyte transfer and the correlation with para cellular permeability. Digestion. 1983;26(3):105-13.

3. Gullikson GW, Cline WS, Lorenzsonn V, et al. Effects of anionic surfactants on hamster small intestinal membrane structure and function: relationship to surface activity. Gastroenterology. 1977; 73(3):501-511.

4. Rafter JJ, Eng VW, Furrer R, Medline A, Bruce WR. Effects of calcium and pH on the mucosal damage produced by deoxycholic acid in the rat colon. Gut. 1986;27(11):1320-9.

5. Craven PA, Pfanstiel J, DeRubertis FR. Role of activation of protein kinase C in the stimulation of colonic epithelial proliferation and reactive oxygen formation by bile acids. J Clin Invest. 1987;79(2):532-41.

6. Milovic V, Teller IC, Faust D, Caspary WF, Stein J. Effects of deoxycholate on human colon cancer cells: apoptosis or proliferation. Eur J Clin Invest. 2002;32(1):29-34.

7. Kandell RL, Bernstein C. Bile salt/acid induction of DNA damage in bacterial and mammalian cells: implications for colon cancer. Nutr Cancer. 1991;16(3-4):227-238.

8. Bernstein H, Bernstein C, Payne CM, Dvorak K. Bile acids as endogenous etiologic agents in gastrointestinal cancer. World J Gastroenterol. 2009;15(27):3329-40.

9. Roda E, Aldini R, Mazzella G, et al. Enterohepatic circulation of bile acids after cholecystectomy. Gut. 1978;19(7):640-9.

10. Hartz A, He T, Ross JJ. Risk factors for colon cancer in 150,912 postmenopausal women. Cancer Causes Control. 2012;23(10):1599-605.

11. Chan AT, Giovannucci EL. Primary prevention of colorectal cancer. Gastroenterology. 2010;138(6):2029-2043.

12. Huxley RR, Ansary-Moghaddam A, Clifton P, et al. The impact of dietary and lifestyle risk factors on risk of colorectal cancer: a quantitative overview of the epidemiological evidence. Int J Cancer. 2009;125(1):171-80.

13. Tavani A, Rosato V, Di Palma F, et al. History of cholelithiasis and cancer risk in a network of case-control studies. Ann Oncol. 2012;23(8):2173-8.

14. Altieri A, Pelucchi C, Talamini R, et al. Cholecystectomy and the risk of colorectal cancer in Italy. Br J Cancer. 2004;90(9):1753-1755.

15. Goldacre MJ, Abisgold JD, Seagroatt V, Yeates D. Cancer after cholecystectomy: record-linkage cohort study. Br J Cancer. 2005;92(7):1307-1309.

16. Chiong C, Cox MR, Eslick GD. Gallstone disease is associated with rectal cancer: a meta-analysis. Scand J Gastroenterol. 2012;47(5):553-64.

17. Schmidt M, Småstuen MC, Søndenaa K. Increased cancer incidence in some gallstone diseases, and equivocal effect of cholecystectomy: a long-term analysis of cancer and mortality. Scand J Gastroenterol 2012;47(12):1467-74.

18. Fabian O, Oniu T, Bosu R, et al. Remarks regarding the relationship between biliary lithiasis and/or cholecystectomy and colorectal cancer. Jurnalul de Chirurgie (Iasi). 2012; 8(3):245-254.

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

20. Azzoni C, Bottarelli L, Campanini N, et al. Distinct molecular patterns based on proximal and distal sporadic colorectal cancer: arguments for different mechanisms in the tumorigenesis. Int J Colorectal Dis. 2007;22(2):115-26.

Acta Medica Marisiensis

The Journal of The University of Medicine and Pharmacy of Targu-Mures

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 173 169 10
PDF Downloads 55 54 5