Molecular Subtypes and Personalized Therapy in Metastatic Colorectal Cancer
Abstract
Development of colorectal cancer occurs via a number of key pathways, with the clinicopathological features of specific subgroups being driven by underlying molecular changes. Mutations in key genes within the network of signalling pathways have been identified; however, therapeutic strategies to target these aberrations remain limited. As understanding of the biology of colorectal cancer has improved, this has led to a move toward broader genomic testing, collaborative research and innovative, adaptive clinical trial design. Recent developments in therapy include the routine adoption of wider mu...
Source: Current Colorectal Cancer Reports - April 17, 2016 Category: Cancer & Oncology Source Type: research
Extramural Venous Invasion (EMVI) and Tumour Regression Grading (TRG) as Potential Prognostic Factors for Risk Stratification and Treatment Decision in Rectal Cancer
Abstract
Routine implementation of risk-adapted therapeutic strategies is one of the highest priorities in the management of locally advanced rectal cancer (LARC). Refinement of risk stratification and better treatment selection have the potential to minimise undesirable treatment-related side effects and improve oncological outcome of patients with this disease. Pathological extramural venous invasion (pEMVI) and tumour regression grade (pTRG) within the resection specimens have been historically regarded as prognostic factors for LARC. More recently, studies have increasingly reported suggesting that th...
Source: Current Colorectal Cancer Reports - April 15, 2016 Category: Cancer & Oncology Source Type: research
Circulating Tumor Cells Versus Circulating Tumor DNA in Colorectal Cancer: Pros and Cons
Abstract
Circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) are emerging noninvasive multifunctional biomarkers in liquid biopsy allowing for early diagnosis, accurate prognosis, therapeutic target selection, spatiotemporal monitoring of metastasis, as well as monitoring response and resistance to treatment. CTCs and ctDNA are released from different tumor types at different stages and contribute complementary information for clinical decision. Although big strides have been taken in technology development for detection, isolation and characterization of CTCs and sensitive and specific dete...
Source: Current Colorectal Cancer Reports - April 6, 2016 Category: Cancer & Oncology Source Type: research
Minimally Invasive Liver Surgery for Hepatic Colorectal Metastases
Abstract
Minimally invasive surgery has been cautiously introduced in surgical oncology over the last two decades due to a concern of compromised oncological outcomes. Recently, it has been adopted in liver surgery for colorectal metastases. Colorectal cancer is a major cause of cancer-related death in the USA. In addition, liver metastasis is the most common site of distant disease and its resection improves survival. While open resection was the standard of care, laparoscopic liver surgery has become the standard of care for minor liver resections. Laparoscopic liver surgery provides equivalent oncologi...
Source: Current Colorectal Cancer Reports - March 8, 2016 Category: Cancer & Oncology Source Type: research
Understanding Epigenetics: an Alternative Mechanism of Colorectal Carcinogenesis
Abstract
Colorectal cancer (CRC) is a multifactorial disease that arises due to the accumulation of genetics as well as epigenetic alterations in a number of onco-, tumor suppressor-, mismatch repair-, and cell cycle-genes in colon mucosa cells. Epigenetic silencing of the key tumor suppressor genes has been identified as one of the new and distinct mechanisms driving the tumor initiation and progression. In this review we have explored the mechanism of hypermethylation of the CpG islands and its consequent role in colorectal carcinogenesis. We have also discussed the epigenetic view of molecular and path...
Source: Current Colorectal Cancer Reports - March 3, 2016 Category: Cancer & Oncology Source Type: research
Is Curcumin a Chemopreventive Agent for Colorectal Cancer?
Abstract
Curcumin is the main component of the Indian spice curcuma (Indian saffron), originating from its rhizome. Curcumin is consumed as food, anywhere in the world and almost daily in India. It has also been used as a drug in Ayurvedic medicine for centuries. This polyphenol substance has pleiotropic effects, interfering with many signaling molecules: pro-inflammatory molecules, transcription factors, enzymes, protein kinases, transport proteins, proteins involved in cell survival, adhesion molecules, growth factors, receptors, proteins regulating cell cycle, chemokines, nucleic acids…. Oral bioavai...
Source: Current Colorectal Cancer Reports - March 3, 2016 Category: Cancer & Oncology Source Type: research
Are Gene Signatures Ready for Use in the Selection of Patients for Adjuvant Treatment?
Abstract
Fluoropyrimidine-based chemotherapy improves survival in stage III colon cancer patients in the adjuvant setting, whereas its clinical benefit in stage II is limited. Adjuvant therapy could be considered in patients with high-risk stage II disease, who are more likely to benefit from chemotherapy. Clinicopathological factors have been routinely used for risk stratification in stage II, as well as microsatellite instability (MSI) analysis, which has been recently incorporated in clinical guidelines as a prognostic marker. Other molecular markers, such as KRAS and BRAF mutations, suggested improvin...
