br principais sintomas observados em
principais sintomas observados em pacientes iraquianos.
Pacientes e métodos: O estudo avaliou pacientes com câncer colorretal recém-diagnosticado
por achados de colonoscopia e confirmados por exame histopatológico de biópsias
endoscópicas do cólon.
Resultados: O estudo incluiu 63 casos de pacientes com câncer colorretal recém-
de idade. O sangramento retal fresco foi o sintoma mais comum em 48 (76,2%) pacientes;
o sintoma menos comum foi a perda de peso (19%). A durac¸ ão média dos sintomas antes
do encaminhamento para especialista foi de 7,3 ± 12,6 meses. Os principais sítios tumorais
Conclusões: No presente estudo, o câncer colorretal foi observado em grupos etários relati-
vamente mais jovens do que em estudos conduzidos em países desenvolvidos; a neoplasia
retal foi o tipo de câncer colorretal mais comumente observado.
© 2019 Sociedade Brasileira de Coloproctologia. Publicado por Elsevier Editora Ltda. Este
e´ um artigo Open Access sob uma licenc¸ a CC BY-NC-ND (http://creativecommons.org/
Colorectal cancer (CRC), the most common gastrointestinal cancer, is an important global health problem. Worldwide, CRC is the third most commonly diagnosed malignancy after lung and breast cancer.1 It affects more than one million individuals each year and causes 694,000 deaths in both sexes with almost equal gender distribution.2 Although CRC occurs mainly in Western and industrialized countries the incidence of this USP7/USP47 inhibitor neoplasm has also increased in tradition-ally low-incidence regions since 1950.3 The incidence of CRC is influenced more heavily by age than any other demographic variable. Sporadic CRC is rarely diagnosed before the age of
40. The incidence of this malignancy increases dramatically between 45 and 50 years of age, with 90% of cases occurring after the age of 50 years; consequently, deaths from CRC begin
to increase slowly in the fifth decade of life, rising steeply with advancing age.4,5 The occurrence of CRC varies greatly worldwide, with an almost 25-fold difference between specific populations in high- and low-risk regions. The highest annual incidence rates occur in Australia and New Zealand, followed by North
America and Japan. Incidence tends to be lowest in middle, south central, and western Africa.1 Ethnic differences can also account for inherited predilection to CRC, African Americans suffer greater incidence and mortality due to CRC than other
racial/ethnic groups in the United States and have a much lower five-year survival rate than whites. 6,7 The etiology for most cases of CRC appears to be related to environmental factors. The disease occurs more often in upper socioeconomic populations who live in urban areas. Geographic variations in incidence are unrelated to genetic differences since migrant groups tend to assume the large bowel cancer incidence rates of their adopted countries, while a high animal fat diet (western diet) is associated with a higher incidence of CRC, a low-animal fat diet (rich in fruits and veg-etables) appears to be protective against the development of this malignancy.8-14
Type 2 diabetes mellitus (T2DM) has been positively associated with CRC risk in multiple observational studies; presumably because insulin and/or insulin-like growth fac-tors have growth promoting effects in the colorectal mucosa. Patients with CRC and T2DM have a higher risk of mortal-ity than patients with CRC who do not have T2DM.15 Excess body weight, particularly when centrally distributed (visceral adiposity) may also increase CRC risk through an insulin-mediated mechanism. Of note, recent long-term follow-up data suggest that overall cancer mortality is reduced among morbidly obese patients who undergo bariatric surgery.16