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Original Article
TFAP2E–DKK4 and Chemoresistance in Colorectal Cancer
The treatment options and prognosis for patients with advanced colorectal cancer have improved through the development of novel drugs. However, studies of the molecular biology of cancer initiation and progression have so far provided scant knowledge of the molecular mechanisms contributing to…
Case Records of the Massachusetts General Hospital
Case 13-2011 — A 49-Year-Old Man with Adenocarcinoma of the Rectum
Presentation of Case. A 49-year-old man was seen in the cancer center at this hospital for management of adenocarcinoma of the rectum. The patient had been well until approximately 3 months earlier, when he noted blood in his stools, without pain. Ten weeks before this evaluation, he saw his…
- Video
Editorial
The Spindle-Assembly Checkpoint, Aneuploidy, and Gastrointestinal Cancer
Genomic instability is a common occurrence in solid tumors, and it has long been conjectured that this process plays a causal role in cancer. The field of human molecular genetics has provided a means to test this hypothesis, fueled in part by the analysis of hereditary cancer-predisposition…
Original Article
Brief Report: Homozygous BUB1B Mutation and Susceptibility to Gastrointestinal Neoplasia
All cancers contain numerous alterations in DNA, some of which are heritable. Genomewide surveys of several tumor types have shown that most solid tumors accumulate a large number of mutations that affect several different pathways. Tumors that have many mutations may have acquired them as a result…
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In a man with a BUB1B mutation, multiple gastrointestinal polyps and gastric and colonic aneuploid neoplasms developed. Abnormalities affecting the spindle-assembly checkpoint, which ensures that each daughter cell of a cell division contains the correct number of chromosomes, may contribute to common types of cancer.
Case Records of the Massachusetts General Hospital
Case 19-2010 — A 35-Year-Old Man with Adenocarcinoma of the Cecum
Presentation of Case. A 35-year-old man was seen in the outpatient cancer center of this hospital because of adenocarcinoma of the cecum. The patient had been well until approximately 3 weeks before this evaluation, when he passed bright red stools on several days and discomfort developed in the…
- CME
A 35-year-old man was seen in the outpatient cancer center at this hospital because of adenocarcinoma of the cecum. Three weeks earlier, he had passed bright red blood in the stool. Imaging studies revealed a mass in the cecum and the peritoneal and omental nodules. Colonoscopic-biopsy specimens of the cecal mass revealed adenocarcinoma. There was no family history of cancer. A management decision was made.
Original Article
Quality Indicators for Colonoscopy and the Risk of Interval Cancer
Although colonoscopy is widely used for colorectal-cancer screening,– its miss rate for cancers and adenomatous polyps (benign premalignant tumors or adenomas), which is low but not negligible, remains a concern.– It has been suggested that a high-quality examination that ensures the detection…
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In this large study of colorectal-cancer screening, the endoscopist's rate of adenoma detection was associated with the risk of interval colorectal cancer after screening colonoscopy. Colorectal cancers were less likely to be diagnosed between screening examinations when colonoscopies were performed by endoscopists with an adenoma detection rate of 20% or more.
Review Article
Molecular Origins of Cancer: Molecular Basis of Colorectal Cancer
Every year in the United States, 160,000 cases of colorectal cancer are diagnosed, and 57,000 patients die of the disease, making it the second leading cause of death from cancer among adults. The disease begins as a benign adenomatous polyp, which develops into an advanced adenoma with high-grade…
This review gives an account of recent advances in our knowledge of the molecular mechanisms in colorectal cancer. Genetic changes in the germ line, combined with somatic mutations, occur in familial syndromes of colorectal cancer, whereas somatic mutations are the outstanding feature of sporadic colorectal cancer. Genetic changes drive the progression from adenoma to carcinoma and probably influence individual susceptibility and response to treatment.
Correspondence
Capsule Endoscopy versus Colonoscopy
To the Editor: The article by Van Gossum et al. (July 16 issue) and the corresponding editorial by Bretthauer describe a low sensitivity of colon capsule endoscopy as compared with colonoscopy for the detection of advanced neoplasia. The overall rate of detection of advanced neoplasia in a…
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Clinical Practice
Screening for Colorectal Cancer
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A healthy 76…
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A healthy 76-year-old woman presents as a new patient for primary care. She reports having one daily bowel movement and no rectal bleeding. She has no family history of colorectal cancer. She reports having negative stool-card tests during gynecologic examinations, most recently at 65 years of age. Would you advise this patient to undergo colon-cancer screening, and if so, what test would you recommend?
