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Two colons-two cancers: paradigm shift and clinical implications

Published in Journal of Surgical Oncology. 2004, vol. 88, no. 4, p. 261-6
Abstract Embryological and physiological data suggest that proximal (in relation to the splenic flexure) and distal parts of the colon represent distinct anatomical and functional entities. Since 1990, molecular biologists have identified two distinct pathways, microsatellite instability (MSI) and chromosomal instability (CIN), which are involved in the pathogenesis of colon cancer (CC). Thus, a new paradigm has emerged with the discovery that CC is a heterogeneous disease; furthermore recent data have demonstrated that these two distinct pathways in colorectal carcinogenesis are characterized by a different clinical outcome. The implications for the clinicians are twofold; (1) tumors originating from the proximal colon have a better prognosis due to a high percentage of MSI-positive lesions; and (2) location of the neoplasm in reference to the splenic flexure should be documented before group stratification in ongoing trials of adjuvant chemotherapy for CC. In the future, clinical decision-making regarding adjuvant chemotherapy might be stratified according to the MSI status of cancers located proximally to the splenic flexure.
Keywords Chemotherapy, AdjuvantChromosomal InstabilityColon/anatomy & histology/pathology/physiologyColon, Transverse/anatomy & histology/pathologyColonic Neoplasms/drug therapy/embryology/genetics/pathologyGenes, DCCGenes, p53HumansLoss of HeterozygosityMicrosatellite RepeatsMutationNeoplasm StagingPhenotypePrognosis
PMID: 15565587
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Research groups Chirurgie viscérale (104)
Chirurgie viscérale (HUG)
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GERVAZ, Pascal, BUCHER, Pascal Alain Robert, MOREL, Philippe. Two colons-two cancers: paradigm shift and clinical implications. In: Journal of Surgical Oncology, 2004, vol. 88, n° 4, p. 261-6. doi: 10.1002/jso.20156 https://archive-ouverte.unige.ch/unige:41709

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Deposited on : 2014-11-12

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