Minimally Invasive Surgery for Rectal Cancer: Current Trends
AbstractPurpose of the ReviewThe literature regarding minimally invasive surgical approaches to rectal adenocarcinoma is reviewed, and techniques introduced over recent decades are assessed for oncological and patient-centered outcomes.Recent FindingsTotal mesorectal excision (TME) is the gold standard for surgical treatment of rectal adenocarcinoma, and while laparoscopic TME is safe and feasible, with acceptable oncologic outcomes, its non-inferiority with regard to completeness of TME specimen when compared to open surgery could not be established in two recent randomized trials. Long-term follow-up for these trials is ...
Source: Current Colorectal Cancer Reports - March 22, 2017 Category: Cancer & Oncology Source Type: research

Short-Course Radiation Therapy Versus Long-Course Chemoradiation in the Neoadjuvant Treatment of Locally Advanced Rectal Cancer: New Insights from Randomized Trials
AbstractPurpose of ReviewExamine prospective evidence supporting preoperative short-course radiotherapy (SCRT) and long-course chemoradiotherapy (LCRT) for locally advanced rectal cancer and discuss recently published data that are helping to clarify the utility of SCRT.Recent FindingsSCRT with early surgery results in lower pCR rates, lower severe acute toxicities, no difference in late toxicities, and no apparent difference in local control, DFS, and OS when compared with LCRT. When surgery is delayed after SCRT, cancer outcomes appear equivalent, including pCR rates. The addition of full-dose systemic therapy with SCRT ...
Source: Current Colorectal Cancer Reports - March 11, 2017 Category: Cancer & Oncology Source Type: research

The Impact of Novel Radiation Treatment Techniques on Toxicity and Clinical Outcomes in Rectal Cancer
AbstractPurpose of ReviewThree-dimensional conformal radiation therapy (3DCRT) has been the standard technique in the treatment of rectal cancer. The use of new radiation treatment technologies such as intensity-modulated radiation therapy (IMRT), proton therapy (PT), stereotactic body radiation therapy (SBRT), and brachytherapy (BT) has been increasing over the past 10  years. This review will highlight the advantages and drawbacks of these techniques.Recent FindingsIMRT, PT, SBRT, and BT achieve a higher target coverage conformity and a higher organ at risk sparing and enable dose escalation compared to 3DCRT. Some ...
Source: Current Colorectal Cancer Reports - March 10, 2017 Category: Cancer & Oncology Source Type: research

Personalizing Locoregional Therapy for Patients with Metastatic Colorectal Cancer
AbstractPurpose of reviewThe management of metastatic colorectal liver disease has improved overall survival by multidisciplinary approach utilizing systemic treatment followed by local control of metastatic disease. There has been an evolution of local control therapy which has expanded the new armamentarium for treatment of resectable and unresectable liver disease. The review article will address the various types of locoregional therapy and various indications for its use.Recent findingsThe application of ablative therapies combined with resections has allowed single-stage resection for patients with bilobar disease wi...
Source: Current Colorectal Cancer Reports - March 7, 2017 Category: Cancer & Oncology Source Type: research

Optimal Sequencing of Neoadjuvant Therapies (NAT) in Rectal Cancer: Upfront Chemotherapy vs. Upfront Chemoradiation
AbstractNew strategies for the treatment of cancer in the rectum should be directed towards the improvement of micrometastatic disease and the reduction of long-term sequelae, without prejudice to good local control. To achieve this, in the last decade, new strategies have been postulated. Treatment with preoperative chemotherapy (CT) alone or induction CT followed by chemoradiation CRT/short course radiation (CRT/SCPRT) or CRT/SCPRT and consolidative CT is being planned. We currently have data from phase II studies with results of stimulating efficacy and/or compliance. New single-arm and randomized trial is underway and ...
Source: Current Colorectal Cancer Reports - March 7, 2017 Category: Cancer & Oncology Source Type: research

