Heterogeneity of colorectal adenomas, the serrated adenoma, and implications for screening and surveillance
Heterogeneity of colorectal adenomas, the serrated adenoma, and implications for screening and surveillance
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DOI：
10.3748/wjg.14.3461
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发表时间：
2008-06-14
影响因子：
4.3
通讯作者：
Freeman, Hugh James
中科院分区：
文献类型：
--
作者：
Freeman, Hugh James
目前用于结肠癌筛查和监测的算法是有价值的，但可能受到靶向肿瘤病变的潜在性质的限制。尽管腺瘤切除的成功部分与所谓的“腺瘤-癌序列”的中断有关，但通往结肠癌的另一种锯齿状途径可能会给传统结肠镜方法取得的最终结果带来困难。这种独特途径的终点癌可能来源于发育不良的锯齿状腺瘤。这些往往主要位于右结肠，特别是在女性中，并且经常与共存的结肠癌相关。然而，不幸的是，几乎没有其他可识别的风险因素，包括年龄或结肠息肉或结肠癌的家族史。此外，这种交替的锯齿状途径本身也可能是相当生物异质性的，如无蒂锯齿状腺瘤（SSA）所反映的，其具有由BRAF或KRAS突变的存在所定义的几乎唯一的分子特征。未来的筛查算法可能需要修改和个性化，这取决于可能出现在这些生物异质性病变的自然史上的新信息，这些病变不同于传统的腺瘤性息肉。(C)2008年，WIG出版社。All rights reserved.
Current algorithms for screening and surveillance for colon cancer are valuable, but may be limited by the underlying nature of the targeted neoplastic lesions. Although part of the success of adenoma removal relates to interruption of so-called "adenoma-carcinoma sequence", an alternate serrated pathway to colon cancer may pose difficulties with the ultimate results achieved by traditional colonoscopic methods. The endpoint carcinoma in this unique pathway may be derived from a dysplastic serrated adenoma. These tend to be located primarily in the right colon, especially in females, and are frequently associated with coexistent colon cancer. Unfortunately, however, there are few, if any, other identifiable risk factors, including age or family history of colon polyps or colon cancer. Moreover, this alternate serrated pathway may itself also be quite biologically heterogeneous as reflected in sessile serrated adenomas (SSA) with virtually exclusive molecular signatures defined by the presence of either BRAF or KRAS mutations. Screening algorithms in the future may need to be modified and individualized, depending on new information that likely will emerge on the natural history of these biologically heterogeneous lesions that differs from traditional adenomatous polyps. (C) 2008 The WIG Press. All rights reserved.