Colorectal cancer(CRC)is one of the most prevalent malignancies worldwide.Although most prevalent among older people,its incidence above 50 years old has been decreasing globally in the last decades,probably as a resu...Colorectal cancer(CRC)is one of the most prevalent malignancies worldwide.Although most prevalent among older people,its incidence above 50 years old has been decreasing globally in the last decades,probably as a result of better screening.Paradoxically,its incidence in patients below 50 years old[early-onset CRC(EO-CRC)]has been increasing,for reasons not yet fully understood.EOCRC’s increasing incidence is genre independent but shows racial disparities and has been described to occur worldwide.It follows a birth-cohort effect which probably reflects a change in exposure to CRC risk factors.Its incidence is predicted to double until 2030,which makes EO-CRC a serious public health issue.Both modifiable and non-modifiable risk factors have been identified-some are potential targets for preventive measures.EO-CRC is often diagnosed at advanced stages and histological features associated with poor prognosis have been described.EO-CRC presents some distinctive features:Microsatellite instability is common,but another subtype of tumours,both microsatellite and chromosome stable also seems relevant.There are no age-specific treatment protocols and studies on EO-CRC survival rates have shown conflicting data.Due to the higher germline pathological mutations found in EO-CRC patients,an accurate genetic risk evaluation should be performed.In this review,we summarize the current evidence on epidemiological,clinical,histopathological and molecular features of EO-CRC and discuss the contribution of genetics and lifestyle risk factors.We further comment on screening strategies and specific dimensions to consider when dealing with a younger cancer patient.展开更多
Colorectal cancer(CRC)remains one of the main causes of cancer death in developed countries.Yet,it is potentially preventable,by removing the precursor lesions-adenomas or serrated lesions.Several studies proved that ...Colorectal cancer(CRC)remains one of the main causes of cancer death in developed countries.Yet,it is potentially preventable,by removing the precursor lesions-adenomas or serrated lesions.Several studies proved that this intervention reduces CRC mortality and that the first colonoscopy’s results can guide surveillance strategies.More recently,it became clear that several carcinogenesis pathways may lead to sporadic CRC.CRC is a heterogeneous disease,characterized by multiple molecular subtypes.Three main pathways have been implicated in the development of CRC:Chromosomal instability,microsatellite instability,and the“serrated”pathways,with overlapping features between them.This and other molecular and genetic based CRC classifications are known to have clinical implications,spanning from familial risk assessment to therapy choices.The authors review basic science data and provide insight on current implications for the management of patients with CRC.展开更多
文摘Colorectal cancer(CRC)is one of the most prevalent malignancies worldwide.Although most prevalent among older people,its incidence above 50 years old has been decreasing globally in the last decades,probably as a result of better screening.Paradoxically,its incidence in patients below 50 years old[early-onset CRC(EO-CRC)]has been increasing,for reasons not yet fully understood.EOCRC’s increasing incidence is genre independent but shows racial disparities and has been described to occur worldwide.It follows a birth-cohort effect which probably reflects a change in exposure to CRC risk factors.Its incidence is predicted to double until 2030,which makes EO-CRC a serious public health issue.Both modifiable and non-modifiable risk factors have been identified-some are potential targets for preventive measures.EO-CRC is often diagnosed at advanced stages and histological features associated with poor prognosis have been described.EO-CRC presents some distinctive features:Microsatellite instability is common,but another subtype of tumours,both microsatellite and chromosome stable also seems relevant.There are no age-specific treatment protocols and studies on EO-CRC survival rates have shown conflicting data.Due to the higher germline pathological mutations found in EO-CRC patients,an accurate genetic risk evaluation should be performed.In this review,we summarize the current evidence on epidemiological,clinical,histopathological and molecular features of EO-CRC and discuss the contribution of genetics and lifestyle risk factors.We further comment on screening strategies and specific dimensions to consider when dealing with a younger cancer patient.
文摘Colorectal cancer(CRC)remains one of the main causes of cancer death in developed countries.Yet,it is potentially preventable,by removing the precursor lesions-adenomas or serrated lesions.Several studies proved that this intervention reduces CRC mortality and that the first colonoscopy’s results can guide surveillance strategies.More recently,it became clear that several carcinogenesis pathways may lead to sporadic CRC.CRC is a heterogeneous disease,characterized by multiple molecular subtypes.Three main pathways have been implicated in the development of CRC:Chromosomal instability,microsatellite instability,and the“serrated”pathways,with overlapping features between them.This and other molecular and genetic based CRC classifications are known to have clinical implications,spanning from familial risk assessment to therapy choices.The authors review basic science data and provide insight on current implications for the management of patients with CRC.