Current and future perspectives in the management and treatment of colorectal cancer

In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment of colorectal cancer(CRC),one of the leading causes of cancer-related morbidity and mortality worldwide.The article analyzed the therapeutic modalities and their sequencing,focusing on total neoadjuvant therapy for locally advanced rectal cancer.It highlighted the role of immunotherapy in tumors with high microsatellite instability or deficient mismatch repair,addressing recent advances that have improved prognosis and therapeutic response in localized and metastatic CRC.Innovations in surgical techniques,advanced radiotherapy,and systemic agents targeting specific mutational profiles are also discussed,reflecting on how they revolutionized clinical management.Circulating tumor DNA has emerged as a promising tool for detecting minimal residual disease,prognosis,and therapeutic monitoring,solidifying its role in precision oncology.This review emphasized the importance of technological and therapeutic advancements in improving clinical outcomes and personalizing CRC treatment.

Why is early detection of colon cancer still not possible in 2023?

Colorectal cancer(CRC)screening is a fundamental tool in the prevention and early detection of one of the most prevalent and lethal cancers.Over the years,screening,particularly in those settings where it is well organized,has succeeded in reducing the incidence of colon and rectal cancer and improving the prognosis related to them.Despite considerable advancements in screening technologies and strategies,the effectiveness of CRC screening programs remains less than optimal.This paper examined the multifaceted reasons behind the persistent lack of effect-iveness in CRC screening initiatives.Through a critical analysis of current methodologies,technological limitations,patient-related factors,and systemic challenges,we elucidated the complex interplay that hampers the successful reduction of CRC morbidity and mortality rates.While acknowledging the ad-vancements that have improved aspects of screening,we emphasized the necessity of addressing the identified barriers comprehensively.This study aimed to raise awareness of how important CRC screening is in reducing costs for this disease.Screening and early diagnosis are not only important in improving the prognosis of patients with CRC but can lead to an important reduction in the cost of treating a disease that is often diagnosed at an advanced stage.Spending more sooner can mean saving money later.

Colonoscopy surveillance for high risk polyps does not always prevent colorectal cancer

AIM To determine the frequency and risk factors for colorectal cancer(CRC) development among individuals with resected advanced adenoma(AA)/traditional serrated adenoma(TSA)/advanced sessile serrated adenoma(ASSA). METHODS Data was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. Patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp. RESULTS84/4610(1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years(mean 4.89 years), and 1.2%(54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years(mean 6.67 years). Approximately, 30%(25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8%(15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC developmentat the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site. CONCLUSION Recognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.

Lymph node harvest in colon and rectal cancer:Current considerations

The prognostic significance of identifying lymph node (LN) metastases following surgical resection for colon and rectal cancer is well recognized and is reflected in accurate staging of the disease. An established body of evidence exists, demonstrating an association between a higher total LN count and improved survival, particularly for node negative colon cancer. In node positive disease, however, the lymph node ratios may represent a better prognostic indicator, although the impact of this on clinical treatment has yet to be universally established. By extension, strategies to increase surgical node harvest and/or laboratory methods to increase LN yield seem logical and might improve cancer staging. However, debate prevails as to whether or not these extrapolations are clinically relevant, particularly when very high LN counts are sought. Current guidelines recommend a minimum of 12 nodes harvested as the standard of care, yet the evidence for such is questionable as it is unclear whether an increasing the LN count results in improved survival. Findings from modern treatments, including down-staging in rectal cancer using pre-operative chemoradiotherapy, paradoxically suggest that lower LN count, or indeed complete absence of LNs, are associated with improved survival; implying that using a specific number of LNs harvested as a measure of surgical quality is not always appropriate. The pursuit of a sufficient LN harvest represents good clinical practice; however, recent evidence shows that the exhaustive searching for very high LN yields may be unnecessary and has little influence on modern approaches to treatment.