Innovative Therapeutic Strategies Targeting Colorectal Cancer Stem Cells
AbstractColorectal cancer is the fourth most common cause of cancer-related death. Although many advances in the treatment of this disease have been made, a large number of patients develop metastasis and resistance to current therapies. The current evidence indicates that cancer stem cells (CSCs) and epithelial-to-mesenchymal transition (EMT) have crucial roles in colorectal carcinogenesis and metastasis. It is also very important to understand the mechanisms that allow the survival of CSCs, such as metabolic reprogramming, which permits them to obtain specific properties or the activation of alternative signaling pathway...
Source: Current Colorectal Cancer Reports - March 7, 2017 Category: Cancer & Oncology Source Type: research

Pelvic Reirradiation for the Treatment of Locally Recurrent Rectal Cancer
This study aims to summarize the literature on pelvic reirradiation for the treatment of locally recurrent rectal cancer. Symptom palliation, rates of local progression after reirradiation with or without surgery, overall survival, and toxicity outcomes are discussed.Recent findingsThe majority of patients received total doses of 30 –40 Gy given in 1.2 or 1.5 Gy twice-daily fractions. Treatment evolved over time to include more conformal fields. The overall rates of local control generally range from 25 to 70% and surgical salvage after reirradiation was performed in 20–79% of patients. Some studies s...
Source: Current Colorectal Cancer Reports - March 7, 2017 Category: Cancer & Oncology Source Type: research

WNT Signaling and Colorectal Cancer
AbstractThe WNT signaling pathway is a critical mediator of tissue homeostasis and repair, and frequently co-opted during tumor development. Almost all colorectal cancers (CRC) demonstrate hyperactivation of the WNT pathway, which in many cases is believed to be the initiating and driving event. In this short review, we provide a focused overview of recent developments in our understanding of the WNT pathway in CRC, describe new research tools that are enabling a deeper understanding of WNT biology, and outline ongoing efforts to target this pathway therapeutically. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - February 28, 2017 Category: Cancer & Oncology Source Type: research

Personalizing Therapy for Locally Advanced Rectal Cancer
AbstractLocally advanced rectal cancer is usually treated with chemotherapy, radiation therapy, and total mesorectal excision. Although effective, this trimodality therapy is arduous and associated with treatment-related toxicity. It has become clear that some patients may not need to undergo all three modalities of treatment and can thus avoid some of the treatment-associated morbidity. Two such approaches include selective use of preoperative radiation and nonoperative management. Limiting radiation can reduce treatment related toxicity and eliminate radiation-induced toxicity, fibrosis, and bowel and urogenital dysfunct...
Source: Current Colorectal Cancer Reports - February 23, 2017 Category: Cancer & Oncology Source Type: research

Gut Microbiome and Colon Cancer: Role of Bacterial Metabolites and Their Molecular Targets in the Host
AbstractPurpose of ReviewThe relationship between colonic bacteria and the host is symbiotic, but how communication between the two partners occurs is just beginning to be understood at the molecular level. Here, we highlight specific products of bacterial metabolism that are present in the colonic lumen and their molecular targets in the host that facilitate this communication.Recent FindingsColonic epithelial cells and mucosal immune cells express several cell surface receptors and nuclear receptors that are activated by specific bacterial metabolites, which impact multiple signaling pathways and expression of many genes...
Source: Current Colorectal Cancer Reports - February 22, 2017 Category: Cancer & Oncology Source Type: research

Lymphadenectomy in Colorectal Cancer: Therapeutic Role and How Many Nodes Are Needed for Appropriate Staging?
AbstractSurgical resection with adequate lymphadenectomy is the treatment of choice for accurate diagnosis and proper treatment in colorectal cancer. Lymph node (LN) staging is an important prognostic factor in colorectal cancer and remains to be the most main criteria to select patients for adjuvant treatment. In colorectal cancer, a focus of treatment has been to collect as many LNs as possible to improve staging and increase survival. However, the scientific evidence for a minimum LN harvest remains controversial and the use of international cut-off values should be considered again. In practice, a thorough pursuit of a...
Source: Current Colorectal Cancer Reports - February 21, 2017 Category: Cancer & Oncology Source Type: research

