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Beech C, Hechtman JF. Molecular Approach to Colorectal Carcinoma: Current Evidence and Clinical Application. Clin Lab Med 2024; 44:221-238. [PMID: 38821642 DOI: 10.1016/j.cll.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Colorectal carcinoma is one of the most common cancer types in men and women, responsible for both the third highest incidence of new cancer cases and the third highest cause of cancer deaths. In the last several decades, the molecular mechanisms surrounding colorectal carcinoma's tumorigenesis have become clearer through research, providing new avenues for diagnostic testing and novel approaches to therapeutics. Laboratories are tasked with providing the most current information to help guide clinical decisions. In this review, we summarize the current knowledge surrounding colorectal carcinoma tumorigenesis and highlight clinically relevant molecular testing.
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Affiliation(s)
- Cameron Beech
- Department of Pathology, Yale New Haven Hospital, New Haven, CT, USA
| | - Jaclyn F Hechtman
- Molecular and GI Pathologist, NeoGenomics Laboratories, Fort Myers, FL, USA.
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Beech C, Hechtman JF. Molecular Approach to Colorectal Carcinoma: Current Evidence and Clinical Application. Surg Pathol Clin 2021; 14:429-441. [PMID: 34373094 DOI: 10.1016/j.path.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Colorectal carcinoma is one of the most common cancer types in men and women, responsible for both the third highest incidence of new cancer cases and the third highest cause of cancer deaths. In the last several decades, the molecular mechanisms surrounding colorectal carcinoma's tumorigenesis have become clearer through research, providing new avenues for diagnostic testing and novel approaches to therapeutics. Laboratories are tasked with providing the most current information to help guide clinical decisions. In this review, we summarize the current knowledge surrounding colorectal carcinoma tumorigenesis and highlight clinically relevant molecular testing.
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Affiliation(s)
- Cameron Beech
- Department of Pathology, Yale New Haven Hospital, New Haven, CT, USA
| | - Jaclyn F Hechtman
- Molecular and GI Pathologist, NeoGenomics Laboratories, Fort Myers, FL, USA.
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Fearon ER. Molecular genetics of colorectal cancer. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2011; 6:479-507. [PMID: 21090969 DOI: 10.1146/annurev-pathol-011110-130235] [Citation(s) in RCA: 1209] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the past three decades, molecular genetic studies have revealed some critical mutations underlying the pathogenesis of the sporadic and inherited forms of colorectal cancer (CRC). A relatively limited number of oncogenes and tumor-suppressor genes-most prominently the APC, KRAS, and p53 genes-are mutated in a sizeable fraction of CRCs, and a larger collection of genes that are mutated in subsets of CRC have begun to be defined. Together with DNA-methylation and chromatin-structure changes, the mutations act to dysregulate conserved signaling networks that exert context-dependent effects on critical cell phenotypes, including the regulation of cellular metabolism, proliferation, differentiation, and survival. Much work remains to be done to fully understand the nature and significance of the individual and collective genetic and epigenetic defects in CRC. Some key concepts for the field have emerged, two of which are emphasized in this review. Specifically, the gene defects in CRC often target proteins and pathways that exert pleiotropic effects on the cancer cell phenotype, and particular genetic and epigenetic alterations are linked to biologically and clinically distinct subsets of CRC.
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Affiliation(s)
- Eric R Fearon
- The Cancer Center, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, 48109-2200, USA.
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Abstract
Modern evaluation of specimens from biopsies of colorectal polyps has become increasingly complex because of tremendous progress in the understanding of colorectal neoplasia. Although pathologists are generally familiar with the basic handling of carcinoma in the setting of polypectomies or resections, the comprehensive evaluation of specimens from biopsies of colorectal polyps obtained with forceps is far from intuitive and has yet to be reviewed. Comprehensive evaluation requires always addressing several key issues, even when dealing with seemingly routine cases. These issues include taking further action when initial sections lack polyps, accurately quantitating polyps, accurately classifying polyps, determining whether thresholds are met for considering conditions at high risk for carcinoma, detecting incidental findings other than polyps, and determining which incidental findings are clinically significant. In particular, polyposis with attenuated phenotype or Lynch syndrome may be clinically occult, and the possibility of these entities should always be kept in mind, regardless of age or history. Ancillary studies performed immediately on carcinoma that is detected at biopsy guides surgery, guides medical therapy, prognosticates, provides evidence for hereditary neoplasia, and guides surveillant colonoscopy for the family.
