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Scientific article
Review
English

Two colons-two cancers: paradigm shift and clinical implications

Published inJournal of surgical oncology, vol. 88, no. 4, p. 261-266
Publication date2004
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, Adjuvant
  • Chromosomal Instability
  • Colon/anatomy & histology/pathology/physiology
  • Colon, Transverse/anatomy & histology/pathology
  • Colonic Neoplasms/drug therapy/embryology/genetics/pathology
  • Genes, DCC
  • Genes, p53
  • Humans
  • Loss of Heterozygosity
  • Microsatellite Repeats
  • Mutation
  • Neoplasm Staging
  • Phenotype
  • Prognosis
Citation (ISO format)
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. 261–266. doi: 10.1002/jso.20156
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Article (Published version)
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ISSN of the journal0022-4790
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