Foundations of Colorectal Cancer

1st Edition - October 28, 2021
Editor: Alejandro Pazos Sierra
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 9 0 0 5 5 - 3
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 8 8 5 7 1 - 3

Foundations of Colorectal Cancer provides a holistic and comprehensive dive into colorectal cancer, discussing the contributions of each discipline that studies it, allowing its un… Read more

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Foundations of Colorectal Cancer provides a holistic and comprehensive dive into colorectal cancer, discussing the contributions of each discipline that studies it, allowing its understanding from the most demographic and ethical facts, to the treatment process, its varieties and genetic background. Written by experts in diverse areas such as cancer research, oncology, genetics, biochemistry, psychology, social sciences, bioinformatics and palliative care, the book brings real-world experiences to help readers with any challenge they may face when dealing with patients or during their research workflow.

The content is split into nine sections: Clinical manifestations and disease detection, covering primary and secondary prevention, and the role of primary care; Diagnosis and staging, discussing endoscopy, colonoscopy, molecular pathology, and anatomopathological diagnosis; Treatment, including endoscopic, surgical, radiological, and postoperative approaches; Molecular and biological mechanisms, with the role of intestinal microbiota, stem cells and signaling pathways; New diagnostic methods, encompassing biomarkers and bioinformatics tools for research; Biobanks, with an overview of their regulations and importance in the research; Epidemiological studies, focusing on incidence and mortality globally and by regions; Hereditary colorectal cancer, differentiating nonpolyposis and polyposis types; and Addressing the consequences of colorectal cancer, covering psychological effects, nutrition and ethical issues.

