Renal cell carcinoma patients under 60 should be screened for colorectal carcinoma


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Joseph John1,Eleanor Burden2,Edward Smyth1,Adam Chambers1
1Taunton and Somerset NHS Foundation Trust, Taunton, UK,2Royal Devon and Exeter Hospital, Exeter, UK

Abstract

Background

The link between renal cell carcinoma (RCC) and colorectal cancer (CRC) is widely recognised but poorly quantified. This systematic review describes the current available evidence and considers whether we should take additional steps to screen for CRC in patients diagnosed with RCC. 

Method

Literature searches were performed using Pubmed and Web of science. Six hundred and twelve papers were returned, of which papers were selected which quantified the risk of antecedent, synchronous or subsequent CRC in RCC patients. 

Results

Seven studies met our inclusion criteria. The inclusion criteria used in each study were heterogenous. Three papers were single centre studies assessing their institutional records, giving risks of CRC in the presence of RCC between 3.67 and 4.70%. Four were national or regional population-based studies from the USA (3) and Norway (1). Standardised incidence ratios (SIR) were calculated in three of these. The largest study (n = 194,329 urological cancer patients) identified a modestly elevated SIR of CRC in patients with RCC (1.14, 95% confidence interval 1.04 - 1.25), with an increasing SIR with decreasing age of RCC diagnosis. Of the further two studies reporting SIRs, one indicated an increased SIR of 3.1 - 3.4 (p < 0.05, n = 551 RCCs), and one reported no significantly different SIR of colon cancer in RCC patients, but excluded rectal cancer from analysis. 

Conclusion

The highest quality available evidence suggests an association between RCC and CRC, with a possible stronger association in younger patients. The advent of highly sensitive and specific quantitative faecal immunochemical testing (QFIT) means we should consider non-invasive screening for CRC in RCC patients who fall below the current age for national bowel cancer screening. Such screening would constitute effective resource allocation.