Lifestyle and Sporadic Colorectal Cancer in India

  • Sinha, Rupal (Department of Research, Rajiv Gandhi Cancer Institute & Research Centre) ;
  • Doval, Dinesh Chandra (Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre) ;
  • Hussain, Showket (Division of Molecular Genetics & Biochemistry, Institute of Cytology & Preventive Oncology (ICMR)) ;
  • Kumar, Kapil (Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre) ;
  • Singh, Shivendra (Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre) ;
  • Basir, Seemi Farhat (Department of Biosciences, Jamia Millia Islamia) ;
  • Bharadwaj, Mausumi (Division of Molecular Genetics & Biochemistry, Institute of Cytology & Preventive Oncology (ICMR))
  • Published : 2015.12.03


Background: The study evaluated the patient, lifestyle and tumor profile in patients undergoing upfront surgery for sporadic colorectal cancer (CRC) in Indian population. Materials and Methods: One hundred consecutive patients were included. Details related to their demographic profile, habits, signs and symptoms, tumor profile, further treatment and follow up were recorded. Results: The majority of the patients had colonic cancer (68%), advanced tumor stage 3 & 4 (46%), moderately differentiated tumors (70%) with absence of lymphatic invasion (60%) and metastasis (90%). Correlations between tumor location and abdominal pain (p-value 0.002), bleeding per rectum (p-value <0.001), difficulty in micturition (p-value 0.012) and constipation (p-value 0.007) were found to be statistically significant. Abdominal pain was more frequently reported in patients with metastasis (p-value 0.031). Loss of weight statistically correlated with absence of lymphatic invasion (p-value 0.047). Associations between tumor stage and alcohol intake (p-value 0.050) and non vegetarian diet (p-value 0.006); lymphatic invasion and intake of spicy food (p-value 0.040) and non vegetarian diet (p-value 0.001) and metastasis and alcohol intake (p-value 0.041) were also observed. Age and tumor grade were also correlated (p-value 0.020). Conclusions: Minimizing the adverse lifestyle factors can help in reducing the overall incidence of CRC in the Indian population.


