Colorectal
cancer (CRC) is a heterogeneous disease that is caused by the interaction
of genetic and environmental factors. CRC develops through a gradual
accumulation of genetic and epigenetic changes, leading to the transformation
of normal colonic mucosa into invasive cancer. CRC is one of the most prevalent
and incident cancers worldwide, as well as one of the most deadly.
Colorectal cancer had a
low incidence several decades ago. However, it has become a predominant cancer
and now accounts for approximately 10% of cancer-related mortality in western
countries. The rise of colorectal cancer in all over countries has been characterized
to the increasingly ageing population,
unfavourable modern dietary habits and an increase in risk factors such as
smoking, low physical exercise and obesity.
There are different
strategies for screening and although the number of such strategies is
increasing due to the potential of emerging technologies in molecular marker
application, not all strategies meet the criteria required for screening tests
in population programs; the three most accepted tests are the fecal occult
blood test (FOBT), colonoscopy and sigmoidoscopy.
The design of genetic
and epigenetic marker panels that are able to provide maximum coverage in the
diagnosis of colorectal neoplasia seems a reasonable strategy. In coming years,
the use of DNA, RNA and protein markers in different biological samples has
been traverse as strategies for CRC diagnosis. Although there is not yet
sufficient evidence to recommend the analysis of biomarkers such as
DNA, RNA or proteins in the blood or stool, it is likely that given the quick advancement
of technology tools in molecular biology progressively sensitive and not so
expensive, these tools will gradually be employed in clinical practice and will
likely be developed in mass.
Colorectal metastatic
cancer treatment- Approximately half of the patients diagnosed with CRC
eventually develops metastases, mainly those of metachronic presentation. The
most common site for metastases occurrence is the liver.
This has made the
metastatic CRC therapeutic approach more complex, with multiple treatment
options that increasingly require a multidisciplinary medical team, which can
combine locoregional treatment of metastases with systemic treatment to obtain
disease resectability.
These treatments
include- Surgery, Local liver treatments, Chemotherapy, New drugs.
Chemotherapy remains
the cornerstone of systemic treatment today, but several new targeted drugs
have emerged in this filed in the last decade, improving the management of
metastatic disease. The recent advances in molecular biology and the genetic
classification of CRC are essential to individualize these therapies and will
be basic for improving the treatment in the next years.
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