Cover image
Title page
Table of Contents
Copyright
Contributors
Editor’s note
Prologue
Acknowledgments
Section A: Epidemiological studies in CRC
Chapter 1: Incidence and mortality of CRC
Abstract
Incidence
Mortality
Discussion
Chapter 2: Prognosis and follow-up of CRC patients: Role of diagnostic and therapeutic delay
Abstract
Survival and prognosis
Follow-up strategies
Quality of life and long-term sequelae
Impact of diagnostic and therapeutic delay on stage and prognosis
Section B: Clinical manifestations and disease detection
Chapter 3: Primary prevention of CRC
Abstract
Introduction
Epidemiology and CRC
Environment and CRC
Diet
Foods recommended to be reduced
Food and drink recommended to be increased
Lifestyle behaviors
Therapeutic strategies linked to lowering CRC risk
Dietary patterns and CRC
Relationship between dietary index and CRC
Summary: Evidence and recommendations
Chapter 4: Early onset of CRC
Abstract
Introduction
Exposure to environmental factors
Microbiota alteration
Hereditary factors
Molecular differences
Clinical features
Conclusions
Chapter 5: Population-based universal screening for CRC: Secondary prevention
Abstract
Secondary prevention and screening concept
Colorectal cancer screening tests
Requirements for the implementation of a screening program
Situation of screening in Spain
Chapter 6: The role of primary care in early referral of CRC patients
Abstract
The role of primary care in the early release of patients with CRC7,8
Prevention and promotion of health9, 10
Early diagnosis11
Monitoring of index or precursor injuries (polyps)
CRC of family/hereditary characteristics16, 17
Chapter 7: Rapid diagnostic pathways for patients with suspected CRC
Abstract
Clinical pathways
Rapid diagnosis pathways for colorectal cancer
Published research
Possibilities for increasing effectiveness of CRC rapid pathways
Conclusions
Section C: Diagnosis and staging
Section C.I: Current diagnosis methods in colorectan cancer
Chapter 8: Colon capsule endoscopy
Abstract
Introduction
Technical characteristics of the second-generation colon capsule
Preparation of the patient
Comparative studies between colon capsule endoscopy and colonoscopy
Comparative studies between CCE and colonography by computerized axial tomography
Current indications and contraindications of the colon capsule endoscopy: Future perspectives
Conclusions
Chapter 9: Endoscopic ultrasound in CRC
Abstract
Outline of technique
EUS for rectal cancer staging
Interventional EUS
Conclusion
Chapter 10: CT-Colonography (CTC): Technical requirements, indications and current status
Abstract
Introduction
Technical requirements
Indications for virtual colonoscopy
Clinically significant findings in CTC
Conclusions
Chapter 11: Rectal pathology: Findings at CT-Colonography
Abstract
Introduction
Technical considerations
Rectal pathology
Conclusion
Chapter 12: Applications of [18F] FDG PET and PET/CT in colorectal carcinoma
Abstract
Introduction
Staging
Restaging
Others: Incidental diagnosis of colorectal cancer. Assessment of treatment response
New perspectives
Chapter 13: Magnetic resonance imaging (MRI) in staging and restaging after neoadjuvant therapy
Abstract
Introduction
Total mesorectal excision
Key anatomical references
Local staging
Restaging after neoadjuvant treatment
The structured radiology report
Locoregional recurrence
Chapter 14: Histopathological diagnosis of CRC
Abstract
Introduction
Histopathological diagnosis of CRC in biopsies and endoscopic polypectomies
Anatomopathological diagnosis of CRC in surgical specimens
Histopathological types of colorectal neoplasms
Biomarkers in CRC
Chapter 15: Colonoscopy: Technique and quality factors
Abstract
Historical introduction
Colorectal cancer
Colonoscopy technique
Magnification techniques
Classification of colorectal polyps
Serrated pathway in CRC
Colonoscopy in the diagnosis of CRC in medium-risk populations
Colonoscopy in the diagnosis of CRC in high-risk populations
Colonoscopy quality indicators
Endoscopic iconography
Chapter 16: Endoscopic diagnosis of preneoplastic and neoplastic lesions
Abstract
Introduction
Identification of lesions
Characterization of lesions
Role of colonoscopy in the diagnostic of advanced colonic lesions
Chapter 17: Oligometastatic disease
Abstract
Chapter 18: Hereditary nonpolyposis CRC
Abstract
Introduction
Genetic basis
Molecular identification of Lynch syndrome
Clinical features
Diagnosis of Lynch syndrome (HNPCC) and criteria for referral to a genetic counseling unit (GCU)
Molecular study strategy
Predictive models
Clinical controls and surveillance
Other entities
Conclusions
Chapter 19: Hereditary polyposis CRC
Abstract
Adenomatous polyposis syndromes: Familial adenomatous polyposis and MUTYH-associated polyposis
Genetics
Clinical symptoms
Diagnostics
Monitoring of healthy individuals with classic PAF
Follow-up of healthy individuals with AFAF
Treatment of FAP
Treatment of AFAP
Chemoprevention
Other inherited adenomatous polyposis syndromes
Hamartomatous polyposis syndrome
Juvenile polyposis syndrome
Cowden syndrome
Rare hereditary hamartomatous polyposis syndromes
Section C.II: New tools of diagnosis in CRC
Chapter 20: Diagnostic, prognostic, predictive and therapeutic molecular biomarkers in CRC: Understanding the present and foreseeing the future
Abstract
Introduction
What are biomarkers? Concept and classification
Blood and stool biomarkers for CRC screening