CT colonography in the diagnosis and management of colorectal cancer:Emphasis on pre-and post-surgical evaluation

This article addresses the use of computed tomographic colonography (CTC) for the diagnosis and management of colorectal cancer, focusing on presurgical evaluation of the colon proximal to an occlusive cancer and surveillance after cancer resection surgery. The key evidences accumulated in the literature and future work needed are summarized. CTC is a technically robust and the most practical method to evaluate the colon proximal to an occlusive cancer, which prevents colonoscopic examination past the occlusion, either before or after metallic stent placement. The high sensitivity of CTC for detecting cancers and advanced adenomas in the proximal colon can help prevent additional surgical procedures in patients showing negative results. However, the accuracy of CTC for distinguishing intramural cancers from adenomas is low, and the technique is limited in guiding management when a medium-sized lesion that do not show invasive features such as pericolic extension or nodal metastasis is found in the proximal colon. A maximal diameter ≥ 15 mm has been proposed as a criterion for surgical removal of proximal lesions. However, this needs to be verified in a larger cohort. In addition, the influence of presurgical CTC results on the current post-cancer resection colonic surveillance timeline remains to be determined. CTC can be readily added to the routine abdominopelvic CT in the form of contrast-enhanced CTC, which can serve as an effective stand-alone tool for post-cancer resection surveillance of both the colorectum and extracolonic organs. Although the accuracy of CTC has been demonstrated, its role in the current colonoscopy-based postoperative colonic surveillance protocols remains to be determined. Readers of CTC also need to be knowledgeable on the colonic lesions that are unique to the postoperative colon.

Outcomes of preoperative chemoradiotherapy followed by surgery in patients with unresectable locally advanced sigmoid colon cancer

Background: Complete resection of locally advanced sigmoid colon cancer(LASCC) is sometimes difficult. Patients with LASCC have a dismal prognosis and poor quality of life, which has encouraged the evaluation of alternative multimodality treatments. This prospective study aimed to assess the feasibility and efficacy of neoadjuvant chemora?diotherapy(neo CRT) followed by surgery as treatment of selected patients with unresectable LASCC.Methods: We studied the patients with unresectable LASCC who received neo CRT followed by surgery between October 2010 and December 2012. The neoadjuvant regimen consisted of external?beam radiotherapy to 50 Gy and capecitabine?based chemotherapy every 3 weeks. Surgery was scheduled 6–8 weeks after radiotherapy.Results: Twenty?one patients were included in this study. The median follow?up was 42 months(range, 17–57 months). All patients completed neo CRT and surgery. Resection with microscopically negative margins(R0 resection) was achieved in 20 patients(95.2%). Pathologic complete response was observed in 8 patients(38.1%). Multivisceral resection was necessary in only 7 patients(33.3%). Two patients(9.5%) experienced grade 2 postopera?tive complications. No patients died within 30 days after surgery. For 18 patients with pathologic M0(yp M0) disease, the cumulative probability of 3?year local recurrence?free survival, disease?free survival and overall survival was 100.0%, 88.9% and 100.0%, respectively. For all 21 patients, the cumulative probability of 3?year overall survival was 95.2% and bladder function was well preserved.Conclusion: For patients with unresectable LASCC, preoperative chemoradiotherapy and surgery can be performed safely and may result in an increased survival rate.

Recurrence of sigmoid colon cancer–derived anal metastasis:A case report and review of literature

BACKGROUND Distant metastasis of colorectal cancer to the anus is very rare,with only 30 related cases published in PubMed thus far.Therefore,recurrence of colorectal cancer derived anus metastases is rarely seen and less presented.CASE SUMMARY Here we report an 80-year-old male patient who underwent radical resection for sigmoid colon cancer in January 2010 and another surgery for anal fistula resection in December 2010.Postoperative pathology of the anal fistula revealed a metastatic moderately differentiated adenocarcinoma.The patient subsequently received chemotherapy and radiotherapy.In May 2020,after the patient reported symptoms of anal swelling and pain,computed tomography and magnetic resonance imaging revealed a perianal abscess.Perianal mass biopsy was performed,and the postoperative pathological diagnosis was metastatic moderately differentiated adenocarcinoma.CONCLUSION This case highlights that there is a risk of recurrence of anal metastasis of colorectal cancer even after 10 years of follow-up.We also reviewed the literature and discuss potential mechanisms for anal metastasis of colorectal cancer,thus providing some suggestions for treatment of these cases.

