Skip to main content

Advertisement

SpringerLink
Log in

Rectal Cancer in Asian vs. Western Countries: Why the Variation in Incidence?

  • Lower Gastrointestinal Cancers (AB Benson, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Colorectal cancer (CRC) is the third most common cancer worldwide. CRC has been thought to be less common in Asia compared to Western countries. However, the incidence rates of CRC in Asia are high and there is an increasing trend in the Asian population. Furthermore, colorectal cancer accounts for the greatest number of all incidences of CRC in Asia. The increasing adoption of a Western lifestyle, particularly in dietary habits, is likely the most important factor contributing to the rapid increase in colon cancer incidence; it is noteworthy that trends for rectal cancer were flat. The etiology of colon and rectal cancer is a bit different. The risks of distal colon and rectal cancers are more likely to be related to environmental factors, such as polluted surface water sources, alcohol consumption, and habitual smoking. The lack of great change in the incidence of rectal cancer might be due to weaker associations with such lifestyle factors. Therefore, it has been hypothesized that proximal and distal sections of the colon and rectum are two different organs in terms of function and genetic background. It may mean differences in differential sensitivities and exposures to carcinogens. However, despite the decrease in whole incidence, the CRC incidence in young adults in Western countries are reversely increasing, especially in rectal cancer, due to reasons largely unknown. Although the treatment algorithm is different between Asia and western countries, globally, the survival rate for patients with rectal cancer has risen during the past 10 years. Screening contributes a great deal to reducing the incidence and improving survival. Most countries in Asia, such as China, need nationwide registration and screening systems to provide better data.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •Of importance, ••Of major importance

  1. Sieide RL, Mgraor KD, J dA. Cancer statistics, 2017. CA Cancer J Clin. 2017;67:7–30.

    Article  Google Scholar 

  2. • Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108. Global statistics of cancer provide incidence of all kinds of cancer geographically.

    Article  PubMed  Google Scholar 

  3. Yuen ST, Chung LP, Leung SY, et al. Colorectal carcinoma in Hong Kong: epidemiology and genetic mutations. Br J Cancer. 1997;76:1610–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Cao KJ, Ma GS, Liu YL, Wan DS. Incidence of colorectal cancer in Guangzhou City from 2000 to 2002. Ai Zheng. 2009;28:441–4.

    CAS  PubMed  Google Scholar 

  5. Jung KW, Won YJ, Park S, et al. Cancer statistics in Korea: incidence, mortality and survival in 2005. J Korean Med Sci. 2009;24:995–1003.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–32.

    Article  PubMed  Google Scholar 

  7. Zheng S. Recent study on colorectal cancer in China: early detection and novel related gene. Chin Med J. 1997;110:309–10.

    CAS  PubMed  Google Scholar 

  8. Li HL, Gao YT, Zheng Y, Zhang W, Gao LF, et al. Incidence trends of colorectal cancer in urban Shanghai, 1973–2005. Zhonghua Yu Fang Yi Xue Za Zhi. 2009;43:875–9.

    PubMed  Google Scholar 

  9. Wei YS, Lu JC, Wang L, Lan P, Zhao HJ, et al. Risk factors for sporadic colorectal cancer in southern Chinese. World J Gastroenterol. 2009;15:2526–30.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chao A, Thun MJ, Connell CJ, McCullough ML, Jacobs EJ, et al. Meat consumption and risk of colorectal cancer. JAMA. 2005;293:172–82.

    Article  CAS  PubMed  Google Scholar 

  11. Purnell JQ, Katz ML, Andersen BL, Palesh O, Figueroa-Moseley C, et al. Social and cultural factors are related to perceived colorectal cancer screening benefits and intentions in African Americans. J Behav Med. 2010;33:24–34.

    Article  PubMed  Google Scholar 

  12. Soong R, Grieu F, Robbins P, Dix B, Chen D, et al. p53 alterations are associated with improved prognosis in distal colonic carcinomas. Clin Cancer Res. 1997;3:1405–11.

    CAS  PubMed  Google Scholar 

  13. Le Marchand L, Wilkens LR, Hankin JH, Kolonel LN, Lyu LC. A case-control study of diet and colorectal cancer in a multiethnic population in Hawaii (United States): lipids and foods of animal origin. Cancer Causes Control. 1997;8:637–48.

