Broadsheet number 52: Molecular genetics of colorectal cancer

Pathogenesis of colorectal cancer

It is frequently stated that all but a few colorectal cancers arise in adenomatous polyps, in turn initiated by APC mutation. Moderation of this view is now required. The proportion of colorectal cancers that arises in a polypoid adenoma is likely to be around 70% [39,61]. The pre-eminence of the adenoma-carcinoma model has been influenced by two factors: (1) the need to avoid overtreatment of innocent lesions, and (2) the absence of a convincing alternative mechanism. The latter position has changed in recent years. Collectively, the alternative pathways may account for the pathogenesis of up to 30% of colorectal cancers. The alternative pathways are difficult to observe in clinical practice because the precursors may be either inconspicuous or show rapid evolution following the establishment of genetic instability. As a concept, the polyp-cancer sequence is entrenched in both specialized and student texts. This is unfortunate, because progress in prevention and early cancer detection will be delayed by the failure to adopt a critical and nondogmatic approach to the pathogenesis of colorectal cancer. The advent of DNA chip technology will catalyze the development of revised paradigms. Specifically, modern genomics will allow polyps and cancers to be grouped within pathogenic pathways on the basis of shared gene expression profiles. The era of molecular medicine has dawned for colorectal cancer.

Proteome study of colorectal carcinogenesis

Development of cancer is a complex process involving multiple changes in gene expression. To unravel these alterations, a proteome approach aimed at the identification of qualitative and quantitative changes in protein composition, including their post-translational modifications, attracts great attention. Our study was focused on the identification of proteins whose amount is altered in the course of malignant transformation of colon mucosa. Proteins extracted from tissue specimens or cell lysates were separated by two-dimensional gel electrophoresis (2-DE). Comparative analyses of 2-DE protein patterns were done using computerized image analysis. Selected proteins exhibiting statistically significant abundance alterations comparing healthy and diseased tissues were identified by mass spectrometry. Globally, we have found 57 proteins that exhibited either a significant decrease or increase in amount in pathological tissues, and 18 of these were annotated by mass spectrometry. The alterations in the expression of nine proteins were common for both precancerous and neoplastic tissues suggesting their role in colon tumorigenesis. The epithelial origin of all identified spots was checked in two cell lines Caco-2 and DLD-1 originating from well-differentiated and poorly differentiated colon carcinoma, respectively.

Molecular and cellular biology of pre-malignancy in the gastrointestinal tract

Important pathogenic alterations within established cancers are acquired during the pre-malignant stage. These genetic alterations can be grouped into specific neoplastic pathways that differ within and between anatomical sites. By understanding the mechanisms that determine the initiation and progression of each pathway, it will be possible to develop novel approaches to the diagnosis, prevention and treatment of cancer. This chapter outlines the principles underlying the molecular characterization of pre-malignant lesions, taking colorectal neoplasia as the main model.