Megacolon and Colon Cancer

Chagasic megaesophagus increases the incidence of esophageal cancer, with a prevalence ranging from 3.9% to 9%. However, there is no known relationship between Chagasic mega-colon and colon adenocarcinoma. Despite any formal precursor relationship, there are a few reports in the literature of adenocarcinoma of the colon in patients with chagasic megacolon, one of them found by autopsy.

A serologic screening for Chagas' disease in a hospital-based population located in an endemic area of central Brazil, where a seropositivity prevalence of 7% is expected, showed a similar prevalence of this infection between patients with benign and malignant colorectal disease.37-39

More than 95% of the patients with Chagasic megacolon complain of constipation, and the majority have a bowel movement less frequently than every 10 days (Table 25.3). Thus, constipation, as described by many authors, might be considered an important factor in the genesis of colorectal cancer, as it prolongs the contact of potential carcinogens in the stool with the colonic mucosa.40-42 Therefore, it would be expected that a higher incidence of colorectal cancer would occur in individuals with Chagasic megacolon. However, no such association exists.

Colorectal cancer could be underestimated or misdiagnosed among patients with Chagasic megacolon. However, considering that Chagasic megacolon is mainly surgically treated, the possibility of a misdiagnosis of coloretal cancer in such patients is highly unlikely.

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