Colorectal cancer: The issue of uniformity throughout the colon in light of molecular marker expression
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Colorectal Cancer: The Issue of Uniformity Throughout the Colon in Light of Molecular Marker Expression Original Article I. Oikonomakis Received 08/12/2010 Accepted 02/01/2011
Abstract
clinical behavior.
Aim-Background: Colorectal cancer has been classically viewed as the same disease entity. However, differences do exist between right and left sided lesions in terms of clinical features, gross macroscopic pathology and epidemiology. To date, intensive research of molecular markers focusing on this area has yielded ambiguous results. Using a comprehensive immunohistochemical analysis of those markers associated with cancer dynamics, namely mutational character, proliferation rate and apoptosis, this study attempts to clarify whether there is a different biological background in carcinogenesis between the right and left colon. Prognosis in association with molecular markers expression is also addressed, along with a brief review of the relevant literature. Patients and methods: In a retrospective review of a series of 109 colorectal cancer cases, p53, PCNA, Ki-67, bcl-2, and Bax were immunohistochemically determined. Patients were divided into two groups according to tumour location. There were 43 right side and 66 left side tumours. Results: No statistically significant differences were detected between right and left colon cancers, save Bax expression. Grade II right colon adenocarcinomas had a 4.5 higher probability of expressing inactivated Bax (p=0.015). For right colon stage B2 lesions the probability of mutational inactivation of Bax was 4.3 times higher (p=0.085). Location of the tumour was the only variable found to affect Bax expression; right colon lesions carried a 2.45 higher probability of expressing Bax inactivation compared to left colon. Conclusion: Significantly higher levels of inactivated proapoptotic Bax were established in moderate differentiation and B2 right colon cancer. Nevertheless, these values do not seem to impart different
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I. Oikonomakis 401 Hellenic Army General Hospital – 1st Surgical Dept, Athens, Greece e-mail: [email protected]
Colorectal cancer, Molecular markers, Right – left sited tumours
Introduction Colorectal cancer genetics has become the cornerstone of the recent research in the field, focusing on both inherited and sporadic disease. It is speculated that tumour development is the result of abnormal gene expression or function, directly or indirectly involved in the regulation of some aspect of cell proliferation. On the other hand, long known site-dependent differences both in macroscopic appearance and clinical features of colonic adenocarcinomas, in accordance with similar differences in prognosis and epidemiology, have led to the hypothesis that a different biological pattern exists between right and left-sided lesions. This study endeavours to examine the hypothesis that colon cancer varies according to its location in the right or left colon to such a degree that would allow the distinction of two different subtypes of the disease. Wit
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