Centre for Tumour Biology, Barts and the London School of Medicine and Dentistry, London, UK.
J Pathol. 2013 Mar;229(4):502-14. doi: 10.1002/path.4157.
Classically, the risk of cancer progression in premalignant conditions of the gastrointestinal tract is assessed by examining the degree of histological dysplasia. However, there are many putative pro-cancer genetic changes that have occurred in histologically normal tissue well before the onset of dysplasia. Here we summarize the evidence for such pre-tumour clones and the existing technology that can be used to locate these clones and characterize them at the genetic level. We also discuss the mechanisms by which pre-tumour clones may spread through large areas of normal tissue, and highlight emerging theories on how multiple clones compete and interact within the gastrointestinal mucosa. It is important to gain an understanding of these processes, as it is envisaged that certain pre-tumour changes may be powerful predictive markers, with the potential to identify patients at high risk of developing cancer at a much earlier stage.
从经典意义上讲，通过检查组织学异型增生的程度来评估胃肠道癌前状态下癌症进展的风险。然而，在异型增生发生之前，组织学正常的组织中已经发生了许多潜在的促癌遗传改变。在这里，我们总结了这些肿瘤前克隆的证据，以及可用于定位这些克隆并在遗传水平上对其进行特征描述的现有技术。我们还讨论了肿瘤前克隆如何在大面积正常组织中扩散的机制，并强调了关于多个克隆在胃肠道黏膜内如何竞争和相互作用的新理论。了解这些过程非常重要，因为某些肿瘤前变化可能是强有力的预测标志物，可以在更早的阶段识别出癌症风险较高的患者。
