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We report the first case of rectal carcinoma associated with S. japonicum and membranous nephropathy. A 57-year-old Japanese man noticed narrowing of his feces. He had lived in Yamanashi prefecture,
an endemic area of S. japonicum. He had suffered from nephrotic syndrome for about 1 year. Barium enema study showed a severe stricture in the upper re...
Citations
... The eggs of Schistosoma japonicum become trapped in the host's liver after being discharged into the bloodstream, prompting a chronic immunological response. Chronic inflammation ensues, resulting in hepatic stellate cell activation and fibrosis (47,48). Prolonged fibrotic alterations lead to cirrhosis, which is a known precursor to hepatocellular carcinoma (HCC). ...
... Another study found mutations in p53 gene in patients with rectal cancer and advanced schistosomiasis and hypothesized that these mutations were a result of genotoxic products which were endogenously produced throughout the course of infection with Sj [22]. Further, the probable association between rectal cancer and Sj infection was clinically shown in a 57-year-old Japanese man [23]. ...
... The initial epidemiological and clinical studies [20,21,23] along with the recent studies [25,26] and the IARC implications suggest a strong correlation between the infection with Sj and CRC. This is further strengthened by the fact that inflammatory reactions in response to Sj's pathology can lead to a cascade of pre-cancerous events which may lead to initiation of CRC [9]. ...
Background: An association between Schistosoma japonicum and colorectal cancer in humans has been known since a long time; however, this association remains understudied and lacks comprehensive experimentation support.
Objective: Various epidemiological and pathological studies have established the role of chronic inflammation as a major factor behind the induction of colorectal cancer. The aim of this review is to present the current knowledge on the association of Schistosoma japonicum with colorectal cancer.
Result: Mechanisms which lead to induction and progression of colorectal cancer are highlighted along with diagnosis and treatment for the same. Further, various methodologies, including mass drug administration, use of new drugs and vaccines, role of apoptosis, and histone-modifying enzymes, have been described which can either prevent the schistosomal infection itself or can check it from reaching an advanced stage.
Conclusions: Epidemiological, clinical, pathological and surgical studies suggest that Schistosoma japonicum is responsible for induction of colorectal cancer. However, thorough clinical studies are required to support and globally accept this notion. Further, methodologies highlighted in this work can be employed in order to take care of schistosomal infection or address the cancer induction and progression.
... The prevalence of Blastocystis sp. had a fivefold increase in stool samples of CRC subjects [135]. Other parasites such as Cryptosporidium [136], Schistosoma japonicum [137][138][139], Schistosoma mekongi [140], and intestinal helminths [141] have also been linked to CRC oncogenesis [131,136]. There are currently clinical trial studies underway aimed at validating the link between intestinal helminths and protozoa with CRC pathogenesis [142]. ...
Simple Summary
Despite the reduced death rate that comes with improved HIV treatment, chances of developing cancers in HIV infected individuals remains high. The main culprit here is exaggerated inflammatory responses, referred to as chronic inflammation. Inflammation happens when the tissue is damaged by an outside (e.g., injury by falling) or internal (e.g., infection by bacteria/parasites/viruses) sources. Normally, inflammatory responses assist with fighting off infections and promoting wound healing. Opportunistic infections are common in HIV and constantly trigger chronic inflammation responses and ultimately cancer development. Cancers are dubbed the wound that does not heal because cancers survive better in a chronic inflammatory state. Several inflammatory pathways are known to promote colorectal cancer initiation. These can be common in both colorectal cancers and HIV. Toll like receptor inflammatory pathways are important in the detection of injuries. Their role and therapeutic endeavors in HIV and cancers are well studied. These pathways connect to specific inflammatory pathways which in return interconnects with several other pathways that are involved in HIV-related colorectal cancers. Their contribution in colorectal cancers is impactful hence the suggestion to target specific or best, interconnected inflammatory pathways with the hope of halting cancer initiation, development and progression.
Abstract
The advancement of HIV treatment has led to increased life expectancy. However, people living with HIV (PLWH) are at a higher risk of developing colorectal cancers. Chronic inflammation has a key role in oncogenesis, affecting the initiation, promotion, transformation, and advancement of the disease. PLWH are prone to opportunistic infections that trigger inflammation. It has been documented that 15–20% of cancers are triggered by infections, and this percentage is expected to be increased in HIV co-infections. The incidence of parasitic infections such as helminths, with Ascariasis being the most common, is higher in HIV-infected individuals. Cancer cells and opportunistic infections drive a cascade of inflammatory responses which assist in evading immune surveillance, making them survive longer in the affected individuals. Their survival leads to a chronic inflammatory state which further increases the probability of oncogenesis. This review discusses the key inflammatory signaling pathways involved in disease pathogenesis in HIV-positive patients with colorectal cancers. The possibility of the involvement of co-infections in the advancement of the disease, along with highlights on signaling mechanisms that can potentially be utilized as therapeutic strategies to prevent oncogenesis or halt cancer progression, are addressed.
