Hereditary Colorectal Cancer

Since the success in chemical induction of cancer in rabbit's ear skin by K. Yamagiwa in 1915, oncologists of the world have come to believe that they can only solve their problems by means of animal experimen tation. The importance of environmental factors became moreevident in 1935 when T. Yoshida and T. Sasaki introduced azodye hepatocarcino genesis in rats. In the domain of the gastrointestinal tract, T. Sugimura has more recently accumulated enough evidence to indicate that locally active chemical mutagens are carcinogenic. In contrast, principal approaches to colorectal tumors have been quite different: emphasis has been placed on gene identification. Long before cancer of the large bowel was recognized, importance of the roles of adenomatosis coli and its familial occurrence attracted the attention of epidemiologists and geneticists. Morphological characteri zation and analysis of hereditary trends of human material have already bad a long history, and recently detailed analysis of genetic material has become feasible in the wake of rapid development in our knowledge of the oncoviruses, oncogenes, suppressor genes, chromosomal and DNA mapping, molecular mutation and so on. lt is true that in colorectal pathology, and in no other field, these areas of research have been explored more extensively and decisively. The identification of previ ously ill-defined lesions such as precancers and benign neoplasms have been improved because sequential changes can be observed in multiple samples spread over a wide area and followed up in due course.

It is 1946, and a young man stares out his third-story apartment window. He has returned from the war with metastatic cancer and assumes he will die, leaving his wife and infant daughter behind. Instead, he lives another twenty-four years, raising a family of four children, before he succumbs to a second colon cancer. His son, the author, recognizes that there is a hereditary cancer syndrome in the family and resolves to solve the problem as a medical researcher. Eventually, hereditary colorectal cancer is recognized as a medical entity, and multiple genes responsible for this hereditary condition are isolated. However, the mutation responsible in the author’s family escaped detection. In 2001, his laboratory identifies the mutation responsible for the problem and develops a specific test for the family. This permits the mutation carriers to obtain life-saving care, altering the natural history of the disease for his family and others.

Colorectal cancer is the third most commonly diagnosed cancer in the US and the third most recently linked to cancer deaths. The national annual incidence rate of colorectal cancer is approximately 148,000+, striking slightly more females than males. The lifetime risk of colorectal cancer is 5-6%, however patients with a familial risk (with two or more first or second degree relatives) make up 20% of the patients. Persons who carry genetic mutations linked to hereditary colorectal cancer are the most likely to develop the disease.

This book provides information on a wide variety of issues ranging from genetics to clinical description of the syndromes, genetic testing and counseling, and clinical management including surveillance, surgical and prophylactic interventions, and chemoprevention. Moreover, current hot issues, such as the identification of novel causal genes and the challenges we face, and the relevance of cancer risk modifiers, both genetic and environmental, are also discussed. This reference book is great for geneticists, oncologists, genetic counselors, researchers, clinicians, surgeons and nurses dedicated to, or interested in, hereditary cancer. The best and most recognized experts in the field have contributed to this project, guaranteeing updated information, accuracy and the discussion of topical issues.

This book provides a comprehensive review of the clinical management of hereditary colorectal cancer. The text focuses on six distinct patient groups: patients with early age-of-onset colorectal cancer and adenomas, patients with hamartomatous colorectal polyps, patients afflicted with familial adenomatous polyposis (FAP), patients with attenuated familial adenomatous polyposis (AFAP), patients with MYH associated polyposis (MAP), and patients afflicted with lynch syndrome (LS). Each chapter illustrates how clinicians utilize current technologies in genetic testing, pathological review, and endoscopic, surgical, and chemotherapeutic/immunotherapeutic approaches to manage these patient groups. Topics such as the timing of genetic testing, endoscopic screening and surveillance, prophylactic surgical options and chemo-preventive interventions are also discussed in concise yet precise detail. Written by experts in their fields, Management of Hereditary Colorectal Cancer: A Multidisciplinary Approach is a valuable and timely resource for gastroenterologists, surgeons, genetic counselors, medical oncologists, psychologists, and any health caregivers involved with the management of patients and families afflicted with a hereditary form of colorectal cancer.

Genetic susceptibility refers to how variations in a person’s genes increase or decrease his or her susceptibility to environmental factors, such as chemicals, radiation and lifestyle (diet and smoking). This volume will explore the latest findings in the area of genetic susceptibility to gastrointestinal cancers, focusing on molecular epidemiology, DNA repair, and gene-environment interactions to identify factors that affect the incidence of GI cancers. Topics will include germline susceptibility, including Mendelian patterns of inheritance and gene-environment interactions that lead to cancer etiology.

Colorectal cancer is a common cause of morbidity and mortality in which prevention, screening and early detection are vital. Beginning with the patient perspective and following the patient pathway, this new second edition covers epidemiology and prevention, screening programmes, decision support networks, the role of primary care, and supportive care for patients with colorectal cancer. The ABC of Colorectal Cancer provides the core knowledge on clinical genetics, diagnosis, imaging, therapy and surgery options and the latest evidence based guidelines for treating and managing colorectal cancer patients within the multidisciplinary team. Highly illustrated and accessible, it covers the full spectrum of the disease to provide the basis to make a real difference to clinical management. This is an invaluable practical guide for the non-specialist on all aspects of colorectal cancer, and is ideal for general practitioners, junior doctors, nurses and allied health professionals.