Introduction
In the world, colorectal cancer is the second most frequent cancer in women and the third most common disease in men. 90% of instances of colorectal cancer occur in those over 50, making it a disease that mostly affects the elderly. It is currently thought that colorectal cancer develops from an adenoma in a stepwise process known as the adenoma-carcinoma sequence, wherein the adenoma's growing dysplasia is brought on by the accumulation of genetic mutations.
Some experts regard the serum lipid profile to be one of the many additional parameters indicated in the literature as etiologic risk factors for this colorectal cancer. While some studies have discovered a beneficial link with colorectal cancer, others have discovered a detrimental association. The essential elements of the cell membrane are lipids. It is still debatable whether dyslipidemia increases1, 2, 3, 4, 5, 6 or reduces7, 8, 9, 10 or has no impact11 on mortality rates, despite the fact that it has been linked to an increased risk factor for colorectal cancer.12, 13 There are several studies in the literature, in particular, on the link between aberrant lipid levels and colorectal cancer. 14, 15, 16, 17
The current study may provide light on the connection between the illness and serum lipid levels in light of the aforementioned facts on the causes of colorectal cancer, which may assist to lower the occurrence by suitable dietary and other measures in the future.
Materials and Methods
The current work, which represents the thesis "Estimation of relationship between serum lipids level and colorectal carcinoma: a cross-sectional study", was completed between December 2020 and November 2020 in the General Surgery Department at VIMSAR, Burla. Before beginning the study, permission from the institutional ethical committee was acquired (VIMSAR IECo No- 119-2022/IST/107.Dt. 17.05.2022).
Selection of cases
Patients who had been hospitalised to the departments of general surgery and radiotherapy with cancer of the colon and rectum were used as the cases. We chose 40 instances of carcinoma from various locations in the colon and rectum, at various stages, and in various age groups. The trial was open to both male and female patients after the diagnosis was certain. As controls, 40 patients from the Department of General Surgery who did not have colorectal cancer but other conditions were chosen.
Case selection method
Colonoscopy, preoperative proctoscopy, colonoscopy, ultrasonography, and FNAC are some of the investigative modalities used to make the diagnosis of colon cancer. The next morning, colon cancer patients who had been diagnosed had their fasting blood drawn and submitted to the VSS Institute of Medical Science and Research, Burla, for lipid profile testing.
The subsequent serum variables were calculated:
Total cholesterol (TC in serum
HDL-C, or high density lipoprotein cholesterol
VLDL-C (VLDL-cholesterol
Cholesterol
TG, or triglycerides
The semi-automated Logotech-168 analyzer was used at the Department of Biochemistry to measure serum cholesterol utilising enzymatic techniques. At the VSS Institute of Medical Science and Research, Burla, the Department of Biochemistry collected a blood sample from a person who had fasted overnight before measuring the lipid profile.
Aims and Objectives
Should carefully examine the connection between the level of blood lipids and the result of colorectal cancer in order to discover any early warning signs of this deadly condition.
Figure 1
Comparison of lipid profile value of cases in both sex separately with those of the controls
Table 1
In both sexes of the cases, all observations were documented using the control group as the reference point.
Serum values for TC, TG, HDL, VLDL, and LDL are displayed separately for both sexes in the table above. In this case, the serum levels of TC, TG, and LDL-C were lower in both sexes than in the controls with an SD, but because they were between two standard deviations of the control values and the P value was not significant, they were not significant in either sex. Additionally, there wasn't much of a difference in these values between the sexes.
Figure 2
Lipid profile comparison of right and sided colorectal carcinoma in both sexes compared separately with those of the controls.
Table 2
Comparison of the lipid profiles of right and left sided colorectal cancer in each sex with those of the controls.
The caecum, ascending colon, hepatic flexure, transverse colon, descending colon, and rectum on the right side (Dukes' C1 and C2) and the transverse colon, descending colon, sigmoid colon, and rectum on the left side (in both sexes) of patients with advanced stage illnesses were shown on this graph. Lower TC, TG, and LDL-C levels were seen in both cases with left- and right-sided advanced illness, with the right-sided patients exhibiting a more noticeable difference. Right-sided cancer had TC, TG, VLDL-C, and LDL-C levels that were one standard deviation lower than those of controls; However, only in the TC did the mean level of right-sided carcinoma differ by two standard deviations from the level of controls, and this difference was significant (P 0.05). This was not the case with left-sided carcinoma patients.
Figure 3
Comparison of the lipid profile values between early-stage illness patients (Dukes A&B) in both sexes and controls
Table 3
Comparison of the lipid profile values between early stage illness patients (Dukes, A and B), including both sexes, and the controls.
The mean blood values of TC, TG, HDL, VLDL, and LDL were presented here. The Dukes' colorectal cancer A and B stages in both sexes were evaluated. P > 0.05 was used to indicate that the change was not statistically significant even though the blood levels of TC, TG, HDL, VLDL, and LDL all reduced in this case and only the value of TC was one standard deviation greater than that of controls.
Figure 4
Lipid profile comparison of cases of both sex of colorectal ca with advanced stages (Dukes C) with those of controls
Table 4
Comparing the lipid profiles of colorectal cancer patients in both sexes with advanced stages (Dukes C1 and C2) to those of the controls as a whole.
It has been demonstrated that mean blood concentrations of TC, TG, and LDL-C are linked with advanced stages of colorectal cancer. Even though the p value was larger than 0.05 and the patients' blood levels of TC and LDL-C were approximately two standard deviations lower than the mean values of the controls, HDL and VLDL-C did not change in a way that was statistically significant.