RAS: K-RAS and N-RAS, the current key for precision medicine in CRC
B-RAF mutation in colorectal cancer
EGFR/HER FAMILY/TP53-APC/β-CATENINS/C-MET as prognostic indicators
miRNAs, small players with large potential
Aberrant DNA methylation in CRC
Microbial markers in CRC prognosis and therapeutics
New insights in CRC biomarkers, recent advances, and future challenges
Concluding remarks
Chapter 21: Bioinformatic tools for research in CRC
Abstract
Introduction
Methodologies for obtaining primary data in cancer
Bioinformatics tools for cancer research: Applications in colorectal cancer
Biomedical tools for assessing the risk of suffering from colorectal cancer
Deep learning for medical imaging in colorectal cancer
Conclusions
Chapter 22: Omics-based biomarkers for CRC
Abstract
Introduction
Biological samples for the discovery of biomarkers and their clinical application
Genomics approaches for colorectal cancer biomarker discovery and validation
Transcriptomics approaches for colorectal cancer biomarker discovery and validation
Epigenomics approaches for colorectal cancer biomarkers discovery and validation
Proteomics approaches for colorectal cancer biomarkers discovery and validation
Other omics technologies for the discovery of biomarkers
Phases for the development of clinical biomarkers
Section D: Treatment
Section D.I: Endoscopic treatment
Chapter 23: Multidisciplinary committee for a comprehensive approach to CRC patients
Abstract
Introduction
Clinical oncology committees
Factors influencing the performance of committee activity
Effect of the multidisciplinary approach on colon and rectal cancer
Chapter 24: Endoscopic treatment of preneoplastic or early lesions
Abstract
Introduction
Endoscopic polypectomy
Main advanced techniques for endoscopic treatment of colorectal tumors
Chapter 25: Endoscopic surveillance
Abstract
Surveillance of preneoplastic colonic lesions
Nonhereditary polyposis: Nonhereditary attenuated polyposis and serrated polyposis
Nonhereditary attenuated polyposis
Serrated polyposis
Follow-up of pT1 neoplastic lesions after endoscopic treatment
Chapter 26: Advanced endoscopy in colorectal cancer: Colorectal prostheses
Abstract
Introduction
Indications and contraindications
Endoscopic technique
Results and complications
Section D.II: Surgical treatment
Chapter 27: Emergency surgery for CRC
Abstract
Diagnosis in the emergency department
Diagnostic tests
Treatment of complicated colorectal carcinoma
Type of surgery
Chapter 28: Innovation and new technologies in colorectal cancer UNIVEC device development experience
Abstract
Introduction
Minimally invasive surgery
Instruments, innovative devices, and robotic surgery
Flexible single incision surgery
Chapter 29: Colon cancer surgery
Abstract
Surgical treatment of nonmetastatic colon cancer
Treatment of colon cancer presenting as a surgical emergency
Palliative procedures
Laparoscopic approach to colon cancer
Chapter 30: Rectal cancer surgery
Abstract
Surgical treatment of rectal cancer
Preoperative assessment and staging
Oncological and technical principles
Surgical techniques for rectal cancer
Chapter 31: Liver metastases from CRC: A treatment paradigm
Abstract
Introduction
Treatment of metastatic disease
Surgical technique
Treatment of recurrence
Chemotherapy after resection
Follow-up after resection
Conclusions
Chapter 32: Pulmonary metastasectomy for CRC
Abstract
Introduction
Results
Discussion
New perspectives
Conclusions
Section D.III: Pharmacological and radiotherapeutic treatment
Chapter 33: Molecularly targeted therapy in metastatic CRC
Abstract
Introduction
Anti-EGFR antibodies
Inmmune checkpoint inhibitors
BRAF tyrosine kinase inhibitors
HER-2 blockade
Tyrosine kinase inhibitors
KRAS inhibitors
Conclusion
Chapter 34: A roadmap for medical treatment of metastatic CRC
Abstract
Background
Roadmap for treatment
First-line chemotherapy
Selection of bevacizumab or anti-EGFR in combination with chemotherapy
Triplet combinations of 5-fluorouracilo, oxaliplatin, and irinotecan
Duration and intensity of first-line treatment
Second-line treatment strategies
Treatment-refractory metastatic CRC
BRAF V600E-variant metastatic CRC
Immunotherapy
Chemotherapy and surgery of metastases
Management of colorectal cancer and peritoneal metastases
Chapter 35: Adjuvant chemotherapy for colorectal cancer
Abstract
Introduction
Adjuvant treatment of colon cancer
Neoadjuvant/adjuvant treatment of rectal cancer
Chapter 36: Oral administration of cytostatic drugs in the treatment of CRC
Abstract
Treatment of colorectal cancer (CRC) via the oral route
Systemic treatment
Drug dosage forms for colonic delivery
Chapter 37: Neoadjuvant, adjuvant, and intraoperative radiotherapy for rectal cancer
Abstract
Introduction
Adjuvant treatment
Neoadjuvant treatment
Neoadjuvant radiotherapy
Neoadjuvant radiotherapy vs. adjuvant radiochemotherapy
Neoadjuvant radiochemotherapy
Neoadjuvant radiochemotherapy vs. adjuvant radiochemotherapy
Neoadjuvant radiochemotherapy vs. neoadjuvant radiotherapy
Short-course neoadjuvant radiotherapy vs. long-course neoadjuvant radiochemotherapy
Watch and wait
Total neoadjuvant treatment
Neoadjuvant chemotherapy vs. neoadjuvant radiochemotherapy
Meta-analyses and systematic reviews of supplementary treatment of rectal cancer
New agents in combination with radiotherapy
Intraoperative radiotherapy (IORT)
Chapter 38: Radiotherapy (stereotactic body radiotherapy) for oligometastatic disease
Abstract
