Colorectal Cancer

1 The Causes of Colorectal Cancer.- Descriptive Epidemiology and Temporal Trends.- The Environment and Colorectal Cancer.- Diet and Micronutrients.- Physical Activity, Obesity and Energy Imbalance.- Hormonal Factors.- Smoking and Alcoholic Beverages.- Inflammatory Bowel Diseases.- Drugs.- Colorectal Polyps and the Adenoma-Carcinoma Sequence.- Familial and Hereditary Factors.- Familial Colorectal Cancer.- Hereditary Non-polyposis Colorectal Cancer.- Familial Adenomatous Polyposis.- Gene-Environment Interactions.- Conclusions.- References.- 2 Pathogenesis of Colorectal Cancer.- Main Causes of Colorectal Cancer.- Pathogenesis of Colorectal Cancer: Different Molecular Pathways for One Disease.- Sporadic Colorectal Cancer Development (Loss of Heterozygosity Pathway).- Tumor Development in FAP and Other Polyposis Syndromes.- Colorectal Tumorigenesis in HNPCC (Mutator Genes/Microsatellite Instability Pathway).- The Mitotic Checkpoint Gene Mutation Pathway.- Colorectal Cancer Development in Inflammatory Bowel Diseases.- Tumor Development Through the I1307 K Mutation of the APC Gene: Some Clues to Familial Cancer.- Conclusions.- References.- 3 Pathology of Colorectal Cancer.- The Colorectal Mucosa.- Normal Architecture.- Cell Proliferation.- Aberrant Crypts.- Adenomatous Polyps.- Descriptive Epidemiology.- Distribution, Size and Multiplicity.- Histopathology, Dysplasia and “Malignant Polyps”.- Adenomas in Familial Adenomatous Polyposis and Hereditary Non-polyposis Colorectal Cancer.- The Adenoma-Carcinoma Sequence.- Etiology of Adenomatous Polyps.- Other Types of Polyps.- Hyperplastic, Mixed Polyps and Serrated Adenomas.- Flat Adenomas.- Hamartomatous Polyps.- Polyps and Dysplasia in Inflammatory Bowel Diseases.- Other Benign Tumors.- Colorectal Carcinoma.- Adenoma-Carcinoma Sequence Versus “De Novo” Carcinogenesis.- Macroscopic Appearance.- Histological Features and Grading.- Pattern of Metastasis and Staging.- Other Tumors of the Large Bowel.- Conclusions.- References.- 4 Diagnosis and Clinical Features of Colorectal Cancer.- Clinical Findings: Symptoms and Signs.- Laboratory Investigations.- Diagnosis of Colorectal Cancer: Old Methods and Recent Imaging Techniques.- Imaging Studies in Primary Cancer.- Imaging Studies in the Diagnosis of Recurrent or Metastatic Disease.- Conclusions.- References.- 5 Colorectal Cancer Screening and Surveillance.- Colorectal Cancer Screening in the General Population.- Role of Fecal Occult Blood Testing.- Role of Sigmoidoscopy.- Role of Colonoscopy and Barium Enema.- New Screening Procedures Based on Molecular Analysis.- Screening in Individuals with Familial Colorectal Cancer.- Understanding the Nature of the Familial Risk.- Screening Recommendations for Individuals with Familial Risk.- Surveillance After Endoscopic Polypectomy.- Surveillance After Surgery for Colorectal Cancer.- Surveillance in Patients with Inflammatory Bowel Disease.- Surveillance in Hereditary Cancer Syndromes.- Familial Adenomatous Polyposis.- Hereditary Non-polyposis Colorectal Cancer.- Conclusion: Media, Society and Colorectal Cancer Screening.- References.- 6 Prevention and Chemoprevention of Colorectal Neoplasms.- Can We Prevent Colorectal Cancer with an Appropriate Diet?.- Can We Prevent Colorectal Cancer by Modifying Our Lifestyle?.- Secondary Prevention: Is the Removal of Adenomas Effective?.- Colorectal Cancer Prevention Under Special Conditions.- Chemoprevention of Colorectal Cancer.- General Concepts of Chemoprevention.- Main Compounds Used in the Chemoprevention of Colorectal Tumors.- Conclusions.- References.- 7 Treatment of Colorectal Cancer.- Staging Colorectal Neoplasms.- Treatment of Resectable Colorectal Tumors.- Endoscopic Treatment of Malignant Polyps.- Surgical Treatment of Resectable Tumors of the Colon.- Surgical Treatment of Resectable Tumors of the Rectum.