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Stigliano V, Assisi D, Cosimelli M, Palmirotta R, Giannarelli D, Mottolese M, Mete LS, Mancini R, Casale V. Survival of hereditary non-polyposis colorectal cancer patients compared with sporadic colorectal cancer patients. J Exp Clin Cancer Res 2008; 27:39. [PMID: 18803843 PMCID: PMC2559820 DOI: 10.1186/1756-9966-27-39] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 09/19/2008] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Patients with hereditary non-poliposys colorectal cancer (HNPCC) have better prognosis than sporadic colorectal cancer (CRC). Aim of our retrospective study was to compare the overall survival between sporadic CRC and HNPCC patients. METHODS We analyzed a cohort of 40 (25 males and 15 females) HNPCC cases with a hospital consecutive series of 573 (312 males and 261 females) sporadic CRC observed during the period 1970-1993. In 15 HNPCC patients we performed mutational analysis for microsatellite instability. Survival rates were calculated by Kaplan-Meier method and compared with log rank test. RESULTS The median age at diagnosis of the primary CRC was 46.8 years in the HNPCC series versus 61 years in sporadic CRC group. In HNPCC group 85% had a right cancer location, vs. 57% in the sporadic cancer group. In the sporadic cancer group 61.6% were early-stages cancer (Dukes' A and B) vs. 70% in the HNPCC group (p = ns). The crude 5-years cumulative survival after the primary CRC was 94.2% in HNPCC patients vs. 75.3% in sporadic cancer patients (p < 0.0001). CONCLUSION Our results show that overall survival of colorectal cancer in patients with HNPCC is better than sporadic CRC patients. The different outcome probably relates to the specific tumorigenesis involving DNA mismatch repair dysfunction.
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Affiliation(s)
- Vittoria Stigliano
- Gastroenterology and Digestive Endoscopic Unit, Regina Elena Cancer Institute Via Elio Chianesi 53, 00144 Rome, Italy
| | - Daniela Assisi
- Gastroenterology and Digestive Endoscopic Unit, Regina Elena Cancer Institute Via Elio Chianesi 53, 00144 Rome, Italy
| | - Maurizio Cosimelli
- Department of Surgery, Regina Elena Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Raffaele Palmirotta
- Department of Laboratory Medicine and Advanced Biotechnologies IRCCS San Raffaele Pisana, Via della Pisana 235, 00163 Rome, Italy
| | - Diana Giannarelli
- Biostatistic Unit, Regina Elena Cancer Institute Via Elio Chianesi 53, 00144 Rome, Italy
| | - Marcella Mottolese
- Department of Pathology Regina Elena Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Lupe Sanchez Mete
- Gastroenterology and Digestive Endoscopic Unit, Regina Elena Cancer Institute Via Elio Chianesi 53, 00144 Rome, Italy
| | - Raffaello Mancini
- Department of Surgery, Regina Elena Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Vincenzo Casale
- Gastroenterology and Digestive Endoscopic Unit, Regina Elena Cancer Institute Via Elio Chianesi 53, 00144 Rome, Italy
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Daly MB. Genetic Screening and Counseling for High-Risk Populations. Oncology 2007. [DOI: 10.1007/0-387-31056-8_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chang DK, Goel A, Ricciardiello L, Lee DH, Chang CL, Carethers JM, Boland CR. Effect of H(2)O(2) on cell cycle and survival in DNA mismatch repair-deficient and -proficient cell lines. Cancer Lett 2003; 195:243-51. [PMID: 12767533 DOI: 10.1016/s0304-3835(03)00145-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patients who develop tumors with Lynch syndrome, which is caused by mutational inactivation of the DNA mismatch repair (MMR) system, have a relatively favorable prognosis compared to patients who develop sporadic tumors. Paradoxically, DNA MMR-deficient cells are resistant to many chemotherapeutic agents, and are capable of bypassing the G2/M checkpoint in vitro. Colon cancers that develop in the setting of Lynch syndrome show an abundant recruitment of immune cells into tumor tissues, which might be expected to increase oxyradical formation, and make the tumor cells more vulnerable to cell death. We examined the chemosensitivity and cell cycle response to oxidative stress in several MMR-deficient (HCT116, SW48, and DLD1) and -proficient (CaCo2, SW480, and HT29) colorectal cancer cell lines. H(2)O(2) induced a G2/M cell cycle arrest in both MMR deficient and proficient cell lines, however MMR-deficient cell lines were more sensitive to H(2)O(2) toxicity, and the response was more prolonged in MMR-deficient cells. Interestingly, human MutL-homologue (hMLH1-)defective HCT116 and hMLH1-restored HCT116+ch3 cell lines responded to H(2)O(2) with the same degree of G2/M arrest. The survival response of HCT116+ch3 was nearly identical to that of hMLH1-defective HCT116+ch2, although better than the response observed in HCT116 cells. In conclusion, greater cellular sensitivity and G2/M arrest in response to oxidative stress in MMR-deficient colorectal cancer cells could be one of the reasons for the more favorable prognosis seen in patients with Lynch syndrome. However, this sensitivity appears not to be a direct result of a deficient MMR function, but is more likely attributable to spectrum of target gene mutations that occurs in MMR-deficient tumors.