Multidisciplinary Management of Rectal Cancer with Synchronous Resectable Liver Metastases
AbstractLiver metastases are the most common manifestation of metastatic disease in colorectal cancer, and synchronous metastases occur in around 50% of patients. In rectal cancer, this presentation is uniquely challenging because of issues related to competing treatments and sequencing of therapy. Though there is published data on the management of rectal tumor and liver metastasis from colorectal cancer (CRC) individually, data on the management of synchronous disease is sparse. This is a heterogeneous group of patients and should be managed on a case by case basis and with multidisciplinary evaluation. To this end, we p...
Source: Current Colorectal Cancer Reports - February 9, 2017 Category: Cancer & Oncology Source Type: research

Robotic Surgery for Colon and Rectal Cancer: Current Status, Recent Advances, and Future Directions
AbstractPurpose of ReviewThe minimally invasive approach to colorectal cancers has been validated as providing oncologic outcomes comparable to open surgery. Current laparoscopic instrumentation, however, has its limitations especially in the performance of rectal cancer resections. Robotic surgery for colorectal cancers is an important addition to the technologies available to the surgeon. We review the literature and draw on our own experience to examine the advantages and disadvantages of robot-assisted surgery for the treatment of colorectal cancers and the evidence for the superior outcomes frequently cited and to ide...
Source: Current Colorectal Cancer Reports - February 4, 2017 Category: Cancer & Oncology Source Type: research

Local Excision Versus Total Mesorectal Excision for Clinical Stage I (cT1 –cT2) Rectal Cancer
This article aimed to review the current evidence of TME and LE in early rectal cancer, to critically review the role and consequence of chemoradiation in LE, and to update ongoing trials on this subject. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - February 2, 2017 Category: Cancer & Oncology Source Type: research

Microsatellite Instability Pathway and EMAST in Colorectal Cancer
AbstractMicrosatellite instability (MSI) refers to the biochemical detection of frameshifted microsatellite sequences from genomic DNA. Genesis of MSI is due to defective DNA mismatch repair (MMR) that fails to correct post-DNA replicative slippage mistakes at microsatellites. Most of the estimated 100,000 genomic microsatellites are non-coding; however, ∼150–300 microsatellites are coding such that, when frameshifted during the pathogenesis of an MSI tumor, they can generate immunogenic neopeptide antigens that limit the growth of tumor and prolong patient survival. In addition to the immune reaction and longer ...
Source: Current Colorectal Cancer Reports - February 2, 2017 Category: Cancer & Oncology Source Type: research

Molecular Stratification of Colorectal Cancer: Moving from the Laboratory to Clinical Practice
AbstractPurpose of ReviewColorectal cancer is increasingly recognised as a heterogeneous disease entity, and subtyping is carried out based upon clinical and pathological characteristics, individual somatic gene mutations and, more recently, gene expression profiling. This paper will discuss advances in the molecular stratification of colorectal cancer and the potential challenges and applications for real-world clinical management.Recent FindingsBeyond the established biomarkers ofRAS andBRAF mutational status, a number of rarer genetic mutations have been identified, and trials are ongoing to identify and target these ef...
Source: Current Colorectal Cancer Reports - January 26, 2017 Category: Cancer & Oncology Source Type: research

Current Concepts on the Distal Margin of Resection of Rectal Cancer Tumors after Neoadjuvant Chemoradiation
ConclusionA 1.0-cm margin is the most accepted distal margin of resection for adenocarcinoma of the rectum. Subcentimeter margins as small as 2.0 –5.0 mm may be safe, as recent reports show similar rates of recurrence and survival when compared to larger margins. At this time, we require more evidence to conclude that a distal margin of resection smaller than 1.0 cm is appropriate in the surgical management of rectal cancer. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - January 23, 2017 Category: Cancer & Oncology Source Type: research

Current Status of the Watch-and-Wait Policy for Patients with Complete Clinical Response Following Neoadjuvant Chemoradiation in Rectal Cancer
AbstractPreoperative chemoradiation is the standard of care for patients with locally advanced rectal cancer to reduce the risk of local recurrence. Chemoradiation can achieve a pathological complete response (pCR) in 10 –20% of patients when surgery is performed at 4–12 weeks following completion, and a clinical complete response (cCR) in 15–30% if surgery is withheld. The probability of pCR and cCR is partly dependent on initial clinical T- and N-stage. Observational/retrospective studies suggest a selectiv e watch-and-wait policy with rigorous surveillance, avoiding radical surgery, is a safe opti...
Source: Current Colorectal Cancer Reports - January 21, 2017 Category: Cancer & Oncology Source Type: research

