Hereditary nonpolyposis colorectal cancer in northeastern Iran

Ladan Goshayeshi, Aliraza Khooie, Abbas Esmaieelzadeh, Mahla Rahmani khorram, Kambiz Akhavan Rezayat, Kamran Ghaffarzadegan, Zahra Yousefli, Omid Ghanaiee, Ali Bahari, Hooman Mosannan Mozaffari, Azita Ganji, Ali Mokhtarifar, Farnood Rajabzadeh

Abstract


Background:

There are no data on familial aggregation of colorectal cancer (CRC) in northeastern Iran. The aim of this study was to determine the prevalence of early-onset CRC and patients suspected for hereditary non-polyposis colorectal cancer (HNPCC) based on the clinical criteria in this area.

Materials and Methods:

Documents were collected from two hospitals in Mashhad regarding 326 inpatients during 2013-2015. Demographics, clinical, and tumor-related features were recorded. Interviews were done to identify cancer in the family up to second-degree relatives.

Results:

326 patients with CRC (48.5% male) were evaluated. The mean age at diagnosis was 55.44±14.85 years, with 91 patients (27.9%) below 45 years old. Eleven (3.4%) patients fulfilled the Amsterdam II criteria and 136 (41.7%) patients met at least one criterion of  the revised Bethesda guideline. There was no difference between early- and late-onset CRC regarding the frequency of CRC in 1st degree relatives or tumor site (p=0.73, p =0.64). However, CRC in second-degree relatives and cases suspected for HNPCC were more common in early-onset of the disease (p =0.022, p =0.024). The patients who fulfilled the Amsterdam II criteria had lower mean age and higher frequency of proximal cancer (p =0.03, p =0.048).

Conclusion:

As CRC is common in the young population and CRC clustering and patients suspected for HNPCC are also frequently encountered, measures should be taken to CRC screening policy and genetic studies in this area.

 


Keywords


Hereditary nonpolyposis colorectal cancer; colorectal cancer; Amsterdam II criteria

Full Text:

PDF

References


- Kolahdoozan S, Sadjadi A, Radmard AR, Khademi H. Five common cancers in Iran. Arch Iran Med 2010;13:143-6.

- Sadjadi A, Nouraie M, Mohagheghi MA, Mousavi-Jarrahi A, Malekezadeh R, Parkin DM. Cancer occurrence in Iran in 2002, an international perspective. Asian Pac J Cancer Prev 2005;6:359-63.

- Platz EA, Willett WC, Colditz GA, Rimm EB, Spiegelman D, Giovannucci E. Proportion of colon cancer risk that might be preventable in a cohort of middle-aged US men. Cancer Causes Control 2000;11:579-88.

- Lichtenstein P, Holm NV, Verkasalo PK, Iliadou A, Kaprio J, Koskenvuo M, et al. Environmental and heritable factors in the causation of cancer--analyses of cohorts of twins from Sweden, Denmark, and Finland. N Engl J Med 2000;343:78-85.

- Aaltonen LA, Salovaara R, Kristo P, Canzian F, Hemminki A, Peltomäki P, et al. Incidence of hereditary nonpolyposis colorectal cancer and the feasibility of molecular screening for the disease. N Engl J Med 1998;338:1481-7.

- Barnetson RA, Tenesa A, Farrington SM, Nicholl ID, Cetnarskyj R, Porteous ME, et al. Identification and survival of carriers of mutations in DNA mismatch-repair genes in colon cancer. N Engl J Med 2006;354:2751-63.

Hampel H, Frankel WL, Martin E, Arnold M, Khanduja K, Kuebler P, et al. Screening for the Lynch syndrome (hereditary nonpolyposis colorectal cancer). N Engl J Med 2005;352:1851-60.

- Jasperson KW, Tuohy TM, Neklason DW, Burt RW. Hereditary and familial colon cancer. Gastroenterology 2010;138:2044-58.

- Vasen HF, Wijnen JT, Menko FH, Kleibeuker JH, Taal BG, Griffioen G, et al. Cancer risk in families with hereditary nonpolyposis colorectal cancer diagnosed by mutation analysis. Gastroenterology 1996;110:1020-7.

- Mvundura M, Grosse SD, Hampel H, Palomaki GE. The cost-effectiveness of genetic testing strategies for Lynch syndrome among newly diagnosed patients with colorectal cancer. Genet Med 2010;12:93-104.

