Schistosomal Colorectal Cancer: Biomarkers and Treatment Strategies

Hytham K. S. Hamid (Department of Surgery, Soba University Hospital, Khartoum, Sudan.)

Article ID: 1549


About 15.4% of human cancers worldwide have been attributed to infections. Among these, blood and liver flukes, notably Schistosoma sp, Clonorchis Sinesis, and Opisthorchis Viverrini have been associated with the development of various cancer types. Schistosoma sp. promotes colorectal cancer (CRC) progression through multiple mechanisms including production of toxins, symbiotic action with bacterial agents, and more importantly chronic inflammation. Diagnosis of schistosomal colorectal cancer (SCC) requires high index of clinical suspicion in endemic areas. Novel biomarkers may aid early diagnosis of SCC in patients with chronic intestinal schistosomiasis. Treatment should be tailored to individual patients according to the stage and biologic characteristics of the tumour, and the extent of hepatosplenic schistosomiasis. Long-term survival after surgical resection of SCC is lower than that reported in patients with sporadic CRC.


Blood fluke; Schistosoma; Trematoda; Colorectal cancer; Diagnosis; Biomarkers; Treatment

Full Text:



[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin, 2018, 68: 394–424.

[2] Boland CR. Evidence for an association between JC virus and colorectal neoplasia. Cancer Epidemiol Prev Biomarker, 2004, 13: 2285–2286.

[3] Hamid HKS, Mustafa YM. The role of infectious agents in colorectal carcinogenesis. Colorectal cancer biology – from Genes to Tumor Rijeka: INTECH publisher Ettarh R, 2012, 16: 341–374.

[4] Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet, 2014, 26: 1490–1502.

[5] Salim OEH, Hamid HKS, Mekki SO, et al. Colorectal carcinoma associated with schistosomiasis: a possible causal relationship. World J Surg Oncol. 2010, 8: 68.

[6] Hamid HKS. Shistosoma japonicum-associated colorectal cancer: A review. Am J Trop Med Hyg. 2019, 100: 501–505.

[7] Liu W, Zeng HZ, Wang QM, et al. Schistosomiasis combined with colorectal carcinoma diagnosed based on endoscopic findings and clinicopathological characteristics: a report on 32 cases. Asian Pac J Cancer Prev. 2013, 14: 4839–4842

[8] Shindo K. Significance of schistosomiasis japonica in the development of cancer of the large intestine: Report of a case and review of the literature. Dis Colon Rectum, 1976, 19: 460–469.

[9] Ming-Chai C, Chi-Yuan C, Pei-Yu C, et al. Evolution of colorectal cancer in schistosomiasis: transitional mucosal changes adjacent to large intestinal carcinoma in colectomy specimens. Cancer. 1980, 46: 1661–1675.

[10] Zhang W, Wang PJ, Shen X et al. CT presentations of colorectal cancer with chronic schistosomiasis: A comparative study with pathological findings. Eur J Radiol. 2012, 81: e835–843.

[11] Feng H, Lu AG, Zhao XW et al. Comparison of non-schistosomal rectosigmoid cancer and schistosomal rectosigmoid cancer. World J Gastroenterol. 2015, 21: 7225–7232.

[12] Lin M, Hanai J, Gui L. Peanut lectin-binding sites and mucins in benign and malignant colorectal tissues associated with schistomatosis. Histol Histopathol. 1998, 13: 961–966.

[13] Wang M, Zhang YC, Yang XY et al. Prognostic analysis of schistosomal rectal cancer. Asian Pac J Cancer Prev. 2014, 15: 9271–9275.

[14] Damin DC, Lazzaron AR. Evolving treatment strategies for colorectal cancer: a critical review of current therapeutic options. World J Gastroenterol. 2014, 20: 877–887.

[15] Lu R, Wu S, Zhang YG, et al. Enteric bacterial protein AvrA promotes colonic tumorigenesis and activates colonic beta-catenin signaling pathway. Oncogenesis, 2014, 3: e105.

[16] Lu R, Bosland M, Xia Y, et al. Presence of Salmonella AvrA in colorectal tumor and its precursor lesions in mouse intestine and human specimens. Oncotarget. 2017, 8: 55104–55115.

[17] Nath G, Gulati AK, Shukla VK. Role of bacteria in carcinogenesis, with special reference to carcinoma of the gallbladder. World J Gastroenterol, 2010, 16: 5395–5404.

[18] Zhang R, Takahashi S, Orita S, et al. p53 gene mutations in rectal cancer associated with schistosomiasis japonica in Chinese patients. Cancer Lett. 1998, 131: 215–221.

[19] Almeida GFG, Sarinho FW, Carvalho de Abreu E Lima P, et al. DNA Repair Defect and RAS Mutation in Two Patients With Schistosoma mansoni-Associated Colorectal Cancer: Carcinogenesis Steps or Mere Coincidence? J Glob Oncol. 2016, 3: 423–426.