Current Status of Laparoscopic Surgery in Colorectal Cancer
We present a review of current status of laparoscopic surgery in the treatment of colorectal cancer. We discuss recent controversies and describe the results of latest minimally invasive techniques and technological innovations.Recent FindingsDespite recent studies questioning the quality of laparoscopic total mesorectal excision, the long-term data currently available continue to support the use of laparoscopy for the treatment of rectal cancer. Laparoscopy can also achieve a complete oncologic resection of T4 colon cancer similar to open surgery in selected patients. However, the evidence for laparoscopic complete mesoco...
Source: Current Colorectal Cancer Reports - January 18, 2017 Category: Cancer & Oncology Source Type: research

Molecular Classification of Colon Cancer: Perspectives for Personalized Adjuvant Therapy
AbstractAlthough surgery for early-stage colorectal cancer (CRC) is often curative, many patients require adjuvant chemotherapy to treat micrometastatic disease and to reduce the risk of recurrence. Targeted therapies have improved outcomes for patients with metastatic disease but, in the adjuvant setting, options are limited to a fluoropyrimidine alone or in combination with oxaliplatin. There is an unmet need for new predictive biomarkers to personalise treatment in the adjuvant setting. With goals to address this gap and to better characterise disease heterogeneity, several groups including our own have identified three...
Source: Current Colorectal Cancer Reports - October 17, 2016 Category: Cancer & Oncology Source Type: research

Ongoing Adjuvant/Neoadjuvant Trials in Resectable Metastatic Colorectal Cancer
AbstractThe treatment of patients with colorectal cancer with colorectal liver metastases remains an exciting challenge for the multidisciplinary team. The role and choice of induction chemotherapy, the timing of surgery in resectable disease and the prioritisation of resection of the primary or the metastases are all still controversial. A true multidisciplinary approach and individualisation of treatment strategies are recommended. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - September 29, 2016 Category: Cancer & Oncology Source Type: research

The Role of Adjuvant Treatment in Resected T3N0 Rectal Cancer
AbstractSince the adoption of total meso-rectal excision as the standard surgical approach for management of locally advanced rectal cancer, there has been a significant reduction in local recurrence. Neoadjuvant combined modality treatment with 5-fluorouracil-based chemotherapy and radiation has further improved local disease control and overall survival. Given the excellent survival obtained with this combined approach in T3N0 rectal cancer, there are concerns about the need for further exposure to chemotherapy with unproven benefit. We review the evidence for adjuvant chemotherapy in this setting and set out clinico-pat...
Source: Current Colorectal Cancer Reports - September 29, 2016 Category: Cancer & Oncology Source Type: research

Novel Radiation Approaches for the Treatment of Rectal Cancer: Where Are We Now?
This article will explore recent innovations and novel approaches involving radiation therapy to address these issues, including the use of intensity- modulated radiation therapy, avoidance of radical resection with the use of chemoradiation alone, total neoadjuvant chemotherapy with the selective use of chemoradiation, and the use of local excision approaches following neoadjuvant treatment. Although many of these novel strategies appear promisin g, data from prospective randomized trials will be necessary before implementation into standard practice. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - September 24, 2016 Category: Cancer & Oncology Source Type: research

What Is the Best Approach to Avoid Colorectal Cancer Risk in Inflammatory Bowel Disease?
AbstractInflammatory bowel diseases (IBD) comprise ulcerative colitis and Crohn ’s disease that primarily affect the colon and small intestine. IBD patients have a higher incidence of colorectal cancer (CRC) than the general population due to chronic colonic mucosal inflammation that predisposes to the development of dysplasia, the earliest form of neoplastic change in IBD an d other chronic inflammatory disorders (e.g., Barrett’s esophagus). Therefore, the two demonstrated means of reducing the risk of cancer in IBD are to control inflammation and to survey for dysplasia and remove the dysplastic area, if poss...
Source: Current Colorectal Cancer Reports - September 24, 2016 Category: Cancer & Oncology Source Type: research

