Division of Gastroenterology Hepatology, Department of Internal Medicine, Faculty of Medicine Universitas Sumatera Utara - Adam Malik Hospital - Pirngadi Hospital, Medan, Indonesia.
Acta Med Indones. 2022 Jul;54(3):476-486.
This review highlights the most versatile diagnostic test of colonoscopy for CRC. It remains the gold standard diagnostic tools for CRC, and to prevent CRC by screening and removing the polyp or premalignant lesions. This work also provides the most promising biomarkers, which highlights the application of the novel biomarkers in conjunction with clinical and pathologic features have allowed for more individualized approaches and targeted therapy to patients with CRC.CRC is the third most common cancer diagnosed, and the second leading cause of cancer-related deaths worldwide. With a population totaling 273,523,621 people, Indonesia has an estimated of 396,914 new cases of all cancers and 234,511 cancer-related deaths. Among those cancer cases, an estimated of 34,189 new CRC cases and 17,786 CRC deaths occurred in 2020. Most of CRC cases were located in the rectum compared to those in the distal colon or proximal colon. Clinical signs, symptoms and therapeutic approaches vary, depending on the stage and the location of CRC. Those cancer locations are different in terms of their associated molecular alterations.Biomarker tests of tumor tissue from colonoscopy biopsy can help doctors to select a specific CRC treatment, and the tests can be used to determine prognostic value, predictive factors and the targeted therapy. Targeted therapies are recommended for advanced or mCRC patients with KRAS/NRAS/BRAF mutated or wild-type tumors, HER2-amplified tumors, and NTRK gene fusion-positive, while immunotherapy is only offered for tumor with MSI-High (dMMR) status. The biomarkers and targeting approaches against colorectal CSCs are being developed and will be quite challenging.
这篇综述强调了结肠镜检查在 CRC 诊断方面的多功能性。它仍然是 CRC 的金标准诊断工具，通过筛查和切除息肉或癌前病变来预防 CRC。这项工作还提供了最有前途的生物标志物，强调了新型生物标志物与临床和病理特征的结合应用，使针对 CRC 患者的个体化方法和靶向治疗成为可能。CRC 是全球第三大常见癌症，也是癌症相关死亡的第二大主要原因。印度尼西亚总人口为 273523621 人，估计有 396914 例新发癌症病例和 234511 例癌症相关死亡病例。在这些癌症病例中，估计 2020 年有 34189 例新的 CRC 病例和 17786 例 CRC 死亡病例。大多数 CRC 病例位于直肠，而不是远端结肠或近端结肠。临床症状、治疗方法因 CRC 的分期和位置而异。这些癌症位置在其相关的分子改变方面有所不同。来自结肠镜检查活检的肿瘤组织的生物标志物测试可以帮助医生选择特定的 CRC 治疗方法，并且可以用于确定预后价值、预测因素和靶向治疗。对于 KRAS/NRAS/BRAF 突变或野生型肿瘤、HER2 扩增肿瘤和 NTRK 基因融合阳性的晚期或 mCRC 患者，推荐使用靶向治疗，而免疫治疗仅用于 MSI-High（dMMR）状态的肿瘤。针对结直肠 CSCs 的生物标志物和靶向方法正在开发中，这将是非常具有挑战性的。