Long-term outcome of indwelling colon observed seven years after radical resection for rectosigmoid cancer: A case report

BACKGROUND Indwelling colon is characterized by an excluded segment of the colon after surgical diversion of the fecal stream with colostomy so that contents are unable to pass through this part of the colon.We report a rare case of purulent colonic necrosis that occurred 7 years after surgical colonic exclusion.CASE SUMMARY A 73-year-old male had undergone extended radical resection for rectosigmoid cancer.The invaded ileocecal area and sigmoid colon were removed during the procedure,and the ileum was anastomosed side-to-side with the rectum.The excluded ascending,transverse,and descending colon were sealed at both ends and left in the abdomen.After 7 years,the patient developed persistent abdominal pain and distension.Work-up indicated intestinal obstruction.The patient underwent ultrasound-guided catheter drainage of the descending colon and a large amount of viscous liquid was drained,but the symptoms persisted;therefore,surgery was planned.Intraoperatively,extensive adhesions were found in the abdominal cavity,and the small intestine and the indwelling colon were widely dilated.The dilated colon was 56 cm long,5 cm wide(diameter),and contained about 1500 mL of viscous liquid.The indwelling colon was surgically removed and its histopathological examination revealed colonic congestion and necrosis with hyperplasia of granulation tissue.The bacterial culture of the secretions was negative.The patient recovered after the operation.CONCLUSION Although colonic exclusion is routinely performed,this report aimed to increase awareness regarding the possible long-term complications of indwelling colon.

Barriers in early detection of colorectal cancer and exploring potential solutions

This editorial discusses the literature review article by Tonini and Zanni,the paper was published in January 2024,and the authors provided very interesting conclusions regarding existing barriers to the early diagnosis of colon cancer.Many cancers do not have identifiable precursors,or there are currently no screening tests to find them.Therefore,these cancers do not have preventive screening options.Early detection is crucial for reducing mortality rates by identifying cancer at an earlier stage through screening,as opposed to no screening.Colorectal cancer develops from precancerous lesions,which can be detected early and potentially prevented and cured.Early detection leads to improved survival rates,decreased complications,and reduced healthcare expenses.This editorial provides a brief description of the biology of colon cancer,emphasizing the contrast in outcomes between early detection and late detection.We also describe screening programs around the globe and examine the barriers in each program.Finally,we explore potential future solutions to enhance inclusion in screening programs and improve patient compliance.

Distinguishing Rectal Cancer from Colon Cancer Based on the Support Vector Machine Method and RNA-sequencing Data

Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide.Several studies have indicated that rectal cancer is significantly different from colon cancer interms of treatment, prognosis, and metastasis. Recently, the differential mRNA expression of coloncancer and rectal cancer has received a great deal of attention. The current study aimed to identifysignificant differences between colon cancer and rectal cancer based on RNA sequencing (RNA-seq)data via support vector machines (SVM). Here, 393 CRC samples from the The Cancer GenomeAtlas (TCGA) database were investigated, including 298 patients with colon cancer and 95 withrectal cancer. Following the random forest (RF) analysis of the mRNA expression data, 96 genessuch as HOXB13, PR4C, and BCLAFI were identified and utilized to build the SVM classificationmodel with the Leave-One-Out Cross-validation (LOOCV) algorithm. In the training (n= 196)and the validation cohorts (n=197), the accuracy (82. 1 % and 82.2 %, respectively) and the AUC(0.87 and 0.91, respectively) indicated that the established optimal SVM classification modeldistinguished colon cancer from rectal cancer reasonably. However, additional experiments arerequired to validate the predicted gene expression levels and functions.