... The authors proposed that chronic schistosomiasis may predispose patients to colorectal carcinoma in a similar manner to inflammatory bowel disease [16]. The connection between schistosomiasis and colon cancer has often been suggested in the literature, but is not universally accepted [13][14][15][16]21,22]. For example, a case-control study in rural China demonstrated an odds ratio of 3.3 for development of colon cancer in patients with chronic S. japonicum compared to matched controls with no previous exposure to schistosomal infection [22]. ...
... For example, a case-control study in rural China demonstrated an odds ratio of 3.3 for development of colon cancer in patients with chronic S. japonicum compared to matched controls with no previous exposure to schistosomal infection [22]. Cancers in schistosomiasis patients may present at a younger age and show a predilection for the rectum [14,21], both of which would fit with our patient's clinical presentation. We did not identify studies of colorectal cancer risk specifically related to S. mekongi in the literature, and believe that our case is the first report of a rectal carcinoma arising in the setting of S. mekongi infection. ...
Schistosomiasis is a parasitic trematode infection spread by snails with multiple species causing human disease. Infection can cause liver disease, including fibrosis and portal hypertension, and has been linked to malignancies such as bladder and colorectal cancer. We describe a case of Schistosoma mekongi, a geographically limited form of schistosomiasis, in a Laotian immigrant who presented with both hepatic fibrosis and rectal cancer, with numerous schistosome eggs present in the patient’s rectal resection. We believe this case is the first report of a rectal carcinoma arising in the setting of S. mekongi infection.
... Many studies reported a possible link between colonic schistosomiasis and colorectal cancer, and a study in China showed that out of 179 schistosomiasis infection patients, 32 had colorectal cancer [9]. Moreover, many studies reported a link between Schistosoma japonicum in developing colorectal cancer more than for S. mansoni [10,11]. A few cases were reported of colorectal cancer with S. mansoni, but a clear link was not yet established, and they reported that more studies are needed [3,12]. ...
Patient: Female, 53-year-old
Final Diagnosis: Schistosomiasis colitis
Symptoms: Intolerable anal pain • rectal bleeding
Medication: —
Clinical Procedure: —
Specialty: Oncology • Surgery
Objective
Rare co-existance of disease or pathology
Background
Colorectal cancer is one of the most common cancers in men and women worldwide. There are several studies showing an association between chronic schistosomiasis infection and colorectal cancer.
Case Report
A 53-year-old woman presented with recurrent metastatic colon cancer involving the peritoneum and bilateral adnexa. The patient then underwent exploratory laparotomy that involved abdominal wall deposit resection, omentectomy, redo left hemicolectomy, peritonectomy, diaphragmatic stripping, and total abdominal hysterectomy with bilateral salpingectomy-oophorectomy, as well as hyperthermic intraperitoneal chemotherapy (HIPEC). She also underwent adjuvant chemotherapy, but on her 6th cycle, the patient suffered intolerable anal pain, diarrhea, and rectal bleeding. Her colonoscopy showed extended circumferential inflammation with loses of vascular pattern and a few rectal ulcers going up to the anastomosis site. Biopsy revealed Schistosoma mansoni eggs and marked ischemic changes. She was then managed with a single dose of Praziquantel.
Conclusions
Colorectal schistosomiasis infection is a rare cause of such common presentations especially in postoperative settings in a patient with recurrent metastatic colon cancer. The use of multimodality investigations and high clinical suspicion were needed for the diagnosis and to exclude other common etiologies.
... Accumulating evidence in pre-clinical murine models of CRC suggests that differing STH infections can have diverse effects on CRC initiation by exacerbating neoplastic change and tumor formation or inducing intestinal epithelial cell remodeling [29,30]. Although increased CRC following Schistosoma infection has been associated with the deposition of Schistosomal ova, which has been shown to contain oncogenic antigens, it is not currently known how STH antigens influence CRC progression [31,32]. ...
As the global incidences of colorectal cancer rises, there is a growing importance in understanding the interaction between external factors, such as common infections, on the initiation and progression of this disease. While certain helminth infections have been shown to alter the severity and risk of developing colitis-associated colorectal cancer, whether these parasites can directly affect colorectal cancer progression is unknown. Here, we made use of murine and human colorectal cancer cell lines to demonstrate that exposure to antigens derived from the gastrointestinal nematode Heligmosomoides polygyrus significantly reduced colorectal cancer cell proliferation in vitro. Using a range of approaches, we demonstrate that antigen-dependent reductions in cancer cell proliferation and viability are associated with increased expression of the critical cell cycle regulators p53 and p21. Interestingly, H. polygyrus-derived antigens significantly increased murine colorectal cancer cell migration, which was associated with an increased expression of the adherens junction protein β-catenin, whereas the opposite was true for human colorectal cancer cells. Together, these findings demonstrate that antigens derived from a gastrointestinal nematode can significantly alter colorectal cancer cell behavior. Further in-depth analysis may reveal novel candidates for targeting and treating late-stage cancer.
