Colorectal cancer (CRC) is a common disease and one of the leading causes of cancer deaths worldwide. However, the risk of developing CRC in people with hemorrhoids is not well known. This retrospective cohort study evaluated the risk of developing CRC in people with hemorrhoids.

Using Taiwan’s National Health Insurance Research Database, it established three sets of retrospective study cohorts with and without hemorrhoids.  Int J Environ Res Public Health findings suggest that people with hemorrhoids have a higher risk of developing CRC.

The first group of people were matched by sex and age, the second group were matched by their likelihood of colonoscopies without including them, and the third group were matched by their likelihood of colonoscopies with adenomas and appendectomies included.

In the second group, 36,864 people with hemorrhoids that were diagnosed from 2000 to 2010 and a comparison group, with the same size and matched by propensity score, were established and followed up to the end of 2011 to assess the incidence and hazard ratio of CRC.

The overall incidence rate of CRC was almost 2.5 times greater in the hemorrhoid cohort than in the comparison cohort. With a multivariable model measuring adjusted HR of 2.18 after controlling for sex, age, and comorbidity. Further analysis showed higher incidence rates at the rectum and sigmoid than at other sites, with adjusted HRs 2.20 and 1.79, respectively.

The rates of hemorrhoids were similar in the first and second groups of people, but lower in the third group. This is probably because they had a better match. Our findings suggest that people with hemorrhoids are at a higher risk for developing CRC. If they get a positive result from a fecal occult blood test, they should get a colonoscopy to check for CRC.

Colorectal Cancer vs. Hemorrhoids

Colorectal cancer is unfortunately quite common, and it’s one of the leading causes of cancer-related deaths around the world. Both genetic and lifestyle factors can affect your risk of developing CRC. Things like eating red meat, being inactive, overweight, smoking cigarettes, and drinking alcohol are all known risk factors when it comes to CRC.

CRCs usually come from adenomas that get worse and turn into dysplasia and carcinoma. On average, it takes 10 years to go from adenoma to adenocarcinoma. Genetic defects that are inherited and acquired cause neoplastic changes. According to the World Health Organization GLOBOCAN database, CRC is the third most commonly diagnosed malignancy in males and second in females around the world.

Hemorrhoids are gastrointestinal disorders that are diagnosed by general practitioners. The disease is characterized by inflammation of the anorectum, including the submucosal, fibrovascular, and arteriovenous sinusoids. Painless rectal bleeding is a common complaint during defecation, particularly when tissue prolapse appears.

There are a few other symptoms that are associated with hemorrhoids. This includes itchiness, pain, and a lump at the anal verge. These symptoms are usually caused by thrombosis or strangulation.

Some of the risk factors for developing hemorrhoids include a low-fiber diet, low water intake, and increased intra-abdominal pressure (from things like pregnancy, constipation, or prolonged straining). The good news is that most people who have hemorrhoids don’t have any symptoms and don’t need any treatment.

CRC and hemorrhoids often share risk factors, such as low fiber intake, obesity, and lack of adequate exercise. Hemorrhoids can also have similar symptoms to CRC, like the presence of blood in the patient’s stool. Because of this, doctors often advise that people with hemorrhoids get screened for CRC as a precautionary measure.

Can Hemorrhoids Lead to Cancer?

The study found that, in general, the rate of CRC was similar in the hemorrhoids and comparison cohorts. In the third set of study cohorts, however, the CRC incidence was lower in the hemorrhoids cohort than in the comparison cohort. The team behind the Int J Environ Res Public Health study suspected that the third set of study cohorts were overmatched.

This is because they included colonoscopies, colorectal adenomas, and appendectomies in the propensity score matching. However, both cohorts had similar prevalence rates of colonoscopy uses at baseline.

Additionally, the prevalence of colorectal adenomas was even higher in the hemorrhoid cohort than in the comparison cohort. Therefore, the team considered the second set of study cohorts as being adequate for studying the relationship between hemorrhoids and CRC risk.

So far, not many big studies have looked into the link between hemorrhoids and CRC. But in a large retrospective study that followed patients for 12 years, the team found that people with hemorrhoids were 2.18 times more likely to develop CRC. All after taking into account other health conditions that can raise the risk of CRC.

Key Takeaway

Patients with hemorrhoids are at an increased risk of developing colon cancer. Hemorrhoidectomy is seen as a benefit to hemorrhoid patients since it provides a near 50% risk reduction of subsequent colon cancer.