- Miyaki M, Konishi M, Tanaka K, Kikuchi-Yanoshita R, Muraoka M, Yasuno M, et al. Germline mutation of MSH6 as the cause of hereditary nonpolyposis colorectal cancer. Nat Genet 1997;17:271-2.

- Bonadona V, Bonaïti B, Olschwang S, Grandjouan S, Huiart L, Longy M, et al. Cancer risks associated with germline mutations in MLH1, MSH2, and MSH6 genes in Lynch syndrome. JAMA 2011;305(22):2304-10.

- Choi YH, Cotterchio M, McKeown-Eyssen G, Neerav M, Bapat B, Boyd K, et al. Penetrance of colorectal cancer among MLH1/MSH2 carriers participating in the colorectal cancer familial registry in Ontario. Hered Cancer Clin Pract 2009;7:14.

- Dinjens WN, Dubbink HJ, Wagner A. Guidelines on genetic evaluation and management of Lynch syndrome. Am J Gastroenterol 2015;110:192-3.

- Mahdavinia M, Bishehsari F, Ansari R, Norouzbeigi N, Khaleghinejad A, Hormazdi M, et al. Family history of colorectal cancer in Iran. BMC Cancer 2005 Sep 5;5:112.

- Molaei M, Mansoori BK, Ghiasi S, Khatami F, Attarian H, Zali M. Colorectal cancer in Iran: immunohistochemical profiles of four mismatch repair proteins. Int J Colorectal Dis 2010;25:63-9.

- Nemati A, Rahmatabadi ZK, Fatemi A, Emami MH. Hereditary nonpolyposis colorectal cancer and familial colorectal cancer in Central part of Iran, Isfahan. J Res Med Sci 2012;17:67-73.

- Balmaña J, Balaguer F, Castellví-Bel S, Steyerberg EW, Andreu M, Llor X, et al. Comparison of predictive models, clinical criteria and molecular tumour screening for the identification of patients with Lynch syndrome in a population-based cohort of colorectal cancer patients. J Med Genet 2008;45:557-63.

- Green RC, Parfrey PS, Woods MO, Younghusband HB. Prediction of Lynch syndrome in consecutive patients with colorectal cancer. J Natl Cancer Inst 2009;101(5):331-40.

- Mecklin JP, Järvinen HJ, Hakkiluoto A, Hallikas H, Hiltunen KM, Härkönen N, et al. Frequency of hereditary nonpolyposis colorectal cancer. A prospective multicenter study in Finland. Dis Colon Rectum 1995;38:588-93.

- Ponz de Leon M, Sassatelli R, Benatti P, Roncucci L. Identification of hereditary nonpolyposis colorectal cancer in the general population: the 6-year experience of a population-based registry. Cancer 1993, 71:3493-501.

- Cheah PL, Looi LM, Teoh KH, Rahman NA, Wong LX, Tan SY. Colorectal carcinoma in Malaysians: DNA mismatch repair pattern in a multiethnic population. Asian Pac J Cancer Prev 2014;15:3287-91.

- Cai SJ, Xu Y, Cai GX, Lian P, Guan ZQ, Mo SJ, et al. Clinical characteristics and diagnosis of patients with hereditary nonpolyposis colorectal cancer. World J Gastroenterol 2003; 9: 284-7.

- Fakheri H, Bari Z, Merat S. Familial aspects of colorectal cancers in southern littoral of Caspian Sea. Arch Iran Med 2011;14:175-8.

- Lynch HT, Shaw MW, Magnuson CW, Larsen AL, Krush AJ. Hereditary factors in cancer. Study of two large midwestern kindreds. Arch Intern Med 1966;117:206-12.

- Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann Oncol 2005; 16: 481-8.

- Magnani G, Furlan D, Sahnane N, Reggiani Bonetti L, Domati F, Pedroni M. Molecular Features and Methylation Status in Early Onset (?40 Years) Colorectal Cancer: A Population Based, Case-Control Study. Gastroenterol Res Pract 2015;2015:132190.

- Malekzadeh R, Bishehsari F, Mahdavinia M, Ansari R. Epidemiology and molecular genetics of colorectal cancer in Iran: a review. Arch Iran Med 2009;12:161-9.

