Investigating the Relationship between Red Blood Cell Distribution Width and Early Detection of Colorectal Cancer and Colonic Polyps

Document Type: Original Article


1 Internist, Tehran University of Medical Sciences, Tehran, Iran

2 Assistant Professor of gastroenterology, Tehran University of Medical Sciences, Tehran, Iran

3 Associate Professor of gastroenterology, Tehran University of Medical Sciences, Tehran, Iran

4 Professor of colorectal cancer surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran

5 Ph.D. Candidate of Cognitive Neuroscience linguistics, Institute for Cognitive Science Studies (ICSS), Tehran, Iran


Background: Colorectal cancer is a common cancer and has a high rate of mortality and morbidity. This can be reduced by screening tests. Some of the studies have recently referred to Red Cell Distribution Width (RDW) as a marker for early detection of various cancers. The aim of this study was to investigate the RDW and early detection of colorectal cancer and polyp.
Methods:A total of 90 patients were divided into three groups. One group included patients with colon cancer, another group with colon polyps, and the third group with normal colonoscopy as a control group. Blood samples were taken from patients and mean corpuscular volume (MCV), hemoglobin (HB), platelet (PLT), red blood cell distribution width (RDW), ferritin, serum iron, and total iron-binding capacity (TIBC) values were recorded. Transferrin saturation (Tsat) was also calculated. Statistical analysis was performed to remove the anemia effect of patients who had Tsat less than 20%, which was compared to patients who had Tsat over 20%. For the relationship between RDW and colon cancer, a receiver operating characteristic (ROC) curve was used.
Results: The area under the receiver-operating characteristic curve (AUC) of the RDW for predicting colon cancer was 0.698, with cut off >14 which had 80% sensitivity and 60% specificity.
Conclusions: RDW can be considered as a parameter for predicting colorectal cancer.


  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68(6):394-424.
  2. Navarro M, Nicolas A, Ferrandez A, Lanas A. Colorectal cancer population screening programs worldwide in 2016: an update. World J Gastroenterol 2017; 23(20):3632-42.
  3. Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi‚ÄźSociety Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008; 58(3): 130-60.
  4. Väyrynen JP, Tuomisto A, Väyrynen SA, Klintrup K, Karhu T, Mäkelä J, et al. Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival. Scientific Reports 2018; 8(1):1126.
  5. Goyal H, Lippi G, Gjymishka A, John B, Chhabra R, May E. Prognostic significance of red blood cell distribution width in gastrointestinal disorders. World J Gastroenterol 2017; 23(27): 4879-91.
  6. Jandial A, Kumar S, Bhalla A, Sharma N, Varma N, Varma S. Elevated red cell distribution width as a prognostic marker in severe sepsis: a prospective observational study. Indian J Crit Care Med 2017; 21(9):552-62.
  7. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 2009; 133(4):628-32.
  8. Zhang T, Li J, Lin Y, Yang H, Cao S. Association between red blood cell distribution width and all-cause mortality in chronic kidney disease patients: a systematic review and meta-analysis. Arch Med Res 2017; 48(4):378-85.
  9. Kheirkham-Sabetghadam S, Jenab Y, Ghoreyshi-Hefzabad SM, Gohari-Moghadam K, Lotfi-Tokaldany M, Jalali A, et al. Association between elevated red blood cell distribution width and long-term mortality in acute pulmonary embolism. Turk J Med Sci 2018; 48(2): 318-23.
  10. Hu L, Li M, Ding Y, Pu L, Liu J, Xie J, et al. Prognostic value of RDW in cancers: a systematic review and meta-analysis. Oncotarget 2017; 8(9):16027-35.
  11. Ai L, Mu S, Hu Y. Prognostic role of RDW in hematological malignancies: a systematic review and meta-analysis. Cancer Cell Int 2018; 18:61.
  12. Goyal H, Hu ZD. Prognostic value of red blood cell distribution width in hepatocellular carcinoma. Ann Transl Med 2017; 5(13):271.
  13. Cheng S, Han F, Wang Y, Xu Y, Qu T, Ju Y, et al. The red distribution width and the platelet distribution width as prognostic predictors in gastric cancer. BMC Gastroenterol 2017; 17(1):163.
  14. Sun H, Yin CQ, Liu Q, Wang F, Yuan CH. Clinical significance of routine blood test-associated inflammatory index in breast cancer patients. Med Sci Monit 2017; 23:5090-5.
  15. de Gonzalo-Calvo D, de Luxán-Delgado B, Rodríguez-González S, García-Macia M, Suárez FM, Solano JJ, et al. Interleukin 6, soluble tumor necrosis factor receptor I and red blood cell distribution width as biological markers of functional dependence in an elderly population: a translational approach. Cytokine 2012; 58(2):193-8.
  16. Ay S, Eryilmaz MA, Aksoy N, Okus A, Unlu Y, Sevinc B. Is early detection of colon cancer possible with red blood cell distribution width. Asian Pac J Cancer Prev 2015; 16(2):753-6.
  17. Yang D, Quan W, Wu J, Ji X, Dai Y, Xiao W, et al. The value of red blood cell distribution width in diagnosis of patients with colorectal cancer. Clin Chim Acta 2018; 479:98-102.
  18. Kust D, Lucijanic M, Urch K, Samija I, Celap I, Kruljac I, et al. Clinical and prognostic significance of anisocytosis measured as a red cell distribution width in patients with colorectal cancer. QJM 2017; 110(6):361-7.
  19. Spell DW, Jones DV Jr, Harper WF, David Bessman J. The value of a complete blood count in predicting cancer of the colon. Cancer Detect Prev 2004; 28(1):37-42.
  20. Li Y, Xing C, Wei M, Wu H, Hu X, Li S, Sun G, Zhang G, Wu B, Zhang F, Li Z. Combining red blood cell distribution width (RDW-CV) and CEA predict poor prognosis for survival outcomes in colorectal Cancer. Journal of Cancer. 2019;10(5):1162.
  21. Zhang X, Wu Q, Hu T, Gu C, Bi L, Wang Z. Elevated red blood cell distribution width contributes to poor prognosis in patients undergoing resection for nonmetastatic rectal cancer. Medicine (Baltimore) 2018; 97(3):e9641.