Colonic pouch confers better bowel function and similar postoperative outcomes compared to straight anastomosis for low rectal cancer

BACKGROUND With advancements in laparoscopic technology and the wide application of linear staplers,sphincter-saving procedures are increasingly performed for low rectal cancer.However,sphincter-saving procedures have led to the emergence of a unique clinical disorder termed anterior rectal resection syndrome.Colonic pouch anastomosis improves the quality of life of patients with rectal cancer>7 cm from the anal margin.But whether colonic pouch anastomosis can reduce the incidence of rectal resection syndrome in patients with low rectal cancer is unknown.AIM To compare postoperative and oncological outcomes and bowel function of straight and colonic pouch anal anastomoses after resection of low rectal cancer.METHODS We conducted a retrospective study of 72 patients with low rectal cancer who underwent sphincter-saving procedures with either straight or colonic pouch anastomoses.Functional evaluations were completed preoperatively and at 1,6,and 12 mo postoperatively.We also compared perioperative and oncological outcomes between two groups that had undergone low or ultralow anterior rectal resection.RESULTS There were no significant differences in mean operating time,blood loss,time to first passage of flatus and excrement,and duration of hospital stay between the colonic pouch and straight anastomosis groups.The incidence of anastomotic leakage following colonic pouch construction was lower(11.4%vs 16.2%)but not significantly different than that of straight anastomosis.Patients with colonic pouch construction had lower postoperative low anterior resection syndrome scores than the straight anastomosis group,suggesting better bowel function(preoperative:4.71 vs 3.89,P=0.43;1 mo after surgery:34.2 vs 34.7,P=0.59;6 mo after surgery:22.70 vs 29.0,P<0.05;12 mo after surgery:15.5 vs 19.5,P=0.01).The overall recurrence and metastasis rates were similar(4.3%and 11.4%,respectively).CONCLUSION Colonic pouch anastomosis is a safe and effective procedure for colorectal reconstruction after low and ultralow rectal resections.Moreover,colonic pouch construction may provide better functional outcomes compared to straight anastomosis.

Comparison of Top down and Bottom up Cost Approaches in Colon and Rectal Cancer Treatment

Introduction: In recent years, health care expenditures have significantly risen across the world and in Turkey. Because of the limited resources allocated to health, it is very important for countries to conduct studies especially on cost of diseases such as colorectal cancer (CRC) with a high burden of disease and labor loss. The aim of this study was to calculate the cost of treatment for colon and rectal cancers based on two different cost approaches from the perspective of SSI (top-down and bottom-up) and to compare the results obtained. Materials and Methods: Data were obtained from the SSI MEDULA System a total of 62,970 colon and rectal cancer patient for the top-down cost approach. In the bottom-up cost approach, treatment costs were determined based on the expert opinions. Results: The average cost of treatment per patient for colon cancer was determined as 3055.5 TL, for rectal cancer was determined as 4146.2 TL with the top-down cost approach. The average cost of treatment per patient for colon cancer was determined as 14,920.4 TL, for rectal cancer was determined as 17,904.6 TL according to the bottom-up cost approach. Conclusion: Since the bottom-up cost approach provides more detailed information on the cost of illness, and thereby on the use of resources allocated to health, it is thought that the combined use of these two cost approaches completes each other’s weaknesses.

The role of OR51E2 in colon cancer and rectal adenocarcinoma and the potential underlying mechanism

Objective Short-chain fatty acids(SCFAs)produced by intestinal microbiota influence the pathogenesis and development of several intestinal diseases.OR51E2 is a newly discovered SCFA receptor.At present,research on the link between OR51E2 and intestinal cancer is limited.This study aimed to analyze the relationship between OR51E2 and colorectal cancer.Methods Bioinformatic analysis revealed the OR51E2 protein expression pattern in different parts of the intestine,regulation of related proteins,and immune cell infiltration.The expression pattern and prognostic value of OR51E2 in colon and rectal cancer was determined,and the miRNAs targeting OR51E2 were predicted.Results The expression level of OR51E2 was relatively high in the colon,small intestine,and duodenum.In addition,OR51E2 expression level was significantly reduced in colon and rectal cancer.A positive correlation between OR51E2 and immune cells was observed,which was associated with the survival of patients with colon and rectal cancer(hazard ratio:1.5).Further,miR-96-5p and miR-1271-5-p were predicted to target OR51E2.Conclusion OR51E2 plays an important positive role in the survival of patients with colon cancer and rectal adenocarcinoma.