[20] Soliman AS, Bondy ML, El-Badawy SA, et al. Contrasting molecular pathology of colorectal carcinoma in Egyptian and Western patients. Br J Cancer, 2001, 85: 1037–1046.

[21] Itzkowitz SH, Yio X. Inflammation and cancer IV. Colorectal cancer in inflammatory bowel disease: the role of inflammation. Am J Physiol Gastrointest Liver Physiol. 2004, 287: G7–17.

[22] Madbouly KM, Senagore AJ, Mukerjee A, et al. Colorectal cancer in a population with endemic Schistosoma mansoni: is this an at-risk population? Int J Colorectal Dis. 2007, 22: 175–181.

[23] Zalata KR, Nasif WA, Ming SC, et al. p53, Bcl-2 and C-Myc expressions in colorectal carcinoma associated with schistosomiasis in Egypt. Cell Oncol. 2005, 27: 245–253.

[24] Waku M, Napolitano L, Clementini E, et al. Risk of cancer onset in sub-Saharan Africans affected with chronic gastrointestinal parasitic diseases. Int J Immunopathol Pharmacol. 2005, 18: 503–511.

[25] Hamed MA, Ahmed SA, Khaled HM. Efficiency of diagnostic biomarkers among colonic schistosomiasis Egyptian patients. Mem Inst Oswaldo Cruz. 2011, 106: 322–329.

[26] Abdelkareem EA, Sharief AH, Huat LB, et al. Identification of specific proteins in colorectal cancer patients with Schistosoma mansoni infection as a possible biomarker for the treatment of this infection. Asian Pac J Trop Dis. 2014, 4: S720–S724.

[27] Ye C, Tan S, Jiang L, et al. Endoscopic characteristics and causes of misdiagnosis of intestinal schistosomiasis. Mol Med Rep. 2013, 8: 1089–1093.

[28] Lombardi L, Morelli F, Cinieri S, et al. Adjuvant colon cancer chemotherapy: where we are and where we’ll go. Cancer Treat Rev. 2010, 36: S34–41.

[29] Ahmed S, Johnson K, Ahmed O, et al. Advances in the management of colorectal cancer: from biology to treatment. Int J Colorectal Dis. 2014, 29: 1031–1042.

[30] Yi Z, Hong-Gang J, Zhi-Heng C et al. Short-Term Efficacy of Laparoscopic Treatment for Colorectal Cancer in Patients with Schistosomiasis Japonica. Gastroenterol Res Pract. 2016, 2016: 8357025.

[31] Zhou S, Zhu H, Li Z, et al. Safety of laparoscopic resection for colorectal cancer in patients with liver cirrhosis: A retrospective cohort study. Int J Surg. 2018, 55: 110–116.

[32] Chen MG. Assessment of morbidity due to Schistosoma japonicum infection in China. Infect Dis Poverty, 2014, 3: 6.

[33] Wang M, Wu QB, He WB, et al. Clinicopathological characteristics and prognosis of schistosomal colorectal cancer. Colorectal Dis. 2016, 18: 1005–1009.

[34] Sauer R, Becker H, Hohenberger W et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004, 351: 1731–1740.

[35] Zhang Y, Chen Z, Li J. The current status of treatment for colorectal cancer in China: A systematic review. Medicine (Baltimore), 2017, 96: e8242.

[36] Abruzzi A, Fried B, Alikhan SB. Coinfection of Schistosoma Species with Hepatitis B or Hepatitis C Viruses. Adv Parasitol, 2016, 91: 111–231.

[37] Li Y, Chen D, Ross AG et al. Severe hepatosplenic schistosomiasis: clinicopathologic study of 102 cases undergoing splenectomy. Hum Pathol. 2011, 42: 111–119.

[38] Rubbia-Brandt L, Audard V, Sartoretti P, et al. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol. 2004, 15: 460–466.

[39] Madbouly KM, Hussein AM, Zeid A. Colorectal cancer surgery in portal hypertensive patients: does adjuvant oxaliplatin affect prognosis? Dis Colon Rectum, 2013, 56: 577–585.

[40] Veenstra CM, Krauss JC. Emerging Systemic Therapies for Colorectal Cancer. Clin Colon Rectal Surg. 2018, 31: 179–191.

[41] Salim EI, Morimura K, Menesi A, et al. Elevated oxidative stress and DNA damage and repair levels in urinary bladder carcinomas associated with schistosomiasis. Int J Cancer, 2008, 123: 601–608.

[42] Motallebnezhad M, Jadidi-Niaragh F, Qamsari ES et al. The immunobiology of myeloid-derived suppressor cells in cancer. Tumour Biol. 2016, 37: 1387–1406.

[43] Van Herk EH, Te Velde AA. Treg subsets in inflammatory bowel disease and colorectal carcinoma: Characteristics, role, and therapeutic targets. J Gastroenterol Hepatol. 2016, 31: 1393–404.



  • There are currently no refbacks.
Copyright © 2019 Author(s)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.