- Medical Treatment of Colorectal Tumors.- Radiation Treatment of Rectal Cancer.- Management of Locally Recurrent Cancer.- Treatment of Advanced Colorectal Tumors.- Surgical Treatment of Metastatic Colorectal Cancer.- Chemotherapy for Advanced Colorectal Cancer.- Toxicity and Cost of Chemotherapy in Advanced Colorectal Cancer.- Other Treatments for Advanced Colorectal Neoplasms.- Innovative Treatments for Colorectal Cancer.- Conclusions.- References.- 8 Survival and Follow-up of Colorectal Cancer.- Factors Influencing Colorectal Cancer Survival.- Gender, Age and Stage at Diagnosis.- Morphological and Clinical Indicators.- Cell Replication, Nuclear Ploidy and Colorectal Cancer Survival.- Molecular Markers of Prognosis.- Micrometastases and Prognosis.- Temporal Trends and Ethnic Differences in Colorectal Cancer Survival.- Follow-up of Colorectal Cancer Patients.- Proposed Surveillance Programs After Colorectal Cancer Resection.- Controlled Studies Evaluating the Effectiveness of Follow-up.- Conclusions.- References.- 9 Cancer of the Anal Canal.- Epidemiology of Anal Cancer.- Descriptive Epidemiology.- Risk Factors.- Clinical Features and Pathology.- Treatment of Cancer of the Anus.- Radiotherapy Alone.- Combination Therapy.- Conclusions.- References.- 10 Hereditary Non-polyposis Colorectal Cancer (Lynch Syndrome).- Brief History of HNPCC.- Epidemiology and Frequency of Lynch Syndrome.- Formal Genetics and the Role of Family History.- Clinical Features of HNPCC.- Age at Diagnosis and Preferential Location in the Right Colon.- Multiple Tumors.- Tumor Spectrum.- Pathology of HNPCC.- Molecular Biology of HNPCC.- DNA Mismatch Repair in Bacteria.- Human Mismatch Repair Genes in Lynch Syndrome.- Microsatellite Instability: the MSI+ Phenotype.- Microsatellite Instability and Cancer Development.- Frequency of Mutations in HNPCC Families.- New Genes Predisposing to HNPCC.- Diagnosis of HNPCC.- Identification of HNPCC.- Suspected HNPCC.- Genetic Counseling in HNPCC.- Management and Survival.- Treatment and Follow-up.- Survival.- Conclusions.- References.- 11 Familial Adenomatous Polyposis.- Definition and Historical Overview.- Epidemiology and Formal Genetics.- Diagnosis, Clinical Features and Morphology.- Colorectal Lesions.- Extracolonic Manifestations.- Molecular Biology of FAP.- The APC Gene and Its Functions.- Genotype-Phenotype Correlations.- Methods for Study of the APC Gene.- Management of Familial Adenomatous Polyposis.- The Role of Counseling in the Diagnosis and Surveillance of Adenomatosis Coli.- Surgical Treatment of FAP.- Overall Prognosis and Follow-up.- Medical Treatment.- Conclusions.- References.- 12 Other Polyposis of the Large Bowel.- Peutz-Jeghers Syndrome.- Clinical Manifestations and Morphology.- Molecular Biology of PJS.- Management.- Juvenile Polyposis.- Phenotypic Characteristics, Genetics and Cancer Risk.- Molecular Biology and Genetic Heterogeneity of JP.- Management of JP.- Cowden’s Disease.- Clinical Manifestations and Morphology.- Molecular Basis of CD.- Management of CD.- Turcot Syndrome.- Clinical and Morphologic Aspects of TS.- Complex Genetic and Molecular Basis of TS.- Management of TS.- Muir-Torre Syndrome and Other Rare Polyposis.- Clinical and Morphologic Features of MTS.- Molecular Biology of MTS.- Management of MTS.- Cronkhite-Canada Syndrome.- Bannayan-Riley-Ruvalcaba Syndrome.- Conclusions.- References.- 13 Carcinoid Tumors of the Large Bowel.- Brief History.- Biology and Pathology of CT.- Clinical Features of Colorectal CT.- Diagnosis and Treatment of CT of the Large Bowel.- Diagnosis of CT.- Treatment of the Primary Tumor.- Treatment of Metastatic CT.- Conclusions.- References.- 14 Colorectal Cancer at the Beginning of the New Millennium.- The Colorectal Cancer Epidemic.- Gene-Environment Interaction.- Dealing with Colorectal Cancer Patients in the “Molecular Era”.- References.