Dietary polyphenols and colorectal cancer risk:The Fukuoka colorectal cancer study

AIM:To investigate the associations between dietary intake of polyphenols and colorectal cancer. METHODS:The study subjects were derived from the Fukuoka colorectal cancer study, a community-based case-control study. The study subjects were 816 cases of colorectal cancer and 815 community-based controls. The consumption of 148 food items was assessed by a computer-assisted interview. We used the consumption of 97 food items to estimate dietary intakes of total, tea and coffee polyphenols. The Phenol-Explorer database was used for 92 food items. Of the 5 foods which were not listed in the Phenol-Explorer Database, polyphenol contents of 3 foods (sweet potatoes, satoimo and daikon) were based on a Japanese study and 2 foods (soybeans and fried potatoes) were estimated by ORAC-based polyphenol contents in the United States Department of Agriculture Database. Odds ratios (OR) and 95%CI of colorectal cancer risk according to quintile categories of intake were obtained by using logistic regression models with adjustment for age, sex, residential area, parental history of colorectal cancer, smoking, alcohol consumption, body mass index 10 years before, type of job, leisure-time physical activity and dietary intakes of calcium and n-3 polyunsaturated fatty acids.RESULTS:There was no measurable difference in total or tea polyphenol intake between cases and controls, but intake of coffee polyphenols was lower in cases than in controls. The multivariate-adjusted OR of colorectal cancer according to quintile categories of coffee polyphenols (from the first to top quintile) were 1.00 (referent), 0.81 (95%CI:0.60-1.10), 0.65 (95%CI:0.47-0.89), 0.65 (95%CI:0.46-0.89) and 0.82 (95%CI:0.60-1.10), respectively (P trend = 0.07). Similar, but less pronounced, decreases in the OR were also noted for the third and fourth quintiles of total polyphenol intake. Tea polyphenols and non-coffee polyphenols showed no association with colorectal cancer risk. The sitespecific analysis, based on 463 colon cancer cases and 340 rectal cancer cases, showed an inverse association between coffee polyphenols and colon cancer. The multivariate-adjusted OR of colon cancer for the first to top quintiles of coffee polyphenols were 1.00 (referent), 0.92 (95%CI:0.64-1.31), 0.75 (95%CI:0.52-1.08), 0.69 (95%CI:0.47-1.01), and 0.68 (95%CI:0.46-1.00), respectively (P trend = 0.02). Distal colon cancer showed a more evident inverse association with coffee polyphenols than proximal colon cancer. The association between coffee polyphenols and rectal cancer risk was U -shaped, with significant decreases in the OR at the second to fourth quintile categories. There was also a tendency that the OR of colon and rectal cancer decreased in the intermediate categories of total polyphenols. The decrease in the OR in the intermediate categories of total polyphenols was most pronounced for distal colon cancer. Intake of tea polyphenols was not associated with either colon or rectal cancer. The associations of coffee consumption with colorectal, colon and rectal cancers were almost the same as observed for coffee polyphenols. The trend of the association between coffee consumption and colorectal cancer was statistically significant. CONCLUSION:The present findings suggest a decreased risk of colorectal cancer associated with coffee consumption.

Conversion of laparoscopic colorectal resection for cancer: What is the impact on short-term outcomes and survival?

Laparoscopic resection for colon and rectal cancer is associated with quicker return of bowel function, reduced postoperative morbidity rates and shorter length of hospital stay compared to open surgery, with no differences in long-term survival. Conversion to open surgery is reported in up to 30% of patients enrolled in randomized control trials comparing open and laparoscopic colorectal resection for cancer. In this review, reasons for conversion are anatomical-related factors, disease-related-factors and surgeon-related factors. Body mass index, local tumour extension and co-morbidities are independent predictors of conversion. The current evidence has shown that patients with converted resection for colon cancer have similar outcomes compared to patients undergoing a laparoscopic completed or open resection. The few studies that have assessed the outcomes after conversion of laparoscopic rectal resection reported significantly higher rates of complications and longer length of hospital stay in converted patients compared to laparoscopically treated patients. No definitive conclusions can be drawn when converted and open rectal resections are compared. Early and pre-emptive conversion appears to have more favourable outcomes than reactive conversion; however, further large studies are needed to better define the optimal timing of conversion. With regard to long-term oncologic outcome, overall and disease-free survival in the case of conversion in laparoscopic colorectal cancer surgery seems to be worse than those achieved in patients in whom resection was successfully completed by laparoscopy. Although a worse long-term oncologic outcome has been suggested, it remains difficult to draw a proper conclusion due to the heterogeneity of the long-term outcomes as well as the inclusion of both colon and rectal cancer patients in most of the studies. Therefore, we discuss the currently available evidence of the impact of conversion in laparoscopic resection for colon and rectal cancer on both short-term outcomes and long-term survival.