Editorial
The Capsule and Colorectal-Cancer Screening — The Crux of the Matter
In the United States and other countries, colonoscopy has emerged as the primary screening test for colorectal cancer. Colonoscopy is believed to prevent colorectal cancer because polyps are removed during the procedure, but randomized trials have not been conducted to show this benefit. Because…
Original Article
Capsule Endoscopy versus Colonoscopy for the Detection of Polyps and Cancer
Optical colonoscopy (henceforth referred to as colonoscopy) is currently considered to be the standard procedure for colon evaluation and screening for colorectal cancer, despite some limitations, such as the invasiveness, the suboptimal performance of colonoscopy, and the poor bowel preparation in…
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This study assessed the ability of a capsule endoscope to detect the colorectal polyps and cancer seen with optical colonoscopy. The sensitivity and specificity of capsule endoscopy for the detection of advanced adenomas were 73% and 79%, respectively. These findings demonstrate the relatively low sensitivity of capsule endoscopy and do not support its use for colorectal-cancer screening at this time.
Correspondence
BRAF Mutation in Metastatic Colorectal Cancer
To the Editor: We recently found that progression-free survival was shorter among patients with metastatic colorectal cancer treated with chemotherapy, bevacizumab, and cetuximab (CBC regimen) than among patients who received chemotherapy and bevacizumab alone (CB regimen) (Feb. 5 issue). Other…
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Correspondence
Cetuximab for Metastatic Colorectal Cancer
To the Editor: As a gastroenterologist who claims to have been the first physician in Connecticut to give fluorouracil to a patient with colon cancer, I was delighted to read in the Conclusions of the Abstract of the article by Van Cutsem et al. (April 2 issue) that "First-line treatment with…
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Correspondence
Chemotherapy and Immunotherapy in Metastatic Colorectal Cancer
To the Editor: Tol et al. (Feb. 5 issue) report that the addition of cetuximab to a combination of capecitabine, oxaliplatin, and bevacizumab reduced progression-free survival among patients with metastatic colorectal cancer, regardless of the KRAS status of the tumor. Similar results with…
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Original Article
Cetuximab and Chemotherapy as Initial Treatment for Metastatic Colorectal Cancer
Colorectal cancer is the third most common cancer worldwide. Approximately 25% of patients with colorectal cancer present with overt metastatic disease, and metastatic disease develops in 40 to 50% of newly diagnosed patients. Standard first-line treatments include fluorouracil with leucovorin and…
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Previous trials have shown that the combination of fluorouracil-based chemotherapy and cetuximab is active when used as salvage treatment in patients with metastatic colorectal cancer; the present trial shows activity of this combination as first-line treatment as well. The trial also found that for cetuximab to be active, an unmutated KRAS gene in the tumor was required.
Correspondence
Medical Mystery: Constipation — The Answer
To the Editor: The medical mystery in the January 22 issue involved a 56-year-old woman with a medical history of scoliosis and chronic constipation who presented with shortness of breath and cough of 10 days' duration. Plain films and computed tomography (CT) of the chest revealed dilated colonic…
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Editorial
Targeted Therapy for Advanced Colorectal Cancer — More Is Not Always Better
During the past few years, the outlook for patients with colorectal cancer has brightened considerably. Fluorouracil, an inhibitor of thymidylate synthase (and therefore DNA synthesis), was until recently the only effective systemic treatment for this disease. Fluorouracil is usually administered…
Original Article
Chemotherapy, Bevacizumab, and Cetuximab in Metastatic Colorectal Cancer
Fluoropyrimidines (e.g. fluorouracil and capecitabine), irinotecan, and oxaliplatin are the standard cytotoxic drugs used in treating metastatic colorectal cancer. The combination of capecitabine and oxaliplatin is similar to the combination of fluorouracil and oxaliplatin in efficacy and safety.…
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Capecitabine, oxaliplatin, and bevacizumab are standard treatment for metastatic colorectal cancer. This trial tested whether adding cetuximab to this combination is beneficial. The addition of cetuximab resulted not only in shorter progression-free survival than standard treatment but also in a reduced quality of life.
Correspondence
Accuracy of CT Colonography for Colorectal Cancer Screening
To the Editor: Johnson et al. (Sept. 18 issue) discuss the use of computed tomographic (CT) colonography as a noninvasive option in screening for colorectal cancer, with optical colonoscopy and histologic review serving as the reference standard. Two important points merit discussion. First,…
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Original Article
Effect of Aspirin or Resistant Starch on Colorectal Neoplasia in the Lynch Syndrome
The regular use of aspirin or aspirin-like agents is associated with a moderate reduction in the risk of colonic polyps and colorectal cancer.– Randomized trials of high-fiber diets have not shown a reduction in the risk of adenomas or colorectal cancer, but none have investigated the effects of…
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