Despite considerable advances in our understanding of cancer biology, early diagnosis of colorectal cancer remains elusive. Based on the adenoma-carcinoma sequence, cancer develops through the progressive accumulation...Despite considerable advances in our understanding of cancer biology, early diagnosis of colorectal cancer remains elusive. Based on the adenoma-carcinoma sequence, cancer develops through the progressive accumulation of mutations in key genes that regulate cell growth. However, recent mathematical modelling suggests that some of these genetic events occur prior to the development of any discernible histological abnormality. Cells acquire pro-tumourigenic mutations that are not able to produce morphological change but predispose to cancer formation. These cells can grow to form large patches of mucosa from which a cancer arises. This process has been termed "field cancerisation". It has received little attention in the scientific literature until recently. Several studies have now demonstrated cellular, genetic and epigenetic alterations in the macroscopically normal mucosa of colorectal cancer patients. In some reports, these changes were effectively utilised to identify patients with a neoplastic lesion suggesting potential application in the clinical setting. In this article, we present the scientific evidence to support field cancerisation in colorectal cancer and discuss important limitations that require further investigation. Characterisation of the field defect is necessary to enable early diagnosis of colorectal cancer and identify molecular targets for chemoprevention. Field cancerisation offers a promising prospect for experimental cancer research and has potential to improve patient outcomes in the clinical setting.展开更多
A 24 year old man asks you for help with his heroin problem. He has been taking the drug for about a year and is spending at least ￡60 ( = 90; $110) a day on it. Abstract: What issues you should cover You should do...A 24 year old man asks you for help with his heroin problem. He has been taking the drug for about a year and is spending at least ￡60 ( = 90; $110) a day on it. Abstract: What issues you should cover You should do a full assessment before deciding on any action; this is likely to take more than one consultation. An empathic and non-judgmental approach will engage him and help him to begin the process of change. You need to clarify why he has come to you now and what he wants-often, but not always, this is a prescription. All GPs should be able to gather the information they need for an appropriate referral and to provide general care. Current drug use-Ask about all illicit drugs he has taken in the past month (including cannabis). Record quantity and frequency of use, together with route of administration. Also note his smoking and drinking habits. Past drug history and treatment experience-Ask about onset of drug use and when it first became a problem. What do drugs do for him? Has he tried stopping previously?展开更多
基金Bowel Disease Research Foundation,United Kingdom
文摘Despite considerable advances in our understanding of cancer biology, early diagnosis of colorectal cancer remains elusive. Based on the adenoma-carcinoma sequence, cancer develops through the progressive accumulation of mutations in key genes that regulate cell growth. However, recent mathematical modelling suggests that some of these genetic events occur prior to the development of any discernible histological abnormality. Cells acquire pro-tumourigenic mutations that are not able to produce morphological change but predispose to cancer formation. These cells can grow to form large patches of mucosa from which a cancer arises. This process has been termed "field cancerisation". It has received little attention in the scientific literature until recently. Several studies have now demonstrated cellular, genetic and epigenetic alterations in the macroscopically normal mucosa of colorectal cancer patients. In some reports, these changes were effectively utilised to identify patients with a neoplastic lesion suggesting potential application in the clinical setting. In this article, we present the scientific evidence to support field cancerisation in colorectal cancer and discuss important limitations that require further investigation. Characterisation of the field defect is necessary to enable early diagnosis of colorectal cancer and identify molecular targets for chemoprevention. Field cancerisation offers a promising prospect for experimental cancer research and has potential to improve patient outcomes in the clinical setting.
文摘A 24 year old man asks you for help with his heroin problem. He has been taking the drug for about a year and is spending at least ￡60 ( = 90; $110) a day on it. Abstract: What issues you should cover You should do a full assessment before deciding on any action; this is likely to take more than one consultation. An empathic and non-judgmental approach will engage him and help him to begin the process of change. You need to clarify why he has come to you now and what he wants-often, but not always, this is a prescription. All GPs should be able to gather the information they need for an appropriate referral and to provide general care. Current drug use-Ask about all illicit drugs he has taken in the past month (including cannabis). Record quantity and frequency of use, together with route of administration. Also note his smoking and drinking habits. Past drug history and treatment experience-Ask about onset of drug use and when it first became a problem. What do drugs do for him? Has he tried stopping previously?