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MESH Headings
- Adaptor Proteins, Signal Transducing
- Aneuploidy
- Base Pair Mismatch
- Carrier Proteins
- Cell Cycle/drug effects
- Cell Survival/drug effects
- Colorectal Neoplasms/genetics
- Colorectal Neoplasms/pathology
- Colorectal Neoplasms, Hereditary Nonpolyposis/pathology
- DNA Damage
- DNA Repair
- DNA, Neoplasm/drug effects
- DNA, Neoplasm/genetics
- Dose-Response Relationship, Drug
- G2 Phase/drug effects
- Genes, Reporter
- Genes, p53
- Green Fluorescent Proteins
- Humans
- Hydrogen Peroxide/pharmacology
- Luminescent Proteins/biosynthesis
- Luminescent Proteins/genetics
- MutL Protein Homolog 1
- Neoplasm Proteins/deficiency
- Neoplasm Proteins/genetics
- Neoplasm Proteins/physiology
- Nuclear Proteins
- Oxidation-Reduction
- Oxidative Stress
- Protein Serine-Threonine Kinases
- Proto-Oncogene Proteins/deficiency
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins c-bcl-2
- Receptor, IGF Type 2/deficiency
- Receptor, IGF Type 2/genetics
- Receptor, Transforming Growth Factor-beta Type II
- Receptors, Transforming Growth Factor beta/deficiency
- Receptors, Transforming Growth Factor beta/genetics
- Tumor Cells, Cultured/drug effects
- Tumor Stem Cell Assay
- bcl-2-Associated X Protein
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Affiliation(s)
- Dong Kyung Chang
- Department of Medicine and Comprehensive Cancer Center, University of California San Diego, 4028 Basic Science Building, 9500 Gilman Drive, La Jolla 92093-0688, USA
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Bertario L, Russo A, Sala P, Eboli M, Radice P, Presciuttini S, Andreola S, Rodriguez-Bigas MA, Pizzetti P, Spinelli P. Survival of patients with hereditary colorectal cancer: comparison of HNPCC and colorectal cancer in FAP patients with sporadic colorectal cancer. Int J Cancer 1999; 80:183-7. [PMID: 9935197 DOI: 10.1002/(sici)1097-0215(19990118)80:2<183::aid-ijc4>3.0.co;2-w] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Conflicting data exist on the prognosis of hereditary colorectal cancer. HNPCC patients, in particular, are often reported to have a better survival. We examined 2,340 colorectal-cancer patients treated in our Institution: 144 HNPCC patients (Amsterdam Criteria), 161 FAP patients and 2,035 patients with sporadic cancer. Data on hereditary-cancer patients treated between 1980 and 1995 was collected in a registry. The 2,035 sporadic colorectal-cancer patients (controls) included all new cases treated in the Department of Gastrointestinal-Tract Surgery during the same period. Observed survival was estimated using the Kaplan-Meier method. Cumulative survival probability was estimated at 5 years within each group and stratified by various clinical and pathological variables. The age distribution at diagnosis of sporadic patients was significantly higher than that of FAP and HNPCC patients (median 60 years vs. 43 and 49 years; p < 0.0001). In the HNPCC group, 40% had a right cancer location, vs. 14% in the FAP group and 13% in the sporadic-cancer group. In the sporadic group, 51% were early-stage cancers (Dukes A or B) vs. 48.4% and 52.1% in the FAP and HNPCC groups respectively. In the HNPCC, FAP and sporadic-cancer groups, the 5-year cumulative survival rate was 56.9%, 54.4% and 50.6% respectively. Survival analysis by the Cox proportional-hazards method revealed no substantial survival advantage for HNPCC and FAP patients compared with the sporadic group, after adjustment for age, gender, stage and tumor location. The hazard ratio for HNPCC was 1.01 (95% CI 0.72-1.39) and 1.27 (95% CI 0.95-1.7) for FAP patients compared with the sporadic-colorectal-cancer group.
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Affiliation(s)
- L Bertario
- Surgical Department, National Cancer Institute, Milan, Italy.
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