特集名 | 直腸(Rb)癌の謎 | |
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題名 | [総論](5) 直腸癌と結腸癌の臨床病理学的特徴と遺伝子異常からみた対比 | |
発刊年月 | 2010年 11月 | |
著者 | 藤盛 孝博 | 獨協医科大学病理学(人体分子) |
著者 | 固武 健二郎 | 栃木県立がんセンター外科 |
著者 | 田中 宏幸 | 獨協医科大学病理学(人体分子) |
著者 | 廣瀬 元彦 | 獨協医科大学病理学(人体分子) |
著者 | 博多 裕子 | 獨協医科大学病理学(人体分子) |
著者 | 藤盛 友佳理 | 獨協医科大学病理学(人体分子) |
著者 | 山岸 秀嗣 | 獨協医科大学病理学(人体分子) |
著者 | 市川 一仁 | 獨協医科大学病理学(人体分子) |
著者 | 冨田 茂樹 | 獨協医科大学病理学(人体分子) |
著者 | 井村 穣二 | 獨協医科大学病理学(人体分子) |
著者 | 佐藤 英章 | 済生会川口総合病院 |
著者 | 藤井 茂彦 | 京都桂病院消化器内科 |
著者 | 佐野 寧 | 薫風会佐野病院消化器病センター |
著者 | 松田 尚久 | 国立がん研究センター中央病院消化管内視鏡科 |
著者 | 加藤 洋 | 獨協医科大学日光医療センター |
著者 | 寺野 彰 | 獨協医科大学学長 |
【 要旨 】 | 直腸癌と結腸癌の違いを自験例による遺伝子解析の結果と大腸癌研究会による全国大腸癌登録調査報告書1999年調査(28号)をもとに対比した.大腸癌の発生を固定癌(basic cancer)と変動癌(environmental cancer)という病理総論的概念で説明した.あわせて腺腫癌相関(adenoma-carcinoma sequence;ACS)とde novoがどのように違うかを概説した. 大腸癌はこの20年で増加傾向にあるとされているが,罹患数も死亡数も結腸癌の増加が著しい.しかも,高齢者が増加している.欧米では今,polyp切除後のfollow-upでの進行結腸癌の発見頻度の増加が注目されている.その原因として,IIc,LST-NGなどのK-ras野生型である表面型大腸癌を対象にした早期発見,早期治療が重要な因子であるとともに,見逃されやすいS状結腸癌と高齢者の右半結腸にできるLST-Gに注目する必要があることを強調した.直腸癌の謎としてACFの前癌病変としての位置づけや絨毛腫瘍が重要であることに言及した. |
Theme | Mystery concerning the lower rectum | |
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Title | Clinicopathological study and the detection of K-ras codon 12 point mutation in colorectal carcinomas -- Differences between colonic carcinomas and rectal carcinomas from genetic and morphologic perspectives | |
Author | Takahiro Fujimori | Department of Pathology, Dokkyo Medical University |
Author | Kenjiro Kotake | Department of Surgery, Tochigi Cancer Center |
Author | Hiroyuki Tanaka | Department of Pathology, Dokkyo Medical University |
Author | Motohiko Hirose | Department of Pathology, Dokkyo Medical University |
Author | Yuko Hakata | Department of Pathology, Dokkyo Medical University |
Author | Yukari Fujimori | Department of Pathology, Dokkyo Medical University |
Author | Hidetsugu Yamagishi | Department of Pathology, Dokkyo Medical University |
Author | Kazuhito Ichikawa | Department of Pathology, Dokkyo Medical University |
Author | Shigeki Tomita | Department of Pathology, Dokkyo Medical University |
Author | Johji Imura | Department of Pathology, Dokkyo Medical University |
Author | Hideaki Sato | Saiseikai Kawaguchi General Hospital |
Author | Shigehiko Fujii | Gastroenterology, Kyoto Katsura Hospital |
Author | Yasushi Sano | Gastrointestinal Cencer, Sano Hospital |
Author | Takahisa Matsuda | Endoscopy Division, National Cancer Center Hospita |
Author | Yo Kato | Dokkyo Medical University Nikko Medical Center |
Author | Akira Terano | Dokkyo Medical University President |
[ Summary ] | In this article, we present recent reviews regarding the prevalence of morphologic backgrounds and codon 12 K-ras mutation analysis in colorectal carcinomas in comparison with multi-institutional registry of large bowel cancer in Japan (prospective registry data, cases treated in 1999). This registry was based on pathological concepts related to basic and environmental cancer. We present an outline of differences between the adenoma-carcinoma sequence (ACS) and de novo carcinogenesis. Over the past twenty years, the incidence of and mortality rates for colorectal carcinomas in Japan have risen in relation to the adoption of Western life styles and the increased numbers of elderly patients. It is widely accepted that advanced neoplasias (AVN) are detected in patients with clean colons during surveillance colonoscopies in Western countries. We predict that Western endoscopists may overlook not only IIc and LST-NG (both K-ras wild type), but also LST-G (K-ras mutant type) conditions, which are causally related to AVN in the right-side of the colon. This study concluded that not only is the presence of codon 12 K-ras mutations important in relation to cancer progression in right side colon carcinomas but also that it may predispose patients to more aggressive biological actions when interval cancers, are under surveillance after clean colons have been determined. To resolve this issue, further studies are required, based on concepts related to basic and environmental carcinomas, as well as genetic analysis of ACF and villous tumors, which may be premalignant lesions. |