Colorectal cancer screening by non-invasive metabolic biomarker fecal tumor M2-PK

AIM: To evaluate the utility of the innovative fecal tumor M2-Pyruvate kinase (M2-PK) test in our daily clinical routine, as a marker for the pre-selection of patients who should subsequently undergo colonoscopy for the diagnosis or exclusion of colorectal cancer. METHODS: Fecal tumor M2-PK was measured in stool samples of 96 study participants (33 patients with colorectal cancer, 21 patients with rectal carcinoma and 42 controls) who all underwent total colonoscopy. RESULTS: In 39 of 42 individuals in the control group, fecal tumor M2-PK was below 4.0 kU/L (93% specificity). Colorectal tumors were accompanied by a highly significant increase (P < 0.001) in fecal tumor M2- PK levels (median: colon carcinoma, 23.1 kU/L; rectal carcinoma, 6.9 kU/L; colorectal carcinoma, 14.7 kU/L), which correlated with Duke’s staging and T-classification. The overall sensitivity was 78% for colorectal cancer, increasing from 60% for stage T1 to 100% for stage T4 and from 60% for Duke’s A to 90% for Duke’s D tumors. CONCLUSION: Fecal tumor M2-PK is an appropriately sensitive tool to pre-select those patients requiring colonoscopy for the further diagnostic confirmation or exclusion of colorectal cancer.

Clinical characteristics of sentinel polyps and their correlation with proximal colon cancer: A retrospective observational study

BACKGROUND Colorectal cancer is a common malignant tumor of the digestive tract.The relationship between sentinel polyps(rectal polyps with proximal colon cancer)and proximal colon cancer has received extensive attention in recent years.However,there is still no clear conclusion regarding the relationship.AIM To investigate the clinical characteristics of sentinel polyps and their correlation with proximal colon cancer.METHODS A retrospective analysis of 2587 patients with rectal polyps from January 2006 to December 2017 was performed.According to whether or not proximal colon cancer was diagnosed,the patients were divided into either a sentinel polyp group(192 patients)or a pure rectal polyp group(2395 patients).The endoscopic features,clinicopathological features,therapeutic effects,and short-term prognosis were analyzed and compared between the two groups.RESULTS The mean age of patients in the sentinel polyp group was generally higher than that of the pure rectal polyp group,and the positivity rates of anemia,stool occult blood,and tumor markers of the sentinel polyp group were also significantly higher than those in the rectal polyp group(χ^2=90.56,P<0.01;χ^2=70.30,P<0.01;χ^2=92.80,P<0.01).The majority of the patients in the sentinel polyp group had multiple polyps,large polyps,adenomatous polyps,or sessile polyps(χ^2=195.96,P<0.01;χ^2=460.46,P<0.01;χ^2=94.69,P<0.01;χ^2=48.01,P<0.01).Most of the proximal colon cancers were Duke’s A and B stages in the sentinel polyp group.In the pure rectal polyp group,2203 patients underwent endoscopic treatment,and all of the patients were cured and discharged.In the sentinel polyp group,65 patients underwent radical operation,and 61 patients received endoscopic submucosal dissection or endoscopic mucosal resection.Additionally,21 patients were lost to follow-up after 6-12 mo,and the loss rate was 10.94%.A total of 63.16%of patients experienced remission without tumor recurrence or metastasis,33.33%of patients experienced tumors regression or improved symptoms,and the other 3.51%of the patients died.CONCLUSION If there are multiple,sessile,and adenomatous rectal polyps with a maximum diameter>1 cm,the possibility of the carcinogenesis of the polyps or of the proximal colon should be monitored closely.These patients should be followed in the short-term and should undergo a whole-colon examination.

