Study on the Relation between Colorectal Cancer and Gall Bladder Disease.

INTRODUCTION: Colorectal cancer is cancer of the large intestine, the lower part of digestive system which includes the sigmoid colon and rectum.

AIM: To study the relation of incidence of colorectal cancer with previous gall bladder disease or post-cholecystectomy status, a relation between gall bladder disease and smoking in particular and the most common region of colon involved in colorectal cancer in gall bladder disease and non-gall bladder disease patients.

MATERIALS AND METHODS: A total of 256 patients with symptoms of rectal bleeding, change in bowel habit, unexplained tiredness, weight loss, pelvic pain, jaundice and abdominal distension were screened by using colonoscopy among whom 30 patients were diagnosed with colorectal cancer. Detailed history was taken with the help of a modified questionnaire and the patients were assessed, examined and the list of investigations such as faecal occult blood test, ultrasound of abdomen and pelvis, colonoscopy, sigmoidoscopy, barium enema, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) of the abdomen and pelvis, tumour markers like Carcinoembryonic Antigen (CEA) and biopsy were collected. Patient pool was categorized into Gall Bladder Disease (GBD) and Non Gall Bladder Disease (NGBD). Proportions test and Fisher's-Exact test were used to calculate the p-values.

RESULTS: Ten patients had previous gall bladder disease (33%) which was significant with a p-value of 0.016 by proportions test. Two patients underwent cholecystectomy, two patients underwent Endoscopic Retrograde Cholangio Pancreatography (ERCP) and the remaining six patients did not take any treatment for their gall bladder disease. Five patients with previous gall bladder disease were found to be smokers with a p-value of 0.091. The average age was 47.2 years in males and 42.2 years in females. Males constituted 66.6% (20 males) of the diseased population whereas, females constituted 33.4% (10 females). Rectal bleeding and altered bowel habits were the commonest symptoms. Confirmation of the disease was proven using CT abdomen and biopsy. Right sided colorectal cancer was common in GBD patients. Left sided colon cancer was common in NGBD patients.

CONCLUSION: This study established a statistically significant risk of colorectal cancer following cholelithiasis though no risk was apparent following cholecystectomy.