#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#
CS
proLékaře.cz / Journals / Journal of Czech Physicians / 2026 - 2

Colorectal cancer and comorbidities –⁠ implications for surgical practice

Czech version

Authors: Ádám Varga 1;  Peter Ihnát 1;  Jan Štembírek 2;  Lucia Ihnát Rudinská 3
Authors‘ workplace: Chirurgická klinika LF OU a FN Ostrava 1;  Klinika ústní, čelistní a obličejové chirurgie LF OU a FN Ostrava 2;  Ústav soudního lékařství LF OU a FN Ostrava 3
Published in: Čas. Lék. čes. 2026; 165: 55-60
Category: Review Article

Overview

Colorectal cancer (CRC) is one of the most common malignant diseases worldwide. Its etiology and prognosis are significantly influenced by numerous comorbidities that may affect both the risk of tumor development and the course of the disease, including treatment response. The aim of this review article is to summarize current knowledge regarding the relationship between CRC and selected diseases and comorbid conditions, drawing on evidence from systematic reviews, meta-analyses, and cohort studies.

Type 2 diabetes mellitus, inflammatory bowel disease, metabolic syndrome, obesity, hypertension, chronic kidney disease, and chronic obstructive pulmonary disease are associated with an increased risk of CRC development and adversely affect its prognosis. In the case of obstructive sleep apnea, evidence suggests a potential association; however, current data remain inconsistent and do not allow for a definitive conclusion. Tooth agenesis has been linked to AXIN2 gene mutations, which may reflect a familial predisposition to CRC. The pathophysiological mechanisms connecting these comorbidities with CRC include chronic inflammation, insulin resistance, metabolic and immunological dysregulation, hypoxic pathways, and genetic predispositions.

Colorectal cancer is thus a multifactorial disease whose risk of developing and prognosis are substantially modified by patient comorbidities. Understanding these relationships is essential for optimizing preventive strategies, screening programs, and individualized treatment approaches in patients with CRC.

Keywords:

obesity – inflammatory bowel disease – colorectal cancer – metabolic syndrome – chronic obstructive pulmonary disease – diabetes mellitus – comorbidities – chronic kidney disease

