Abstract
Background/Aims. To evaluate the incidence of gastric adenoma and gastric cancer in colorectal cancer patients, as well as the clinicopathological features that affect their incidence. Methods. Among patients who underwent surgery after being diagnosed with colorectal cancer between January 2004 and December 2013 at Chungnam National University Hospital, 142 patients who underwent follow-up upper gastrointestinal endoscopy were assigned to the patient group. The control group included 426 subjects randomly selected. The patient group was subdivided into two: one that developed gastric adenoma or cancer and one that did not. Clinicopathological characteristics were compared between these groups. Results. In total, 35 (24.6%) colorectal cancer patients developed a gastric adenoma or gastric cancer, which was higher than the number in the control group (20 [4.7%] patients; p < 0.001). Age, alcohol history, and differentiation of colorectal cancer were associated with higher risks of gastric adenoma or gastric cancer, with odds ratios of 1.062, 6.506, and 5.901, respectively. Conclusions. In colorectal cancer patients, screening with upper gastrointestinal endoscopy is important, even if no lesions are noted in the upper gastrointestinal tract at colorectal cancer diagnosis. Endoscopic screening is particularly important with increasing age, history of alcohol consumption, and poor cancer differentiation.
Highlights
Based on the National Cancer Registration Annual Report 2010, in Korea, gastric cancer and colorectal cancer are the second and third most common cancers, respectively, nationwide
Precancerous lesions such as gastric adenomas or gastric cancer were regarded as significant lesions: their incidence was analyzed and their clinicopathological correlation was investigated by comparing with colorectal cancer patients negative for upper GI lesions
Clinical and pathological variables were compared between 35 patients who developed significant upper GI lesions, which were detected during follow-up upper GI endoscopy after colorectal cancer surgery (13 synchronous lesions and 22 metachronous lesions), and 107 patients who did not develop such lesions
Summary
Based on the National Cancer Registration Annual Report 2010, in Korea, gastric cancer and colorectal cancer are the second and third most common cancers, respectively, nationwide. The pathogenesis of gastric cancer differs from that of colorectal cancer in that it is affected by racial, regional, and environmental factors and that its molecular biological pathogenesis involves genetic and epigenetic alteration and histological differentiation; all this leads to various findings within tumors or tumor heterogeneity, suggesting biologically and/or genetically heterogeneous complexity [3]. Some reports have found a high correlation between upper GI lesions in patients with colorectal cancer and colon polyp [7]. These studies have classified upper GI lesions such as gastric ulcer, duodenal ulcers, gastric polyp, and gastric cancer as meaningful findings. Only a few studies detail the frequency of precancerous lesions such as gastric adenomas or gastric cancer in colorectal cancer patients.
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