Signs and symptoms;tumor profile;lifestyle factors;sporadic colorectal cancer


  1. Astin M, Griffin T, Neal RD, et al (2011). The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review. Br J Gen Pract, 61, 231-43.
  2. Boyle T, Fritschi L, Heyworth J, et al (2011). Long-term sedentary work and the risk of subsite-specific colorectal cancer. Am J Epidemiol, 173, 1183-91.
  3. Carvalho B, Sillars-Hardebol AH, Postma C, et al (2012). Colorectal adenoma to carcinoma progression is accompanied by changes in gene expression associated with ageing, chromosomal instability, and fatty acid metabolism. Cell Oncol, 35, 53-63.
  4. Cozart DT, Lang NP, Hauser-Jensen M (1993). Contributors to the southwestern surgical congress unusual case registry. colorectal cancer in patients under 30 years of age. Am J Surg, 166, 764-7.
  5. Edge S, Byrd DR, Compton CC, et al (Eds.) (2010). Cancer staging handbook: from the AJCC cancer staging manual. Springer Publishing Company, 173-206.
  6. Elliot MS, Steven DM (1984). Carcinoma of the colon and rectum in patients under 30 years of age. S Afr Med J, 66, 129-31.
  7. Farkas SA, Vymetalkova V, Vodickova L, et al (2014). DNA methylation changes in genes frequently mutated in sporadic colorectal cancer and in the DNA repair and Wnt/$\beta$-catenin signaling pathway genes. Epigenomics, 6, 179-91.
  8. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917.
  9. Frank B, Hoffmeister M, Klopp N, et al (2010). Polymorphisms in inflammatory pathway genes and their association with colorectal cancer risk. Int J Cancer, 127, 2822-30.
  10. Gardner B, Dotan J, Shaikh L, et al (1981). The influence of age upon the survival of adult patients with carcinoma of the colon. Surg Gyn Oncol, 153, 366-8.
  11. Gingras D, Beliveau R (2011). Colorectal cancer prevention through dietary and lifestyle modifications. Cancer Microenviron, 4, 133-9.
  12. Giovannucci E, Ascherio A, Rimm EB, et al (1995). Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med, 122, 327-34.
  13. Giovannucci E, Martinez ME (1996). Tobacco, colorectal cancer, and adenomas: A review of the evidence. J Nat Cancer Inst, 88, 1717-30.
  14. Giovannucci E, Rimm EB, Stampfer MJ, et al (1994). Intake of fat, meat, and fiber in relation to risk of colon cancer in men. Cancer Res, 54, 2390-7.
  15. Hibi K, Nakao A (2006). Highly-methylated colorectal cancers show poorly-differentiated phenotype. Anticancer Res, 26, 4263-6.
  16. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90.
  17. Kaplan EL, Meier P (1958). Nonparametric estimation from incomplete observations. J Am Stat Assoc, 53, 457-81.
  18. Kim J, Park S, Nam BH (2011). The risk of colorectal cancer is associated with the frequency of meat consumption in a population-based cohort in Korea. Asian Pac J Cancer Prev, 12, 2371-6.
  19. Kune GA, Vitetta L (1992). Alcohol consumption and the etiology of colorectal cancer: a review of the scienti?c evidence from 1957 to 1991. Nutr Cancer, 18, 97-111.
  20. Lao VV, Grady WM (2011). Epigenetics and colorectal cancer. Nat Rev Gastroenterol Hepatol, 8, 686-700.
  21. MacArthur C, Smith A (1984). Factors associated with speed of diagnosis, referral, and treatment in colorectal cancer. J Epidemiol Community Health, 38, 122-6.
  22. Magalhaes B, Peleteiro B, Lunet N (2012). Dietary patterns and colorectal cancer: Systematic review and meta-analysis. Eur J Cancer Prev, 21, 15-23.
  23. Majumdar SR, Fletcher RH, Evans AT (1999). How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol, 94, 3039-45.
  24. McGaharen ED, Mills SE, Wilhem MC (1995). Colorectal Carcinoma in patients 30 years or younger. Am Surg, 61, 78-82.
  25. Miller FE, Liechty RD (1967). Adenocarcinoma of the colon and rectum in persons under thirty years of age. Am J Surg, 113, 507-10.
  26. Mills SE, Shannon Allen M (1979). Colorectal carcinoma in the first three decades of life. Am J Surg Path, 3, 443-448.
  27. Minardi AJ Jr, Sittig KM, Zibari GB, et al (1998). Colorectal cancer in the young patient. Am Surg, 64, 849-53.
  28. Notani PN (2001). Global variation in cancer incidence and mortality. Current Science, 81, 465-74.
  29. Palmer ML, Herrera L, Petrelli NJ (1991). Colorectal adenocarcinoma in patients less than 40 years of age. Dis Colon Rectum, 34, 343-6.
  30. Rao BN, Pratt CB, Fleming ID, et al (1985). Colon carcinoma in children and adolescents. A review of 30 cases. Cancer, 55, 1322-6.<1322::AID-CNCR2820550627>3.0.CO;2-5
  31. Recio P, Bussey HJR (1965). The pathology and prognosis of carcinoma of the rectum in the young. Proc R Soc Med, 58, 789-91.
  32. Rodriguez-Bigas MA, Mahoney MC, Weber TK, et al (1996). Colorectal cancer in patients aged 30 years or younger. Surgical Oncol, 5, 189-94.
  33. Seitz HK, Simanowski UA, Garzon FT, et al (1990). Possible role of acetaldehyde in ethanol-related rectal cocarcinogenesis in the rat. Gastroenterol, 98, 406-413.
  34. Sinha R, Hussain S, Mehrotra R, et al (2013). Kras gene mutation and RASSF1A, FHIT and MGMT gene promoter hypermethylation: indicators of tumor staging and metastasis in adenocarcinomatous sporadic colorectal cancer in Indian population. PLoS One, 8, 60142.

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