Abstract
Colorectal cancer (CRC) is a complex disease with at least three distinct molecular pathways of carcinogenesis termed as chromosomal instability (CIN), microsatellite instability (MSI) and CpG island methylator phenotype (CIMP). Most CRC cases are sporadic while hereditary nonpolyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP) represent the inherited tumor syndromes. CRC is mostly asymptomatic until disease progression and most of the CRC cases are detected at advanced stages, responsible for poor survival and high mortality. Many efforts have been made to study the molecular patterns of CRC and there is growing evidence to suggest how they affect the tumor characteristics, prognosis and response to therapy. Identification of MSI status of CRC is indispensable for diagnosing Lynch syndrome while detecting KRAS mutation in metastatic disease predicts response to anti-EGFR monoclonal antibodies. Currently CRC screening and diagnosis is largely based on colonoscopy while fecal occult blood tests (FOBT) and serum based carcinoembryonic antigen (CEA) assays lack sensitivity and specificity. PCR based techniques, DNA sequencing and immunohistochemistry are mainstay of studying molecular patterns of CRC.
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