Role of SBRT in lung metastases from CRC
Role of SBRT in lymph node metastases from CRC
ROLE of SBRT in liver metastases from CRC
Conclusions
Chapter 39: Palliative radiotherapy in CRC
Abstract
Introduction
Retrospective studies
Prospective studies
Systematic reviews
Conclusions
Chapter 40: Immunology and immunotherapy in CRC
Abstract
Immunity, inflammation, intestinal microbiota, and colorectal cancer
Inflammatory bowel disease and dysbiosis
Dysbiosis. Oral microbiota
Other risk factors and their relationship with inflammation
NSAIDs, inflammation, and CRC
Suppression mechanisms of the immune system in the tumor microenvironment
Immunotherapy in CRC
Other immunotherapeutic approaches tested in humans
Section D.IV: Anesthetic treatment and postoperative management
Chapter 41: Multimodal rehabilitation: Pre- and intraoperative optimization in CRC surgery
Abstract
Introduction
Preoperative
Factors that cannot be influenced preoperatively
Factors that can be influenced preoperatively
Intraoperative
Perioperative management of nausea and vomiting
Drugs used to achieve rapid recovery
Perioperative fluid therapy
Baseline fluid and electrolyte needs
Changes in the surgical patient
Calculation of perioperative fluid loss and replenishment
Types of fluids
Fluid management schemes
Hemodynamic monitoring
Advanced monitoring
Emergency surgery
Chapter 42: Postoperative control: Complications and management in critical care units
Abstract
Introduction
Suture dehiscence with anastomotic leak
Intraabdominal abscess
Enterocutaneous fistula
Generalized peritonitis
Sepsis and septic shock
Empirical antibiotic treatment for an IAI
Abdominal compartment syndrome
Chapter 43: Pain units: Symptom control
Abstract
Acute postoperative pain
Chronic pain in colorectal cancer
Conclusions
Section E: Microbiota, molecular and biological mechanisms of CRC
Chapter 44: The role of intestinal microbiota in the colorectal carcinogenesis
Abstract
Introduction
Human gut microbiota and colorectal cancer
Chapter 45: Genetic susceptibility to CRC
Abstract
Introduction
High penetrance rare variants: Hereditary colorectal cancer predisposition syndromes
Other hereditary cancer syndromes
Candidate CRC susceptibility genes and NGS
Low-penetrance variants and association studies
Multiomic integration
Polygenic risk scores
Chapter 46: Signaling pathways in CRC
Abstract
Introduction
Signaling pathways
Chapter 47: CRC: A Darwinian model of cellular immunoselection
Abstract
Cancer immunoedition: From immunosurveillance to tumor escape
Tumor escape strategies
Colorectal carcinomas with microsatellite instability: Role of the B2M gene
The prognostic value of tumor lymphocyte infiltration: The importance of the “Immunoscore”
Chapter 48: Epithelial-mesenchymal transition and CRC
Abstract
Introduction
Epithelial plasticity
Mechanisms responsible for E-cadherin inactivation during tumor progression
Conclusions
Chapter 49: Colorectal carcinoma: From molecular pathology to clinical practice
Abstract
Introduction
Colorectal cancer: Molecular-genetic context
Microsatellite instability and Lynch syndrome
Clinical application of molecular diagnostics: Biomarker analysis
Final considerations: the pathologist's point of view
Section F: Biobanks
Chapter 50: The role of biobanks in the study of colorectal carcinoma
Abstract
Biobanks and biomedical research
Organization and operation of the biobank
Biobank orientation
Integration of diagnostic anatomical pathology files in biobanks
The role of biobanks in cancer research
Tumor banking and high-throughput techniques
Colorectal cancer and biobanks
Conclusions
Section G: Approach to the sequelae and consequences of
Chapter 51: Psychological approach and emotional management in CRC
Abstract
Keys and tools in the relationship between the health care team and the patient
Searching for health information on the Internet
Psychological aspects in the different phases of the disease
Physical sequelae of the treatments
Chapter 52: Nutritional status in patients with CRC: Assessment and recommendations
Abstract
Introduction
Related complications
Causes of malnutrition
Assessment of nutritional status in colorectal cancer patients
Dietary recommendations and nutritional support
Recommendations for symptoms that hinder food intake
Chapter 53: Fecal incontinence and CRC
Abstract
Incontinence in relation to colorectal cancer
Assessment
Treatment and rehabilitation
Conclusion
Chapter 54: Ostomy care
Abstract
Introduction
Gastrointestinal ostomies
Main complications of gastrointestinal ostomies2
Preoperative consultation3, 4
Postoperative follow-up3, 6
Ostomy consultation at discharge3, 7
Chapter 55: Sexual dysfunction among patients with ostomies
Abstract
Introduction
Sexual impairment in patients with ostomies
Assessment of sexual dysfunction
Recommendations to cope with the fear of sexual intimacy
Health education: Help to adapt to change
Section H: Ethical and legal aspects in CRC
Chapter 56: Ethical and legal aspects in CRC: Research and clinical assistance
Abstract
Introduction: The relationship between ethics and law
Ethical principles and research ethics committees
Regulations governing biomedical research
The new regulatory framework for personal data protection
New technologies and research with health data
Index

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health

Foundations of Colorectal Cancer

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Alejandro Pazos Sierra