Molecular Biomarkers of Colorectal Cancer and Cancer Disparities: Current Status and Perspective
AbstractThis review provides updates on the efforts for the development of prognostic and predictive markers in colorectal cancer based on the race/ethnicity of patients. Since the clinical consequences of genetic and molecular alterations differ with patient race and ethnicity, the usefulness of these molecular alterations as biomarkers needs to be evaluated in different racial/ethnic groups. To accomplish personalized patient care, a combined analysis of multiple molecular alterations in DNA, RNA, microRNAs (miRNAs), metabolites, and proteins in a single test is required to assess disease status in a precise way. Therefo...
Source: Current Colorectal Cancer Reports - September 20, 2016 Category: Cancer & Oncology Source Type: research

Adjuvant Chemotherapy for Colon Cancer: Guidelines and Clinical Trials in Japan
AbstractIn Japan, adjuvant chemotherapy for colon cancer was mainly developed using oral fluoropyrimidines. However, all Japanese studies to date have failed to demonstrate a statistically significant survival benefit of adjuvant chemotherapy with a combination of uracil and tegafur (UFT) monotherapy over surgery alone in patients with stage II or III colon cancer. The non-inferiority trials comparing different oral fluoropyrimidine monotherapies showed any fluoropyrimidine except S-1 was comparable in patients with stage III colon cancer. Japanese guideline plays an important role in the distribution of the optimal adjuva...
Source: Current Colorectal Cancer Reports - September 14, 2016 Category: Cancer & Oncology Source Type: research

Modern Technical Approaches in Hepatic Surgery for Colorectal Metastases
AbstractThe liver is the most common site of metastases from colorectal cancer and can present as synchronous or metachronous lesions. Successful, margin-negative resection of all liver metastases is associated with significant long-term survival, but was traditionally possible in only a minority of patients. Due to advances in multimodality systemic therapy, improved understanding of tumor biology, and new advances in technical and procedural strategies, a greater number of patients are eligible for resection and potential cure. The purpose of this report is to review the technical advances in liver resection for patients...
Source: Current Colorectal Cancer Reports - August 30, 2016 Category: Cancer & Oncology Source Type: research

Use of Yttrium-90 Radioembolization for Management of Colorectal Liver Metastases
AbstractApproximately 20  % of patients diagnosed with colorectal cancer present with metastatic disease at the time of diagnosis, predominantly to the liver. Surgical resection is the only real chance at a cure for a majority of these patients. A subset of patients present with unresectable disease with systemic and local therapy as the only available options. The advent of irinotecan- and oxaliplatin-based systemic therapy has increased median survival from about 5 months to greater than 20 months in metastatic disease. Addition of local therapy has the potential to further improve outcomes. With many aven...
Source: Current Colorectal Cancer Reports - August 20, 2016 Category: Cancer & Oncology Source Type: research

Colorectal Cancer Screening: a North American Point of View
AbstractWorldwide, colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and second in females, with an estimated 1.4 million cases and 693,900 deaths in 2012. The current screening modalities utilized in the USA are examined in this review, along with current colonoscopy quality indicators. The contribution of CRC screening to the rising cost of health care in the USA has warranted recent public interest and has overall been demonstrated to be cost-effective. In addition, numerous barriers to screening are analyzed along with models for risk stratifying CRC risk at both an individual and population ...
Source: Current Colorectal Cancer Reports - August 17, 2016 Category: Cancer & Oncology Source Type: research

Organoids as a Model for Colorectal Cancer
AbstractModelling human diseases in in vitro systems is undisputedly an invaluable research tool, yet there are many limitations. Some of those limitations have been overcome through the introduction of organoid culture systems, which have revolutionised colorectal cancer research and enabled an array of new experimental techniques. This 3D system models the physiology, shape, dynamics and cell make-up of the intestinal epithelium producing a relevant and highly adaptable model system. The increased functional relevance of this model compared to the use of 2D cancer cell lines makes it an invaluable tool for both basic and...
Source: Current Colorectal Cancer Reports - August 6, 2016 Category: Cancer & Oncology Source Type: research