... Untreated intestinal schistosomiasis can lead to many complications such as bowel obstruction, portal hypertension, esophageal varices, anemia, recurrent salmonella bacteremia, and malnutrition and growth retardation in children [14][15][16][17]. There is also weak evidence that supports an association between intestinal schistosomiasis (especially S. japonicum) and the development of colorectal cancer [18][19][20]. Therefore, one must be cautious prior to ruling out Schistosoma infection in a patient with probable suggestive history. ...
Schistosomiasis is a common parasitic infestation that affects 200 million people worldwide. There are more than 76 endemic countries that suffer from this infestation, leading to 200,000 deaths annually. Intestinal schistosomiasis is known to cause a variety of serious gastrointestinal complications. Thus, it is important to diagnose it early to prevent such complications and relieve symptoms early. A typical infection with intestinal schistosomiasis tends to present with chronic diarrhea, abdominal pain, dysentery, and in severe cases portal hypertension and hepatosplenomegaly. However, in this study the authors report two cases that came with unusual presentations of intestinal schistosomiasis during their outpatient clinic evaluation.
Case Presentation: The first patient is a 33-year-old male Yemeni national who was referred for investigation of a pedunculated rectal polyp. The patient was otherwise asymptomatic with no significant medical history. The second patient is a 39-year-old male Saudi national who presented with constipation, abdominal pain, and bloating. The patient was initially diagnosed as a case of irritable bowel syndrome and was managed conservatively for 2 years with no improvement.
Conclusion: Histopathological evidence via biopsies revealed intestinal schistosomiasis in both patients. Therefore, in endemic areas it remains important to keep intestinal schistosomiasis in the differentials when dealing with vague intestinal signs and symptoms. It is also important to not rule out schistosomiasis from a negative stool egg screening alone as this tool tends to yield false negative results during acute infections and low-intensity chronic infections.
... Various types of schistosomal eggs have been linked to colorectal cancer. However, schistosoma japonicum has been more frequently implicated [10][11][12][13][14][15] followed by schistosoma mansoni [16] and schistosoma haematobium [11]. Intestinal schistosomiasis has been observed to induce various pathologic conditions including carcinoma [9,[11][12][13][14][15][16][17], lymphoma [18], polyps [19][20], carcinoid [20] pedunculated teratoma [21]· In a hospital-based study in Uganda and Zimbabwe, Waku [22] and colleagues compared 950 cases of infective gastro-intestinal disease, particularly schistosomiasis and amoebiasis, with 249 controls admitted for various diseases other than GI disease. ...
... However, schistosoma japonicum has been more frequently implicated [10][11][12][13][14][15] followed by schistosoma mansoni [16] and schistosoma haematobium [11]. Intestinal schistosomiasis has been observed to induce various pathologic conditions including carcinoma [9,[11][12][13][14][15][16][17], lymphoma [18], polyps [19][20], carcinoid [20] pedunculated teratoma [21]· In a hospital-based study in Uganda and Zimbabwe, Waku [22] and colleagues compared 950 cases of infective gastro-intestinal disease, particularly schistosomiasis and amoebiasis, with 249 controls admitted for various diseases other than GI disease. Further stratification of patients into three groups on the basis of the stage of the disease, acute or chronic was done. ...
... Yu et al [23] arrived at the same conclusion from their studies on different types of schistosomal egg polyps. Schistosomal colorectal carcinomas seem to have a strong pre-dilection for the rectum [12]. Our patient had rectal carcinoma. ...
Reports have revealed the existence of colonic cancer with chronic bowel schistosomiasis. The specie most frequently involved is Schistosoma japonicum. Few cases have, however, shown Schistosoma mansoni as the involved specie. There seems to be an association between rectal cancer and Schistosoma mansoni infestation. Despite earlier studies that refuted any association between schistosomiasis and colonic cancer, more reports are lending credence to the claim that chronic colonic schistosomiasis, especially with S. Japonicum, may induce colonic cancer and the case with are reporting also point to the fact that S. Mansoni may also be implicated. We report a case of a 35-year-old man with a rectal cancer (pT3N0M0) associated with Schistosoma mansoni. He presented with intestinal obstruction and operation revealed a cirrhotic liver with hepatic schistosomiasis.
