ABSTRACT
Obesity is a risk factor for colorectal cancer based on its molecular and metabolic
effects on insulin and IGF-1, leptin, adipocytokines, and sex hormones. Obese men
have a higher risk of colorectal cancer compared with normal weight men, but the association
between obesity and rectal cancer is weaker than with colon cancer. There is a weaker
association between obesity and colon cancer in women than in men, and no appreciable
association between obesity and rectal cancer in women. Although obesity does not
seem to have an effect on the number of lymph nodes harvested with resection, obesity
does seem to be associated with more-aggressive colorectal cancers in a handful of
studies. Survival and local recurrence studies are contradictory with no conclusive
evidence that obesity predisposes to worse overall survival or increased recurrence
in colon and rectal cancers. The literature is not definitive as far as overall morbidity
and mortality rates in the obese are concerned, though obese rectal cancer patients
seem to incur proportionally more morbidity and mortality. Preexisting steatosis or
steatohepatitis in obese colorectal cancer patients or chemotherapy-induced liver
dysfunction may lead to an increased mortality in obese patients with colorectal liver
metastases. Diabetes may cause poorer response to neoadjuvant therapy in rectal cancer
and contribute to higher mortality and recurrence in colon cancer.
KEYWORDS
Obesity - colon cancer - rectal cancer - diabetes - men - women
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Kirk A. LudwigM.D.
Department of Surgery, Division of Colorectal Surgery, Medical College of Wisconsin
9200 W. Wisconsin Ave., Milwaukee, WI 53226
eMail: kludwig@mcw.edu