Adjuvant Chemotherapy for Rectal Cancer After Neoadjuvant Treatment: FOLFOX, 5-FU, or Observation
AbstractA multimodality approach incorporating concurrent chemotherapy with radiotherapy prior to surgery has become the standardized approach in the management of localized rectal cancer. However, it is unknown whether any further therapy after surgery may be beneficial in improving patient outcomes. Previous completed randomized clinical trials have not added any clarity in this regard, whether adjuvant chemotherapy or intensified chemotherapy regimens improve patient outcomes in those who have previously received neoadjuvant therapy. Despite the lack of evidence, based off the survival data in stage III colon cancer, ad...
Source: Current Colorectal Cancer Reports - August 4, 2016 Category: Cancer & Oncology Source Type: research

Advancements in Modeling Colorectal Cancer in Rodents
AbstractColorectal cancer (CRC) has become a large burden on the health care system with 700,000 people dying from this disease annually in the world. Rodent cancer models, especially the mouse models, play critical roles in the understanding of CRC etiology and the development of CRC therapies. This review is focused on reporting the significant progress that has been made in CRC studies using transplant models and forward genetics mouse models. Rat CRC models are also described as they were usually skipped in other related reviews. We also try to discuss what needs to be improved in rodent model studies to better serve a...
Source: Current Colorectal Cancer Reports - August 4, 2016 Category: Cancer & Oncology Source Type: research

Ramucirumab: a Novel Anti-Angiogenic Agent in the Treatment of Metastatic Colorectal Cancer
AbstractAngiogenesis is a multistep process that plays a key role in cancer growth and metastases. It is mediated through multiple vascular endothelial growth factor receptors (VEGFRs) and their ligands. The expression of VEGFR-2 is upregulated in tumor endothelial cells, and it is considered to be the primary receptor driving malignant angiogenesis. Ramucirumab (IMC-1121B, LY3009806) is a fully human monoclonal antibody that directly binds to VEGFR-2 with high affinity and specificity. It is also the most recent addition to our armamentarium of anti-angiogenic drugs approved for the treatment of metastatic colorectal canc...
Source: Current Colorectal Cancer Reports - August 2, 2016 Category: Cancer & Oncology Source Type: research

Findings from the Adjuvant Colon Cancer End Points (ACCENT) Collaborative Group: the Power of Pooled Individual Patient Data from Multiple Clinical Trials
Abstract Randomized clinical trials (RCTs) are relied upon for determining the standard of care and changes to the standard of care in oncology. Through data sharing, the pooled individual patient data (IPD) from these trials can provide high-quality sources and enriched power for analyses beyond the original goals of each trial. To address important scientific questions in early-stage colon cancer, the Adjuvant Colon Cancer End Points (ACCENT) Collaborative Group has continuously integrated IPD from large adjuvant colon cancer RCTs conducted worldwide. Through June 2016, IPD from over 40,000 patients from 27 major trials...
Source: Current Colorectal Cancer Reports - July 30, 2016 Category: Cancer & Oncology Source Type: research

Treatment of High Rectal Cancers: Do We Need Radiation?
Abstract Before total mesorectal excision (TME) and radiation therapy/chemoradiation therapy (RT/CRT) were widely adopted in the treatment of rectal cancer, surgery alone was the standard. Therapies have since evolved to neoadjuvant RT or CRT followed by TME as the established paradigm for locally advanced disease. More recently, issues of toxicity and systemic metastasis have risen to the forefront, prompting the exploration of individualized strategies in an attempt to maximize potential cure and local control yet minimize late toxicities. In this article, we will focus on the treatment of high rectal cancers, exploring...
Source: Current Colorectal Cancer Reports - July 30, 2016 Category: Cancer & Oncology Source Type: research

Is There a Best Radiosensitizing Agent in the Treatment of Locally Advanced Rectal Cancer?
Abstract Over the past several decades, the management of localized rectal cancer has evolved from surgery alone as the definitive treatment to incorporating both radiation and chemotherapy to improve rates of local control and disease-free survival. Several chemoradiation regimens have been tested with different mechanisms of action, efficacy, and toxicity. There is little debate that concurrent radiation and a fluoropyrimidine (5-fluorouracil (5-FU) or capecitabine) is the current standard of care prior to total mesorectal excision (TME). Attempts to add additional chemotherapy, such as oxaliplatin or irinotecan...
Source: Current Colorectal Cancer Reports - June 15, 2016 Category: Cancer & Oncology Source Type: research

