The management of the colorectal cancer: Perspectives
DOI:
https://doi.org/10.26415/2572-004X-vol4iss2p527-534Keywords:
colorectal cancer; molecular profile, polyps.Abstract
Background: The progress of scientific research gives new tracks to be exploited for the management of the colorectal cancers whose the molecular profile study became fundamental. Aim: the aim of this study was to compare the management of the colorectal cancer in our patients to the current international recommendations.
Subjects and methods: In a retrospective study, we analysed 256 files between January, 2015 and September 2019. All the adenocarcinoma of colon and rectum were included.
Our patients were divided into two groups: 161 patients with colorectal cancer (63%) and 95 patients with rectum cancer (37%). We studied if the management of the disease was actually compliant to the international recommendations.
Results: Our study showed that the colorectal cancer occured most frequently in young population, with 45,5% in patients aged more than 60 years, 44% between 40 -60 years and 10 were under 40 years. The tumor was in T3 or more stage in 40,3% for colon cancer and 68,4% for rectum cancer. Elsewhere, none of the patients benefited from a molecular profile study of his tumor.
Discussion:The colorectal cancer is diagnosed in relatively young population with 54,5% of patients aged less than 60 years among whom 10% are less than 40, which explains the diagnostic delay. This delay is also due to the lack of a screening in general population and high risk subjects. Moreover, the absence of a molecular examination has a negative impact on the treatment and on the screening in the apparented, especially in case of tumor with micro satellite instability.
Conclusion: In order to improve the prognosis of the colorectal cancers in our patients, a screening adapted to the groups at risk has to be implemented and a molecular profil examination achived so that evolution and therapeutics perspectives could be set.
Downloads
References
Corrêa., R.d.S., et al., Rectal cancer survival in a Brazilian Cancer Reference Unit. JCOL, 2016. 36(4): p. 203-207. https://doi.org/10.1016/j.jcol.2016.04.015
Wright, M., J.S. Beaty, and C.A. Ternent, Molecular Markers for Colorectal Cancer. Surg Clin North Am, 2017. 97(3): p. 683-701. https://doi.org/10.1016/j.suc.2017.01.014 PMid:28501255
Siegel, R.L., et al., Colorectal cancer statistics, 2017. CA Cancer J Clin, 2017. 67(3): p. 177-193. https://doi.org/10.3322/caac.21395 PMid:28248415
[Consensus conference: Prevention Screening and Management of the Colonic Cancers. Paris, France, January 29-30, 1998. Proceedings]. Gastroenterol Clin Biol, 1998. 22(3 Suppl): p. S1-295.
Bibbins-Domingo, K., et al., Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA, 2016. 315(23): p. 2564-2575. https://doi.org/10.1001/jama.2016.5989 PMid:27304597
Moore, J.S. and T.H. Aulet, Colorectal Cancer Screening. Surg Clin North Am, 2017. 97(3): p. 487-502. https://doi.org/10.1016/j.suc.2017.01.001 PMid:28501242
Winawer, S., et al., Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology, 2003. 124(2): p. 544-60. https://doi.org/10.1053/gast.2003.50044 PMid:12557158
Winawer, S.J., et al., Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med, 1993. 329(27): p. 1977-81. https://doi.org/10.1056/NEJM199312303292701 PMid:8247072
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): colorectal cancer screening., 2018.
National Comprehensive Cancer Network. Rectal Cancer. Version 3.2018., 2018.
Kahi, C.J., et al., Colonoscopy Surveillance after Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol, 2016. 111(3): p. 337-46; quiz 347. https://doi.org/10.1038/ajg.2016.22 PMid:26871541
Devon, K.M., et al., Cancer of the anus complicating perianal Crohn's disease. Dis Colon Rectum, 2009. 52(2): p. 211-6. https://doi.org/10.1007/DCR.0b013e318197d0ad PMid:19279414
Higashi, D., et al., Cancer of the small intestine in patients with Crohn's disease. Anticancer Res, 2013. 33(7): p. 2977-80.
Rutter, M.D., et al., Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis. Gastroenterology, 2006. 130(4): p. 1030-8. https://doi.org/10.1053/j.gastro.2005.12.035 PMid:16618396
National Comprehensive Cancer Network.. NCCN Guidelines For Genetic / familial High-Risk Assessement: Colorectal., 2018.