- Safaee A, Fatemi SR, Ashtari S, Vahedi M, Moghimi-Dehkordi B, Zali MR. Four years incidence rate of colorectal cancer in Iran: a survey of national cancer registry data- implications for screening. Asian Pac J Cancer Prev 2012;13:2695-8.

- Silla IO, Rueda D, Rodríguez Y, García JL, de la Cruz Vigo F, Perea J. Early-onset colorectal cancer: a separate subset of colorectal cancer. World J Gastroenterol 2014 ;20:17288-96.

- Ansari R, Mahdavinia M, Sadjadi A, Nouraie M, Kamangar F, Bishehsari F, et al. Incidence and age distribution of colorectal cancer in Iran: results of a population-based cancer registry. Cancer Lett 2006;240:143-7.

- Ladabaum U, Wang G, Terdiman J, Blanco A, Kuppermann M, Boland CR, et al. Strategies to identify the Lynch syndrome among patients with colorectal cancer: a cost-effectiveness analysis. Ann Intern Med 2011;155:69-79

- Palomaki GE, McClain MR, Melillo S, Hampel HL, Thibodeau SN.EGAPP supplementary evidence review: DNA testing strategies aimed at reducing morbidity and mortality from Lynch syndrome. Genet Med 2009;11:42-65.

- Johns LE, Houlston RS. A systematic review and meta-analysis of familial colorectal cancer risk. Am J Gastroenterol 2001;96:2992-3003.

- Jung I, Gurzu S, Turdean GS. Current status of familial gastrointestinal polyposis syndromes. World J Gastrointest Oncol 2015;7:347-55.

- Losi L, Di Gregorio C, Pedroni M, Ponti G, Roncucci L, Scarselli A, et al. Molecular genetic alterations and clinical features in early-onset colorectal carcinomas and their role for the recognition of hereditary cancer syndromes. Am J Gastroenterol 2005;100:2280-7.

- Liang JT, Huang KC, Cheng AL, Jeng YM, Wu MS, Wang SM. Clinicopathological and molecular biological features of colorectal cancer in patients less than 40 years of age. Br J Surg 2003;90:205-14.

- Perea J, Rodríguez Y, Rueda D, Marín JC, Díaz-Tasende J, Álvaro E, et al. Early-onset colorectal cancer is an easy and effective tool to identify retrospectively Lynch syndrome. Ann Surg Oncol 2011;18:3285-91.

- Mucci LA, Wedren S, Tamimi RM, Trichopoulos D, Adami HO. The role of gene-environment interaction in the aetiology of human cancer: examples from cancers of the large bowel, lung and breast. J Intern Med 2001;249:477-93.

- Kiss I, Sándor J, Pajkos G, Bogner B, Hegedüs G, Ember I. Colorectal cancer risk in relation to genetic polymorphism of cytochrome P450 1A1, 2E1, and glutathione-S-transferase M1 enzymes. Anticancer Res 2000;20(1B):519-22.

- von Holst S, Picelli S, Edler D, Lenander C, Dalén J, Hjern F, et al. Association studies on 11 published colorectal cancer risk loci. Br J Cancer 2010;103:575-80.

- Chang DT, Pai RK, Rybicki LA, Dimaio MA, Limaye M, Jayachandran P, et al. Clinicopathologic and molecular features of sporadic earlyonset colorectal adenocarcinoma: an adenocarcinoma with frequent signet ring cell differentiation, rectal and sigmoid involvement, and adverse morphologic features. Mod Pathol 2012; 25: 1128-1139.

- Giráldez MD, López-Dóriga A, Bujanda L, Abulí A, Bessa X, Fernández-Rozadilla C, et al. Susceptibility genetic variants associated with early-onset colorectal cancer. Carcinogenesis 2012; 33: 613-9.

- Tezcan G, Tunca B, Ak S, Cecener G, Egeli U. Molecular approach to genetic and epigenetic pathogenesis of early-onset colorectal cancer. World J Gastrointest Oncol 2016;8:83-98.

- Davis DM, Marcet JE, Frattini JC, Prather AD, Mateka JJ, Nfonsam VN. Is it time to lower the recommended screening age for colorectal cancer? J Am Coll Surg 2011;213:352-61.




Copyright (c)