en
Scientific article
English

A tale of two colons and two cancers. Distinct carcinogenesis and clinical outcome according to location proximal or distal to the splenic flexure

Published inSwiss surgery, vol. 9, no. 1, p. 3-7
Publication date2003
Abstract

The central hypothesis explored in this paper is that colorectal cancer (CRC) is a heterogeneous disease. The initial clue to this heterogeneity was provided by genetic findings; however, embryological and physiological data had previously been gathered, showing that proximal (in relation to the splenic flexure) and distal parts of the colon represent distinct entities. Molecular biologists have identified two distinct pathways, microsatellite instability (MSI) and chromosomal instability (CIN), which are involved in CRC progression. In summary, there may be not one, but two colons and two types of colorectal carcinogenesis, with distinct clinical outcome. The implications for the clinicians are two-folds; 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 future trials of adjuvant chemotherapy in patients with stage II and III colon cancer.

Keywords
  • Cell Transformation, Neoplastic/genetics/pathology
  • Chromosome Fragility/genetics
  • Chromosome Mapping
  • Colon/pathology
  • Colorectal Neoplasms/genetics/mortality/pathology
  • Disease Progression
  • Humans
  • Microsatellite Repeats/genetics
  • Neoplasm Staging
  • Prognosis
  • Survival Rate
Citation (ISO format)
GERVAZ, Pascal et al. A tale of two colons and two cancers. Distinct carcinogenesis and clinical outcome according to location proximal or distal to the splenic flexure. In: Swiss surgery, 2003, vol. 9, n° 1, p. 3–7.
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Article (Published version)
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ISSN of the journal1023-9332
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