Adjuvant therapies for colorectal cancer

The management of colon and rectal cancer has changed dramatically over the last 25 years. The use of adjuvant therapies has become standard practice in locally advanced （stage M and selected stage 11） colorectal cancer. Improved surgical techniques, chemotherapeutics and radiotherapy are resulting in higher cure rates and the development of agents targeting proliferative and angiogenic pathways offer further promise. Here we explore risk factors for local and distant recurrence after resection of colon and rectal cancer, and the role of adjuvant treatments. Discussion will focus on the evidence base for adjuvant therapies utilised in colorectal cancer, and the treatment of sub-groups such as the elderly and stage 11 disease. The role of adjuvant radiotherapy in rectal cancer in reduction of recurrence will be explored and the role and optimal methods for surveillance post-curative resection with or without adjuvant therapy will also be addressed.

Colorectal cancer in the young,many questions,few answers

At a time where the incidence of colorectal cancer,a disease predominantly of developed nations,is showing a decline in those 50 years of age and older,data from the West is showing a rising incidence of this cancer in young individuals.Central to this has been the 75% increase in rectal cancer incidence in the last four decades.Furthermore,predictive data based on mathematical modelling indicates a 124 percent rise in the incidence of rectal cancer by the year 2030-a statistic that calls for collective global thought and action.While predominance of colorectal cancer(CRC) is likely to be in that part of the large bowel distal to the splenic flexure,which makes flexible sigmoidoscopic examination an ideal screening tool,the cost and benefit of mass screening in young people remain unknown.In countries where the incidence of young CRC is as high as 35% to 50%,the available data do not seem to indicate that the disease in young people is one of high red meat consuming nations only.Improvement in our understanding of genetic pathways in the aetiology of CRC,chiefly of the MSI,CIN and CIMP pathway,supports the notion that up to 30% of CRC is genetic,and may reflect a familial trait or environmentally induced changes.However,a number of other germline and somatic mutations,some of which remain unidentified,may play a role in the genesis of this cancer and stand in the way of a clear understanding of CRC in the young.Clinically,a proportion of young persons with CRC die early after curative surgery,presumably from aggressive tumour biology,compared with the majority in whom survival after operation will remain unchanged for five years or greater.The challenge in the future will be to determine,by genetic fingerprinting or otherwise,those at risk of developing CRC and the determinants of survival in those who develop CRC.Ultimately,prevention and early detection,just like for those over 50 years with CRC,will determine the outcome of CRC in young persons.At present,aside from those with an established familial tendency,there is no consensus on screening young persons who may be at risk.However,increasing awareness of this cancer in the young and the established benefit of prevention in older persons,must be a message that should be communicated with medical students,primary health care personnel and first contact doctors.The latter constitutes a formidable challenge.

Expression and significance of mi R-654-5p and mi R-376b-3p in patients with colon cancer

BACKGROUND The relationship between micro RNAs,such as miR-654-5 p and miR-376 b-3 p,and the prognosis of colon cancer has not been studied until now.AIM To evaluate the expression levels of miR-654-5 p and miR-376 b-3 p and their clinical significance in colon cancer.METHODS RT-q PCR was performed to evaluate miR-654-5 p and miR-376 b-3 p expression in34 pairs of colon cancer and adjacent noncancerous tissues.Subsequently,the association of miR-654-5 p and miR-376 b-3 p expression with clinical factors or the survival of patients suffering from colon cancer was determined by using The Cancer Genome Atlas.RESULTS miR-654-5 p was upregulated and miR-376 b-3 p was downregulated in colon cancer tissues compared with adjacent noncancerous tissues(P<0.001).Increased miR-654-5 p and decreased miR-376 b-3 p expression levels weresignificantly associated with metastasis and clinical stage.Moreover,a univariate analysis demonstrated that colon cancer patients with high miR-654-5 p or low miR-376 b-3 p expression(P=0.044 and 0.007,respectively)had a poor overall survival rate.A multivariate analysis identified high miR-654-5 p expression and low miR-376 b-3 p expression as independent predictors of poor survival in colon cancer patients.CONCLUSION Upregulated miR-654-5 p and downregulated miR-376 b-3 p may be associated with tumour progression in colon cancer,and these micro RNAs may serve as independent prognostic markers for colon cancer.