Source: Current Colorectal Cancer Reports - March 3, 2016 Category: Cancer & Oncology Source Type: research
Liver-Directed Therapy in Metastatic Colorectal Cancer
Abstract
Approximately 50–70 % of patients with colorectal cancer ultimately develop colorectal liver metastases. Determining which patients may benefit from aggressive treatment has historically been achieved through clinical predictive models. However, factors such as radiographic response to neoadjuvant therapy should also be taken into consideration. Recently, molecular markers have emerged as an adjunct to clinical-pathologic factors and provide a surrogate for tumor biology. With improved understanding of tumor biology, the likelihood of recurrence can be better predicted. However, when feasible,...
Source: Current Colorectal Cancer Reports - March 1, 2016 Category: Cancer & Oncology Source Type: research
What is the Best Colonoscopy Surveillance for Lynch Syndrome Patients?
Abstract
Lynch syndrome is the most common form of hereditary colorectal cancer. Screening programs have reduced colon cancer mortality. Despite intensive surveillance, the cumulative risk of developing colorectal cancer is substantial. Identification of modifiable factors has the potential to improve outcome of surveillance. Our article will review current guidelines for Lynch syndrome and how to perform colonoscopy. High-quality surveillance colonoscopy should be performed in an experimented center every 1–2 years, starting at the age of 20–25 years. Colonoscopy should include meticulous inspectio...
Source: Current Colorectal Cancer Reports - February 23, 2016 Category: Cancer & Oncology Source Type: research
Management of Early (T1 or T2) Rectal Cancer
Abstract
Early stage rectal cancers (T1/T2) are being found more commonly due to increasing compliance with population screening guidelines. Patient selection is the most important element in advising local excision versus standard transabdominal resection with total mesorectal excision (TME). Determining the best strategy for an individual patient relies on accurate histologic assessment (a surrogate of biologic behavior), accurate clinical staging (endorectal ultrasound or MRI), and accurate assessment of patient procedural risk. It is important to review the histology for high-risk features associated ...
Source: Current Colorectal Cancer Reports - February 20, 2016 Category: Cancer & Oncology Source Type: research
In Deciphering the Future of Adjuvant Treatment in Colon Cancer, the Journey Matters More than the Achievements
Abstract
The development of adjuvant treatment in colon cancer has followed the same paradigm as in other solid tumors, transposing the drug regimens found to perform the best in the advanced setting into the adjuvant setting. However, despite numerous studies, no progress has been recorded for patients with stage II and III colon cancer since the publication of the MOSAIC trial more than 10 years ago. We performed a comprehensive review of randomized phase III trials both already published and currently recruiting, and revisited the scientific rationale of adjuvant treatment in colon cancer and the phil...
Source: Current Colorectal Cancer Reports - February 15, 2016 Category: Cancer & Oncology Source Type: research
The Importance of Increased Serrated Polyp Detection Rate
Abstract
Based on the World Health Organization (WHO) criteria, serrated lesions were classified as sessile serrated adenoma/polyp (SSA/P), traditional serrated adenoma (TSA), and hyperplastic polyp (HP). Large serrated lesions are found to be associated with advanced colonic adenoma in the colon. Serrated lesions of the colorectum are believed to account for 15–20 % of all colorectal cancers via the “serrated neoplastic pathway” with SSA/P being the main precursor lesion. Serrated lesions are also thought to account for around 30 % of cancers that develop after a negative colonoscopy or the inter...
Source: Current Colorectal Cancer Reports - February 15, 2016 Category: Cancer & Oncology Source Type: research
Aspirin and Colorectal Cancer Prevention and Treatment: Is It for Everyone?
Abstract
There is now a considerable body of data supporting the hypothesis that aspirin could be effective in the prevention and treatment of colorectal cancer, and a number of phase III randomised controlled trials designed to evaluate the role of aspirin in the treatment of colorectal cancer are ongoing. Although generally well tolerated, aspirin can have adverse effects, including dyspepsia and, infrequently, bleeding. To ensure a favourable balance of benefits and risks from aspirin, a more personalised assessment of the advantages and disadvantages is required. Emerging data suggest that tumour PIK3...
Source: Current Colorectal Cancer Reports - February 11, 2016 Category: Cancer & Oncology Source Type: research
Optimizing Colorectal Cancer Care in Older Patients
In conclusion, in order to provide the best care in an older colorectal cancer patient, we need to individualize our approach, selecting the right patient for the right treatment. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - January 22, 2016 Category: Cancer & Oncology Source Type: research
How Can We Improve Adenoma Detection Rate?
Abstract
Adenoma detection rate (ADR) is a considerable component of colonoscopy quality assurance; it has a clear link to future morbidity and mortality from colorectal cancer. There are a number of potential factors, both modifiable and non-modifiable that can impact upon ADR. Modes of improving ADR include techniques and behaviours during colonoscopy, image enhancement techniques, technological advancements, advancements in endoscope designs, developments in accessories and continued medical education. However, whilst a number of technologies are emerging to improve ADR, at present, it seems that educa...
Source: Current Colorectal Cancer Reports - January 20, 2016 Category: Cancer & Oncology Source Type: research
