Sidedness of Colorectal Cancer Impacts Risk of Second Primary Gastrointestinal Malignancy
A history of colorectal cancer (CRC) increases the risk of subsequent gastrointestinal (GI) cancer. Cancers of the right colon, left colon, and rectum differ according to molecular profiles, responses to treatment, and outcomes.
The purpose of this study was to determine if CRC location is associated with differential risk for secondary primary GI malignancy.
A retrospective cohort of adults with CRC was compiled using the Surveillance, Epidemiology, and End Results database (1973–2015). Standardized incidence ratios (SIRs) for second primary GI malignancies were compared based on location of the index CRC (right colon, left colon, or rectum).
The cohort included 281,413 adults with CRC (30.3% right, 35.3% left, 34.3% rectum). With a median 4.9-year follow-up, 12,064 (4.3%) patients developed a second primary GI malignancy (64% CRC, 36% non-CRC). Those with CRC at any location had higher than expected incidences of small intestine, bile duct, and other CRCs, and lower incidences of liver and gallbladder cancer. The SIR for small intestinal cancer was higher after right colon cancer than after left colon or rectal cancer. The esophageal cancer SIR was higher after left colon cancer. Pancreas cancer was higher than expected for right colon cancer, but lower for left colon and rectal cancer.
The location of CRC leads to differences in the incidence and location of second primary GI malignancies and may be related to similarities in the associated carcinogenesis and molecular pathways or response to treatment. CRC location not only impacts treatment response and outcomes, but should also be considered during subsequent surveillance.
- 1.Morton LM, Savage SA, Bhatia S. Multiple primary cancers. In: Schottenfeld D, Fraumeni JF, editors. Cancer epidemiology and prevention. New York: Oxford University Press; 2017.Google Scholar
- 2.Allemani C, Weir HK, Carreira H, et al. The CONCORD working group. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2015;385(9972):977–1010.Google Scholar
- 3.Curtis RE, Freedman DM, Ron E, et al., editors. New malignancies among cancer survivors: SEER cancer registries, 1973–2000. NIH Publication no. 05-5302. Bethesda: National Cancer Institute.Google Scholar
- 11.Venook AP, Niedzwiecki D, Innocenti F, et al. Impact of primary tumor location on overall survival and progression-free survival in patients with metastatic colorectal cancer: analysis of CALGB/SWOG 80405 (Alliance) [abstract no. 3504]. 2016 ASCO annual meeting; 3–7 June 2016: Chicago, IL.Google Scholar
- 15.Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence—SEER 9 Regs Research Data, Nov 2017 Sub (1973–2015) <Katrina/Rita Population Adjustment>—Linked To County Attributes—Total U.S., 1969–2016 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2018, based on the November 2017 submission (www.seer.cancer.gov).
- 16.Multiple Primary and Histology Coding Rules. National Cancer Institute. Surveillance Epidemiology and End Results Program. Published 1 Jan 2007. Bethesda, MD. https://seer.cancer.gov/tools/mphrules/2007_mphrules_manual_08242012.pdf. Accessed 12 Jun 2018.
- 17.US Population Data—1969–2016. National Cancer Institute Surveillance, Epidemiology, and End Results Program. Released December 2017. https://seer.cancer.gov/popdata/. Accessed 27 Jul 2018.
- 20.National Comprehensive Cancer Network. Colon Cancer (Version 2.2018). https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accessed 27 July 2018.
- 23.McCredie M, Macfarlane GJ, Bell J, Coates M. Second primary cancers after cancers of the colon and rectum in New South Wales, Australia, 1972–1991. Cancer Epidemiol Biomarker Prev. 1997. 6(3):155–160.Google Scholar
- 24.Neugut AI, Santos J. The association between cancers of the small and large bowel. Cancer Epidemiol Biomarker Prev. 1993;2(6):551–553.Google Scholar
- 28.Neugut AI, Jacobson JS, Suh S, Mukherjee R, Arber N. The epidemiology of cancer of the small bowel. Cancer Epidemiol Biomarker Prev. 1998;7(3):243–251.Google Scholar
- 31.Howden CW, Hornung CA. A systematic review of the association between Barrett’s esophagus and colon neoplasms. Am J Gastroenterol. 1995;90(10):1814–1819.Google Scholar