... 22 In addition, it was demonstrated that the closer to the tumor the area is, the more the ova tend to be detected. 23 In a separate study, Chen et al. 24 observed variable degrees of colonic epithelial dysplasia in 60% of cases with S. japonicum colitis and regarded these changes as the transition to cancer development in schistosomal colonic disease. A similar conclusion was drawn by Yu et al. 25 from their studies on different types of schistosomal egg polyps. ...
Schistosoma japonicum is a digenetic blood fluke that has been implicated in the carcinogenesis of several human malignancies, notably liver and colorectal cancer (CRC). Schistosoma japonicum-associated colorectal cancer (SACC) is a distinct subtype with biological behavior analogous to colitis-induced CRC. The clinicopathological characteristics of SACC include young age at diagnosis, predominance among males, a strong predilection for the sigmoid colon and rectum, multifocal distribution, frequent mucinous histology, and poor prognosis. In addition to chronic inflammation, immunomodulation, and schistosomal toxins, bacterial coinfection appears to play an important role in the carcinogenic process. The present review provides the most recent updates on epidemiology, pathobiology, and clinical and prognostic features pertaining to SACC.
... (2) In Brazil, approximately 25 million people live in areas at risk for S. mansoni. (3) It has been published that S. japonicum is associated with liver and colorectal cancer (CRC) (4)(5)(6) and S. haematobium with bladder cancer. (7) Evidence for the association between S. mansoni and CRC is scarce. ...
Schistosoma has been associated with colorectal cancer. We compared the number of colorectal cancer admissions between those cities in the state of Pernambuco with and without schistosomiasis. We abstracted data from Datasus and analyzed the number of admissions due to CRC in those cities with (CRC/Schistosoma) and without schistosomi-asis (CRC-alone) in the State of Pernambuco and compared these numbers using odds ratio and relative risk at a significance level of 5%. This was preceded by an F test to reject the null hypothesis that the number of cities in each group was the same. The mean number of admissions due to CRC in CRC-Schistosoma cities was 94.55, with a variability of 366%, while in CRC-alone cities the mean was 11.06, with a variability of 88%. A test at a significance level of 5% rejected the hypothesis that these variances were the same (p-value, 0.0000). A subsequent test also rejected the null hypothesis that the mean of admissions was the same (two-sided p-value 0.0167). The state of Pernambuco encompasses 184 cities of which 103 registered schistosomiases (102 with colorectal cancer and 1 without). We compared the number of admissions due to CRC and/or due to schisto-somiasis with admissions due to other diseases to measure the odds ratio for colorectal cancer due to schistosomiasis exposure. This comparison resulted in an OR of 2.657 (CI 95% 2,478-2,849) for CRC due to exposure to schistosomiasis. We found a statistically significant correlation between colorectal cancer admissions and schistosomiasis in the state of Pernambuco. Pharmacoeconomic studies might proof if investment to prevent nematode infestation would translate into cost spare with less admissions due to cancer and cancer treatments. ABSTRACT Proxy analysis of hospital admissions due to colorectal cancer and Schistosoma mansoni incidence Braz J Oncol. 2018 2 O Schistosoma tem sido associado ao câncer colorretal. Comparamos o número de in-ternações por câncer colorretal entre aquelas cidades do estado de Pernambuco com e sem esquistossomose. Extraímos dados do Datasus e analisamos o número de interna-ções devidas a CRC naquelas cidades com esquistossomose (CRC/Schistosoma) e sem ela (CRC-apenas) no Estado de Pernambuco e comparamos estes números usando odds ratio e risco relativo com um nível de significância de 5%. Isso foi precedido por um teste F para rejeitar a hipótese nula de que o número de cidades em cada grupo era o mesmo. O número médio de admissão devido a CRC em cidades CRC-Schistosoma foi 94,55, com uma variabilidade de 366%, enquanto que nas cidades CRC-apenas, a média foi de 11,06, com uma variabilidade de 88%. Um teste com um nível de significância de 5% rejeitou a hipótese de que essas variâncias fossem as mesmas (valor p, 0,0000). Um teste subse-quente também rejeitou a hipótese nula de que a média de internações era a mesma (valor p bicaudal 0,0167). O estado de Pernambuco abrange 184 cidades, das quais 103 registraram esquistossomose (102 com câncer colorretal e 1 sem). Comparamos o núme-ro de internações devido a CRC e/ou devido a esquistossomose com aquele de admissões devidas a outras doenças para medir o odds ratio para câncer colorrectal por exposição à esquistossomose. Essa comparação resultou em um OR de 2.657 (IC 95% 2.478-2.849) para o CCR devido à exposição à esquistossomose. Encontramos uma correlação estatis-ticamente significativa entre as internações por câncer colorretal e a esquistossomose no estado de Pernambuco. Estudos farmacoeconômicos poderiam comprovar se o inves-timento para prevenir a infestação por nematódeos se traduziria em custo menor com menos admissões devido ao câncer e seu tratamento.