Sources
  1. Larsson S, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst 2005; 97 : 1679–1687.
  2. Deng L, Gui Z, Zhao L et al. Diabetes mellitus and the incidence of colorectal cancer: an updated systematic review and meta-analysis. Dig Dis Sci 2012; 57 : 1576–1585.
  3. Wu L, Yu C, Jiang H et al. Diabetes mellitus and the occurrence of colorectal cancer: an updated meta-analysis of cohort studies. Diabetes Technol Ther 2013; 15 : 419–427.
  4. Khoa Ta HD, Nguyen NN, Ho DKN et al. Association of diabetes mellitus with early-onset colorectal cancer: A systematic review and meta-analysis of 19 studies including 10 million individuals and 30,000 events. Diabetes Metab Syndr 2023; 17 : 102828.
  5. Yuan C, Zhang X, Babic A et al. Preexisting type 2 diabetes and survival among patients with colorectal cancer. Cancer Epidemiol Biomarkers Prev 2021; 30 : 757–764.
  6. Yu G, Li S, Wei R et al. Diabetes and colorectal cancer risk: clinical and therapeutic implications. J Diabetes Res 2022; 2022 : 1747326.
  7. González N, Prieto I, Del Puerto-Nevado L et al. 2017 update on the relationship between diabetes and colorectal cancer: epidemiology, potential molecular mechanisms and therapeutic implications. Oncotarget 2017; 8 : 18456–18485.
  8. Jin E, Han K, Lee D et al. Association between metabolic syndrome and the risk of colorectal cancer diagnosed before 50 years according to tumor location. Gastroenterology 2022; 163 : 637–648.
  9. Shen X, Wang Y, Zhao R et al. Metabolic syndrome and the risk of colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36 : 2215–2225.
  10. Ungvári Z, Fekete M, Varga P et al. Overweight and obesity significantly increase colorectal cancer risk: a meta-analysis of 66 studies revealing a 25–57% elevation in risk. GeroScience 2025; 47 : 3343–3364.
  11. Bardou M, Rouland A, Martel M et al. Review article: obesity and colorectal cancer. Aliment Pharmacol Ther 2022; 56 : 407–418.
  12. Chen H, Zheng X, Zong X et al. Metabolic syndrome, metabolic comorbid conditions and risk of early-onset colorectal cancer. Gut 2020; 70 : 1147–1154.
  13. Pais R, Silaghi H, Silaghi A et al. Metabolic syndrome and risk of subsequent colorectal cancer. World J Gastroenterol 2009; 15 : 5141–5148.
  14. Jones A, Scheurlen K, Macleod A et al. Obesity and inflammatory factors in the progression of early-onset colorectal cancer. Cancers (Basel) 2024; 16 : 1403.
  15. Feliciano E, Kroenke C, Meyerhardt J et al. Metabolic dysfunction, obesity, and survival among patients with early-stage colorectal cancer. J Clin Oncol 2016; 34 : 3664–3671.
  16. Kaneko H, Yano Y, Itoh H et al. Untreated hypertension and subsequent incidence of colorectal cancer: analysis of a nationwide epidemiological database. J Am Heart Assoc 2021; 10: e022479.
  17. Xuan K, Zhao T, Sun C et al. The association between hypertension and colorectal cancer: a meta-analysis of observational studies. Eur J Cancer Prev 2021; 30 : 84–96.
  18. Hua H, Jiang Q, Sun P, Xu X. Risk factors for early-onset colorectal cancer: systematic review and meta-analysis. Front Oncol 2023; 13 : 1132306.
  19. Sur D, Coroama C, Audisio A et al. Clinical outcome of colorectal cancer patients with concomitant hypertension: a systematic review and meta-analysis. J Pers Med 2024; 14 : 520.
  20. Shah S, Itzkowitz S. Colorectal cancer in inflammatory bowel disease: mechanisms and management. Gastroenterology 2022; 162 : 715–730.
  21. Nadeem M, Kumar V, Al-Abbasi F et al. Risk of colorectal cancer in inflammatory bowel diseases. Semin Cancer Biol 2020; 64 : 51–60.
  22. Sato Y, Tsujinaka S, Miura T et al. Inflammatory bowel disease and colorectal cancer: epidemiology, etiology, surveillance, and management. Cancers (Basel) 2023; 15 : 4154.
  23. Lucafò M, Curci D, Franzin M et al. Inflammatory bowel disease and risk of colorectal cancer: an overview from pathophysiology to pharmacological prevention. Front Pharmacol 2021; 12 : 772101.
  24. Hnatyszyn A, Hryhorowicz S, Kaczmarek-Ryś M et al. Colorectal carcinoma in the course of inflammatory bowel diseases. Hered Cancer Clin Pract 2019; 17 : 18.
  25. Keller D, Windsor A, Cohen R et al. Colorectal cancer in inflammatory bowel disease: review of the evidence. Tech Coloproctol 2019; 23 : 3–13.