Winawer, S.J., et al., Risk of colorectal cancer in the families of patients with adenomatous polyps. National Polyp Study Workgroup. N Engl J Med, 1996. 334(2): p. 82-7. https://doi.org/10.1056/NEJM199601113340204 PMid:8531963
Takayama, T., et al., Aberrant crypt foci of the colon as precursors of adenoma and cancer. N Engl J Med, 1998. 339(18): p. 1277-84. https://doi.org/10.1056/NEJM199810293391803 PMid:9791143
Eide, T.J., Risk of colorectal cancer in adenoma-bearing individuals within a defined population. Int J Cancer, 1986. 38(2): p. 173-6. https://doi.org/10.1002/ijc.2910380205 PMid:3733258
Morson, B., President's address. The polyp-cancer sequence in the large bowel. Proc R Soc Med, 1974. 67(6 Pt 1): p. 451-7. https://doi.org/10.1177/00359157740676P115
Bateman, A.C., Pathology of serrated colorectal lesions. J Clin Pathol, 2014. 67(10): p. 865-74. https://doi.org/10.1136/jclinpath-2014-202175 PMid:24561317
Leggett, B. and V. Whitehall, Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology, 2010. 138(6): p. 2088-100. https://doi.org/10.1053/j.gastro.2009.12.066 PMid:20420948
Saito, S., H. Tajiri, and M. Ikegami, Serrated polyps of the colon and rectum: Endoscopic features including image enhanced endoscopy. World J Gastrointest Endosc, 2015. 7(9): p. 860-71. https://doi.org/10.4253/wjge.v7.i9.860 PMid:26240687 PMCid:PMC4515420
Imai, K. and H. Yamamoto, Carcinogenesis and microsatellite instability: the interrelationship between genetics and epigenetics. Carcinogenesis, 2008. 29(4): p. 673-80. https://doi.org/10.1093/carcin/bgm228 PMid:17942460
Longacre, T.A. and C.M. Fenoglio-Preiser, Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. Am J Surg Pathol, 1990. 14(6): p. 524-37. https://doi.org/10.1097/00000478-199006000-00003 PMid:2186644
Torlakovic, E. and D.C. Snover, Serrated adenomatous polyposis in humans. Gastroenterology, 1996. 110(3): p. 748-55. https://doi.org/10.1053/gast.1996.v110.pm8608884 PMid:8608884
Bettington, M., et al., The serrated pathway to colorectal carcinoma: current concepts and challenges. Histopathology, 2013. 62(3): p. 367-86. https://doi.org/10.1111/his.12055 PMid:23339363
Bae, J.M., J.H. Kim, and G.H. Kang, Molecular Subtypes of Colorectal Cancer and Their Clinicopathologic Features, With an Emphasis on the Serrated Neoplasia Pathway. Arch Pathol Lab Med, 2016. 140(5): p. 406-12. https://doi.org/10.5858/arpa.2015-0310-RA PMid:27128298
Markowitz, S.D. and M.M. Bertagnolli, Molecular origins of cancer: Molecular basis of colorectal cancer. N Engl J Med, 2009. 361(25): p. 2449-60. https://doi.org/10.1056/NEJMra0804588 PMid:20018966 PMCid:PMC2843693
Laurent-Puig, P., J. Agostini, and K. Maley, [Colorectal oncogenesis]. Bull Cancer, 2010. 97(11): p. 1311-21. https://doi.org/10.1684/bdc.2010.1216 PMid:21115420
Vogelstein, B., et al., Genetic alterations during colorectal-tumor development. N Engl J Med, 1988. 319(9): p. 525-32. https://doi.org/10.1056/NEJM198809013190901 PMid:2841597
Ribic, C.M., et al., Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer. N Engl J Med, 2003. 349(3): p. 247-57. https://doi.org/10.1056/NEJMoa022289 PMid:12867608 PMCid:PMC3584639
Sargent, D.J., et al., Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer. J Clin Oncol, 2010. 28(20): p. 3219-26. https://doi.org/10.1200/JCO.2009.27.1825 PMid:20498393 PMCid:PMC2903323
Gryfe, R., et al., Tumor microsatellite instability and clinical outcome in young patients with colorectal cancer. N Engl J Med, 2000. 342(2): p. 69-77. https://doi.org/10.1056/NEJM200001133420201 PMid:10631274
Popat, S., R. Hubner, and R.S. Houlston, Systematic review of microsatellite instability and colorectal cancer prognosis. J Clin Oncol, 2005. 23(3): p. 609-18. https://doi.org/10.1200/JCO.2005.01.086 PMid:15659508
Boland, C.R. and M. Shike, Report from the Jerusalem workshop on Lynch syndrome-hereditary nonpolyposis colorectal cancer. Gastroenterology, 2010. 138(7): p. 2197 e1-7. https://doi.org/10.1053/j.gastro.2010.04.024 PMid:20416305 PMCid:PMC3032350
Colussi, D., et al., Molecular pathways involved in colorectal cancer: implications for disease behavior and prevention. Int J Mol Sci, 2013. 14(8): p. 16365-85. https://doi.org/10.3390/ijms140816365 PMid:23965959 PMCid:PMC3759916
Stoffel, E.M. and C.R. Boland, Genetics and Genetic Testing in Hereditary Colorectal Cancer. Gastroenterology, 2015. 149(5): p. 1191-1203 e2. https://doi.org/10.1053/j.gastro.2015.07.021 PMid:26226567
Jass, J.R., et al., Advanced colorectal polyps with the molecular and morphological features of serrated polyps and adenomas: concept of a 'fusion' pathway to colorectal cancer. Histopathology, 2006. 49(2): p. 121-31. https://doi.org/10.1111/j.1365-2559.2006.02466.x PMid:16879389 PMCid:PMC1619718
Vasen, H.F., et al., Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts. Gut, 2013. 62(6): p. 812-23. https://doi.org/10.1136/gutjnl-2012-304356 PMid:23408351 PMCid:PMC3647358
Allegra, C.J., et al., American Society of Clinical Oncology provisional clinical opinion: testing for KRAS gene mutations in patients with metastatic colorectal carcinoma to predict response to anti-epidermal growth factor receptor monoclonal antibody therapy. J Clin Oncol, 2009. 27(12): p. 2091-6. https://doi.org/10.1200/JCO.2009.21.9170 PMid:19188670
Samowitz, W.S., et al., Poor survival associated with the BRAF V600E mutation in microsatellite-stable colon cancers. Cancer Res, 2005. 65(14): p. 6063-9. https://doi.org/10.1158/0008-5472.CAN-05-0404 PMid:16024606
Ward, R.L., et al., Adverse prognostic effect of methylation in colorectal cancer is reversed by microsatellite instability. J Clin Oncol, 2003. 21(20): p. 3729-36. https://doi.org/10.1200/JCO.2003.03.123 PMid:14551292
Sinicrope, F.A., et al., DNA mismatch repair status and colon cancer recurrence and survival in clinical trials of 5-fluorouracil-based adjuvant therapy. J Natl Cancer Inst, 2011. 103(11): p. 863-75. https://doi.org/10.1093/jnci/djr153 PMid:21597022 PMCid:PMC3110173