Use of Bevacizumab in the Management of Potentially Resectable Colorectal Liver Metastases: Safety, Pathologic Assessment and Benefit
Abstract Liver metastases are a frequent and commonly lethal complication of colorectal cancer. Surgical resection of limited liver disease offers currently the best chance of long-term survival, but surgery is not feasible for a rather significant proportion of patients with hepatic metastases. Despite the overall improvement in the medical management of patients with metastatic colorectal cancer, whose median survival has been substantially prolonged with the availability of novel drugs, long-term outcomes remain rather poor if a combined onco-surgical strategy cannot be implemented. Nonetheless, newer chemother...
Source: Current Colorectal Cancer Reports - June 4, 2016 Category: Cancer & Oncology Source Type: research

Surgical Management of the Colorectal Cancer Patient with Simultaneous Liver and Lung Metastases
The objective of this review is not only to review long-term outcomes after resection of simultaneous colorectal liver and lung metastases but also apply recent data regarding the (1) evolution of indeterminate pulmonary nodules discovered during staging evaluation of colorectal liver metastases, (2) impact of genetic mutations in colorectal cancer on disease outcomes, and (3) influence of lung metastases on overall survival outcomes to the management of patients with simultaneous colorectal liver and lung metastases. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - May 28, 2016 Category: Cancer & Oncology Source Type: research

Managing the Primary Tumor with Unresectable Synchronous Colorectal Metastases
Abstract Colorectal cancer is the third most commonly diagnosed cancer in men and the second most common in women. Approximately 20 % of patients with colorectal cancer are found to have metastatic disease (stage IV) at the time of diagnosis. A multidisciplinary approach provides the best chance for a potentially curative option in selected patients with metastases, but in most patients, the metastases are unresectable. The treatment strategy for this entity is not fully established, especially regarding whether and when the primary tumor should be resected. In this manuscript, we review current evidence rega...
Source: Current Colorectal Cancer Reports - May 16, 2016 Category: Cancer & Oncology Source Type: research

The Economics of Personalized Therapy in Metastatic Colorectal Cancer
Abstract Though the prognosis for patients with advanced colorectal cancer has improved significantly over the past two decades due to the development of new chemotherapeutics and biologic agents, this progress has come at an increased cost to patients and to the healthcare system. The cost of cancer care in the USA is rising at an alarming rate and far in excess of spending in other developed countries. The identification of predictive biomarkers that can help clinicians target existing and future therapies to patients who are most likely to benefit (and away from patients who would not benefit) has the potential...
Source: Current Colorectal Cancer Reports - May 14, 2016 Category: Cancer & Oncology Source Type: research

Imaging Advances in Colorectal Cancer
Abstract The optimal management of rectal cancer is achieved through a shared multidisciplinary decision making process with accurate staging by imaging being critical for treatment planning. Good quality, high-resolution MRI has become the imaging gold standard as it allows consistent staging and stratification of patients into distinct prognostic groups according to MR-findings. Imaging features other than T and N have been proven to influence patient outcomes, and increasingly these features are taken into consideration when determining treatment options: distance of tumour to the potential circumferential marg...
Source: Current Colorectal Cancer Reports - April 27, 2016 Category: Cancer & Oncology Source Type: research

Surgical Margin in Hepatic Resections for Colorectal Metastasis: Should We Care?
Abstract Many studies seek to define the appropriate margin width necessary to confer the best survival advantage following hepatic resection for colorectal metastatic disease. The ability to achieve at least a 1-cm tumor-free margin has historically represented one of the strongest prognostic factors determining overall outcomes and has been a necessary condition for resectability. With the advent of modern chemotherapy, the importance of surgical margin width is increasingly questioned and our understanding of its impact is evolving concomitantly to the improvement and the widespread use of more effective system...
Source: Current Colorectal Cancer Reports - April 19, 2016 Category: Cancer & Oncology Source Type: research

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 mutational ...
Source: Current Colorectal Cancer Reports - April 18, 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 these param...
Source: Current Colorectal Cancer Reports - April 16, 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 detection...
Source: Current Colorectal Cancer Reports - April 7, 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 oncological outco...
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 pathological ...
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 bioavailabi...
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 improving accurac...
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