EVOLUTION OF COLORECTAL CANCER IN SCHISTOSOMIASIS

Aim: To define the clinico-patliologic character of schistosomiasis mansoni associated colorectal cancer (S.CRC) and the possible carcinogenic relation of Schistosoma mansoni (S.M). Methods: This study included 176 patients with colorectal cancer associated with S.M. Their clinical database and surgical pathology sheets were documented with the detection of S.M on stool analysis, serologic tests, pathologic associated lesions and tumor P53 protein expression using immuno-cytochemical assay. Results: Sixty eight patients (40%) with S.CRC were below 40 years with male predominance (1.8 - 1), distal CRC predominance in 109 patients (62%), mucinous type in 58 patients (33%), higher grades II, III in 136 patients (79%), with significant angio-invasion in 50 patients (30%), lymph vessels invasion in 50 patients (35%) and perineural invasion in 17 patients (10%), associates with poor immune response in 8 patients (5%), preceded with schistosomal lesions especially in patients with schistosomal colitis ≥10 years, associates with TP53 in 114 cases (65%) and presented at advanced stages in 99 cases (56%) with only hepatic metastasis in 28 cases (90%). Conclusion: S.CRC is a special clinical entity that has an aggressive pathologic pattern, bad biologic behavior and the SM is implicated in SCRC progression.