    Article  PubMed  Google Scholar 

  14. •• Robsahm TE, Aagnes B, Hjartåker A, Langseth H, Bray FI, et al. Body mass index, physical activity, and colorectal cancer by anatomical subsites: a systematic review and meta-analysis of cohort studies. Eur J Cancer Prev. 2013;22:492–505. Provide the fundamental reasons for why the difference of incidence change of rectal and colon cancer occurred.

    Article  PubMed  Google Scholar 

  15. Gu J, Chen N. Current status of rectal cancer treatment in China. Color Dis. 2013;15:1345–50.

    Article  CAS  Google Scholar 

  16. Wang H, Du S, Zhai F, Popkin BM. Trends in the distribution of body mass index among Chinese adults, aged 20-45 years (1989–2000). Int J Obes. 2007;31:272–8.

    Article  CAS  Google Scholar 

  17. Devesa SS, Chow WH. Variation in colorectal cancer incidence in the United States by subsite of origin. Cancer. 1993;71:3819–26.

    Article  CAS  PubMed  Google Scholar 

  18. Qing SH, Rao KY, Jiang HY, Wexner SD. Racial differences in the anatomical distribution of colorectal cancer: a study of differences between American and Chinese patients. World J Gastroenterol. 2003;9:721–5.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zhang S, Cui Y, Weng Z, Gong X, Chen M, et al. Changes on the disease pattern of primary colorectal cancers in Southern China: a retrospective study of 20 years. Int J Color Dis. 2009;24:943–9.

    Article  Google Scholar 

  20. Jiang SX, Wang XS, Geng CH, Wang GY. Altering trend of clinical characteristics of colorectal cancer: a report of 3,607 cases. Ai Zheng. 2009;28:54–6.

    PubMed  Google Scholar 

  21. Chen HM, Weng YR, Jiang B, Sheng JQ, Zheng P, Yu CG, et al. Epidemiological study of colorectal adenoma and cancer in symptomatic patients in China between 1990 and 2009. J Dig Dis. 2011;12:371–8.

    Article  CAS  PubMed  Google Scholar 

  22. Doyle TJ, Zheng W, Cerhan JR, et al. The association of drinking water source and chlorination by-products with cancer incidence among postmenopausal women in Iowa: a prospective cohort study. Am J Public Health. 1997;87:1168–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Backer LC, Ashley DL, Bonin MA, Cardinali FL, Kieszak SM, et al. Household exposures to drinking water disinfection by-products: whole blood trihalomethane levels. J Expo Anal Environ Epidemiol. 2000;10:321–6.

    Article  CAS  PubMed  Google Scholar 

  24. Yang CY, Tsai SS, Lai TC, Hung CF, Chiu HF. Rectal cancer mortality and total hardness levels in Taiwan’s drinking water. Environ Res. 1999;80:311–6.

    Article  CAS  PubMed  Google Scholar 

  25. Chen K, Yu W, Ma X, Yao K, Jiang Q. The association between drinking water source and colorectal cancer incidence in Jiashan County of China: a prospective cohort study. Eur J Pub Health. 2005;15:652–6.

    Article  Google Scholar 

  26. Yang G, Gao Y, Ji B. Dietary factors and cancer of the colon and rectum in a population based case-control study in Shanghai. Zhonghua Liu Xing Bing Xue Za Zhi. 1994;15:299–303.

    CAS  PubMed  Google Scholar 

  27. Lee IM, Paffenbarger RS Jr, Hsieh C. Physical activity and risk of developing colorectal cancer among college alumni. J Natl Cancer Inst. 1991;83:1324–9.

    Article  CAS  PubMed  Google Scholar 

  28. Distler P, Holt PR. Are right- and left-sided colon neoplasms distinct tumors. Dig Dis. 1997;15:302–11.

    Article  CAS  PubMed  Google Scholar 

  29. Oyesanmi O, Snyder D, Sullivan N, Reston J, Treadwell J, et al. Alcohol consumption and cancer risk: understanding possible causal mechanisms for breast and colorectal cancers. Evid Rep Technol Assess (Full Rep). 2010;197:1–151.

    Google Scholar 

  30. Jarvinen R, Knekt P, Hakulinen T, Rissanen H, Heliovaara M. Dietary fat, cholesterol and colorectal cancer in a prospective study. Br J Cancer. 2001;85:357–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78.