  26. Al-Qudimat A, Darwish M, Altahtamouni S et al. Chronic kidney diseases and the risk of colorectal cancer: a systematic review and meta-analysis. Arab J Urol 2023; 21 : 258–266.
  27. Komaki Y, Komaki F, Micic D et al. Risk of colorectal cancer in chronic kidney disease: a systematic review and meta-analysis. J Clin Gastroenterol 2018; 52 : 796–804.
  28. Chen C, Hao W, Hong H et al. Protective effects of influenza vaccine against colorectal cancer in populations with chronic kidney disease: a nationwide population-based cohort study. Cancers (Basel) 2023; 15 : 2398.
  29. Kozłowski L, Bielawska K, Zhymaila A et al. Chronic kidney disease prevalence in patients with colorectal cancer undergoing surgery. Diagnostics (Basel) 2022; 12 : 2137.
  30. Takano Y, Kai W, Kobayashi Y et al. Short-term outcomes of colorectal cancer surgery in patients with dialysis: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408 : 283.
  31. Zhou Y, Lin Z, Xie S et al. Interplay of chronic obstructive pulmonary disease and colorectal cancer development: unravelling the mediating role of fatty acids through a comprehensive multi-omics analysis. J Transl Med 2023; 21 : 587.
  32. Cheng W, Chiang C, Peng M et al. Chronic obstructive pulmonary disease increases the risk of mortality among patients with colorectal cancer: a nationwide population-based retrospective cohort study. Int J Environ Res Public Health 2021; 18 : 8742.
  33. Chen C, Hu J, Shen C et al. Increased incidence of colorectal cancer with obstructive sleep apnea: a nationwide population-based cohort study. Sleep Med 2019; 66 : 15–20.
  34. Niranjan N, Sriram K, Gopalan V. Obstructive sleep apnea and colorectal cancer: a systematic review and meta-analysis. J Gastrointest Cancer 2023; 54 : 1151–1157.
  35. Lacedonia D, Landriscina M, Scioscia G et al. Obstructive sleep apnea worsens progression-free and overall survival in human metastatic colorectal carcinoma. J Oncol 2021; 2021 : 5528303.
  36. Martinez C, Kerr B, Jin C et al. Obstructive sleep apnea activates HIF-1 in a hypoxia dose-dependent manner in HCT116 colorectal carcinoma cells. Int J Mol Sci 2019; 20 (2): 445.
  37. Lammi L, Arte S, Somer M et al. Mutations in AXIN2 cause familial tooth agenesis and predispose to colorectal cancer. Am J Hum Genet 2004; 74 : 1043–1050.
  38. Jensen J, Skakkebæk A, Gaustadness M et al. Familial colorectal cancer and tooth agenesis caused by an AXIN2 variant: how do we detect families with rare cancer predisposition syndromes? Fam Cancer 2022; 21 : 325–332.
  39. Williams M, Biguetti C, Romero-Bustillos M et al. Colorectal cancer-associated genes are associated with tooth agenesis and may have a role in tooth development. Sci Rep 2018; 8 : 2979.
  40. Bonczek O, Krejčí P, Izakovicova-Holla L et al. Tooth agenesis: what do we know and is there a connection to cancer? Clin Genet 2021; 99 : 493–502.
  41. Lindor N, Win A, Gallinger S et al. Colorectal cancer and self-reported tooth agenesis. Hered Cancer Clin Pract 2014; 12 : 7.

Adresa pro korespondenci:

MUDr. Ádám Varga

Chirurgická klinika LF OU a FN Ostrava

17. listopadu 1790/5, 708 52 Ostrava-Poruba

Tel.: 607 243 576

e-mail: adam.varga@fno.cz

Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental Hygienist
Telemedicine video consultations in the Czech Republic and their practical implementation in outpatient practice
Obesity during pregnancy – health risks and prevention options
Periodontitida a diabetes mellitus 2. typu
European Partnership for Personalised Medicine (EP PerMed)
Ancient sanctuary of Eileithyia, goddess of childbirth, on the island of Paros (Greece)
Professor Otto Piffl, the First Full Professor of Otology and Rhinology at the German University in Prague, passed away 100 years ago
MUDr. Václav Náprstek – zapomenutý hrdina
The personality of professor Otakar Štark in the context of the development of medical genetics in Czechoslovakia in the years 1950–1990
Pokyny pro autory a autorky Časopisu lékařů českých – výtah
Article was published in

Journal of Czech Physicians

Issue 2
2026 Issue 2
Download issue PDF
Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#