Clinical significance of magnetic resonance imaging findings in rectal cancer

Staging of rectal cancer is essential to help guide clini-cians to decide upon the correct type of surgery and determine whether or not neoadjuvant therapy is indicated. Magnetic resonance imaging (MRI) is currently one of the most accurate modalities on which to base treatment decisions for patients with rectal cancer. MRI can accurately detect the mesorectal fascia, assess the invasion of the mesorectum or surrounding organs and predict the circumferential resection margin. Although nodal disease remains a difficult radiological diagnosis, new lymphographic agents and diffusion weighted imaging may allow identification of metastatic nodes by criteria other then size. In light of this, we have reviewed the literature on the accuracy of specific MRI findings for staging the local extent of primary rectal cancer. The aim of this review is to establish a correlation between MRI findings, prognosis, and available treatment options.

Telomeres,telomerase and colorectal cancer

Colorectal cancer(CRC)is the third most common cancer worldwide and,despite improved treatments,is still an important cause of cancer-related deaths.CRC encompasses a complex of diseases arising from a multistep process of genetic and epigenetic events.Besides heterogeneity in the molecular and biological features of CRC,chromosomal instability is a hallmark of cancer and cancer cells may also circumvent replicative senescence and acquire the ability to sustain unlimited proliferation.Telomere/telomerase interplay is an important mechanism involved in both genomic stability and cellular replicative potential,and its dysfunction plays a key role in the oncogenetic process.The erosion of telomeres,mainly because of cell proliferation,may be accelerated by specific alterations in the genes involved in CRC,such as APC and MSH2.Although there is general agreement that the shortening of telomeres plays a role in the early steps of CRC carcinogenesis by promoting chromosomal instability,the prognostic role of telomere length in CRC is still under debate.The activation of telomerase reverse transcriptase(TERT),the catalytic component of the telomerase complex,allows cancer cells to grow indefinitely by maintaining the length of the telomeres,thus favouring tumour formation/progression.Several studies indicate that TERT increases with disease progression,and most studies suggest that telomerase is a useful prognostic factor.Plasma TERT mRNA may also be a promising marker for the minimally invasive monitoring of disease progression and response to therapy.