    Article  PubMed  Google Scholar 

  32. Siegel RL, Jemal A, Ward EM. Increase in incidence of colorectal cancer among young men and women in the United States. Cancer Epidemiol Biomark Prev. 2009;18:1695–8.

    Article  Google Scholar 

  33. Tawadros PS, Paquette IM, Hanly AM, Mellgren AF, Rothenberger DA, Madoff RD. Adenocarcinoma of the rectum in patients under age 40 is increasing: impact of signet-ring cell histology. Dis Colon rectum. 2015;58:474–8.

  34. Singh KE, Taylor TH, Pan CG, Stamos MJ, Zell JA. Colorectal cancer incidence among young adults in California. J Adolesc Young Adult Oncol. 2014;3:176–84.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Inra JA, Syngal S. Colorectal cancer in young adults. Dig Dis Sci. 2015;60:722–33.

    Article  PubMed  Google Scholar 

  36. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005;97:1679–87.

    Article  PubMed  Google Scholar 

  37. Austin H, Henley SJ, King J, Richardson LC, Eheman C. Changes in colorectal cancer incidence rates in young and older adults in the United States: what does it tell us about screening. Cancer Causes Control. 2014;25:191–201.

    Article  PubMed  Google Scholar 

  38. Skinner SA, O'Brien PE. The microvascular structure of the normal colon in rats and humans. J Surg Res. 1996;61:482–90.

    Article  CAS  PubMed  Google Scholar 

  39. Shamsuddin AM, Phelps PC, Trump BF. Human large intestinal epithelium: light microscopy, histochemistry, and ultrastructure. Hum Pathol. 1982;13:790–803.

    Article  CAS  PubMed  Google Scholar 

  40. Li M, Li JY, Zhao AL, Gu J. Colorectal cancer or colon and rectal cancer? Clinicopathological comparison between colonic and rectal carcinomas. Oncology. 2007;73:52–7.

    Article  CAS  PubMed  Google Scholar 

  41. Guinney J, Dienstmann R, Wang X, de Reyniès A, Schlicker A, et al. The consensus molecular subtypes of colorectal cancer. Nat Med. 2015;21:1350–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. • Deng Y, Chi P, Lan P, Wang L, Chen W, et al. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the Chinese FOWARC multicenter, open-label, randomized three-arm phase III trial. JCO. 2016;34:3300–7. Provide the treatment algorithm in China. Physicians are more cautious about preoperative radiation being routinely done in locally advanced rectal cancer.

    Article  Google Scholar 

  43. Flemer B, Lynch DB, Brown JM, Jeffery IB, Ryan FJ, et al. Tumour-associated and non-tumour-associated microbiota in colorectal cancer. Gut. 2017;66:633–43.

    Article  PubMed  Google Scholar 

  44. Petrelli F, Tomasello G, Borgonovo K, Ghidini M, Turati L, et al. Prognostic survival associated with left-sided vs right-sided colon cancer: a systematic review and meta-analysis. JAMA Oncol. 2016; doi:10.1001/jamaoncol.2016.4227.

  45. Tejpar S, Stintzing S, Ciardiello F, Tabernero J, Van Cutsem E. Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer: retrospective analyses of the CRYSTAL and FIRE-3 trials. JAMA Oncol. 2016; doi:10.1001/jamaoncol.2016.3797.

  46. Oki E, Ando K, Kasagi Y, Zaitsu Y, Sugiyama M, et al. Recent advances in multidisciplinary approach for rectal cancer. Int J Clin Oncol. 2015;20:641–9.

    Article  CAS  PubMed  Google Scholar 

  47. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, et al. 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;385:977–1010.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital, Sun Yat-sen University , 26 Yuancun Er Heng Road, Guangzhou, 510655, China

    Yanhong Deng MD, PhD

Authors
  1. Yanhong Deng MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yanhong Deng MD, PhD.

Ethics declarations

Conflict of Interest

Yanhong Deng declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Lower Gastrointestinal Cancers

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deng, Y. Rectal Cancer in Asian vs. Western Countries: Why the Variation in Incidence?. Curr. Treat. Options in Oncol. 18, 64 (2017). https://doi.org/10.1007/s11864-017-0500-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11864-017-0500-2

Keywords

Search

Navigation