| Theme |
Current Status of Colorectal Cancer Screening |
| Title |
Stool Based Molecular and Cellular Assays for Early Diagnosis and Screening of Colorectal Cancer |
| Author |
Toshinari Minamoto |
Division of Translational and Clinical Oncology, Cancer Research Institute, and Department of Surgical Oncology, Kanazawa University and Hospital |
| Author |
Chika Uotani |
Cancer Screening Center, Ishikawa Health Service Association |
| Author |
Kazuyuki Kawakami |
Division of Translational and Clinical Oncology, Cancer Research Institute, and Department of Surgical Oncology, Kanazawa University and Hospital |
| [ Summary ] |
The most relevant tool for screening colorectal cancer (CRC) with substantial reimbursement available in clinical setting, is fecal occult blood testing (FOBT). It has been proven to reduce mortality in CRC patients through a number of randomized, controlled clinical trials. Increasing knowledge of the molecular and cellular signatures of CRC development have facilitated the emergence of innovative stool assays to complement the low sensitivity and specificity associated with CRC screening with FOBT. CRC proliferates abundantly into the bowel lumen and DNA and colonocytes recovered from stool samples can be assayed with sensitive and accurate techniques. Therefore, there is a strong biological rationale for detecting molecular alterations characteristic to CRC with the emerging technology, which represents a promising noninvasive approach to screening CRC. The assays examine DNA directly extracted from stool samples or nucleic acids (DNA or RNA) as well as proteins derived from colonocytes, including cancer cells exfoliated into stool samples. A number of trials for stool based detection of CRC which were reported after publication of our reviews of this matter (ref. No. 10 - 13) are examined. Critical issues concerning these trials are examined. Improved testing will lead to improved accuracy safety affordability and patient compliance. |