Figure 5
Comparison of the lipid profiles of controls and all stages of colorectal cancer in both sexes
Table 5
Comparison of the lipid profiles of controls and patients of colorectal cancer in all stages in both sexes.
The mean serum TC, TG, and LDL-C levels of the cases were lower than those of the controls beyond one standard deviation of the controls but within two standard deviations of the controls when taken as a whole and with a P value > 0.05, but this was not statistically significant. No discernible changes were seen when the HDL and LDL cholesterol levels of the patients and controls were compared.
Discussion
The blood markers TC, TG, HDL-C, VLDL-C, and LDL-C were all compared in all 40 cases of colorectal cancer in both men and women. A comparable group of 40 additional patients that did not have colorectal cancer were chosen as controls. In contrast to 146.52 in instances of colorectal cancer, the average total blood cholesterol level was found to be 176.10 in the control group. This is consistent with Seth R et al's findings from 1981, which found that colorectal cancer cases had lower serum cholesterol levels and cases with advanced tumours had significantly lower cholesterol levels than those in the control group. Our colorectal cancer group also had lower total serum cholesterol levels, which is also consistent with those findings. 18
Serum levels were lower in the tumour group than in the control group, just as TG and LDL-C levels were. In this study, the mean TG and LDL-C levels were 176.67 and 98.12 for controls, and 154.95 and 73.95, respectively, for the tumour group. This outcome is consistent with those of Abraham M. Y. et al. (1991), who found that there was an inverse association between blood cholesterol levels and the risk of colon cancer when all the subsites of the various parts of the colon were taken into consideration. 19 The current finding may also be consistent with MC Michel AJ and Potter JD's (1981) discovery that low cholesterol levels in people are linked to higher faecal bile acid concentrations, specifically the deoxycholic acid type of bile acids, which can result in colon cancer in test animals. 20
Lower levels of TC and LDL-C were discovered in the present investigation's Dukes C1 and C2 patients of late-stage colorectal cancer. The blood concentrations of TC and LDL-C in the control groups were 176.10 and 98.12, respectively, as opposed to findings of 134.63 and 64.22 in the tumour groups. This finding is in line with Seth R. et al.'s (1981) conclusion. Seth R. et al. did not estimate LDL-C levels for their investigation, nevertheless. 18
While TG and VLDL-C levels decreased, albeit not significantly, during the course of the study, the mean HDL-C level remained steady. Data from a WHO research by the Committee of Principal Investigators (1978) showed a substantial increase in the risk of gastrointestinal malignancies while using clofibrate to decrease blood cholesterol levels. Ederer F. et al. (1980) demonstrated that lowering blood cholesterol levels with a diet high in polyunsaturated fatty acids did not result in a rise in the incidence of malignancies or a higher death rate from colon cancer. 21
In the current examination, which was conducted at this institution with cancer cases involving the right and left colon and rectum, and it was compared with the selected control group, a novel discovery was noted. The mean values of total cholesterol, triglycerides, and LDL-C in right-sided tumours (caecum, ascending colon, and hepatic flexure) were 131.67, 144.89, and 66, respectively. Comparing these numbers to those in the control group, they were noticeably lower. Naturally, these traits were also weakened in colon and rectal tumours on the left, but not statistically significantly. The characteristics of the three groups—right-sided malignancies, left-sided malignancies, and the control group—mentioned above were, as a result, completely different. However, a standard deviation was used to compare the mean TC values between the control group and the right-sided instance. This discovery is10 According to Abraham M. Y. et al.'s (1991) research, as colorectal cancer incidence switched from the sigmoid colon to the caecum, there was a significant negative relationship between blood cholesterol levels and risk. They proposed that this inverse correlation was caused in part by the metabolic impact of undetected colon cancer. 19 The connection was stronger for caecum and ascending colon cancer than for rectal cancer, but the reason for this was unclear.
The levels of several blood parameters in the early stages of malignancy (Dukes A and B) in the current series did not significantly differ from the equivalent control group. This conclusion is consistent with those of Seth R. et al (1981). The inverse correlation between these serum parameters in the early tumour group and those in the control group in the Seth R. et al. series was not statistically significant. 18
Gender had no impact on the change in blood parameters we assessed in the cancer and control groups. Abraham M. et al. discovered a negative association between male colorectal cancer and blood levels of TC, TG, and LDL-C, which is shown in Table 1, despite the fact that they did not include female patients in their investigation. This finding supports his theory that low serum cholesterol may be a preclinical manifestation of colorectal carcinoma.
Conclusion
The tumour group's blood levels of TC, TG, and LDL-C decreased in comparison to the control group, regardless of sex, site of the infestation, or stage of the malignancy. However, significant variations in blood levels of the aforementioned parameters were only seen in severe cases with Dukes C1 and C2.
Right-sided carcinomas had significantly lower mean levels of TC, TG, and LDL-C than left-sided carcinomas, and the difference in TC serum levels was statistically significant when the serum parameters of cases with right-sided and left-sided carcinomas were compared to those of the control group. Even while left-sided malignancies also showed this inverse link, the association was not as high as it was in right-sided tumours.
Additionally, no discernible variation in these serum values was discovered when the cases of the two sexes were examined independently. We come to the conclusion that there is an inverse relationship between blood levels of TC, TG, and LDL-C and colorectal cancer. In order to screen cases and create a more curative course of treatment for this dreadful illness, serum parameters with low values in the precancerous or early stages of tumours might be employed. Our study only has a limited sample size, thus more research and a population-based cohort study are required to fully understand this link.
Nearly all studies have found a link between elevated total cholesterol levels and advanced colon cancer that only affects the right side of the colon.
