LECTURES

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Hereditary colorectal cancer syndromes - Dr. Agapi Kataki

Even though the majority of colorectal cancer cases diagnosed annually are due to sporadic events, up to 10% are attributed to hereditary factors. Known monogenic disorders include Lynch syndrome, Familial Adenomatous Polyposis, MUTYH-associated polyposis, Peutz Jeghers Syndrome, Cowden Syndrome and Juvenile polyposis Syndrome. Genetic counseling and testing of these patients are important issues leading to a substantial reduction in morbidity and mortality among themselves as well as their at risk families as inherited colorectal cancer syndromes confer a markedly increased risk for the development of multiple cancers.

Histological and molecular subtypes of colorectal cancer (CRC) - Dr. Efthymios Koniaris

The presentation will be focused on the main histological subtypes of colorectal cancer as defined by WHO (2019): a) adenocarcinomas (NOS, adenoma-like, micropappillary, mucinous poorly cohesive, signet ring cell, medullary, adenosquamous and sarcomatoid), b) neuroendocrine tumors (G1-3, L-cell, glucagon-like, PP, serotonin and enterochromaffin cell), c) neuroendocrine carcinoma, d) mesenchymal tumors (GIST, kaposi sarcoma, leiomyosarcoma) and e) lymphomas (mantle cell, MALT, DLBCL).

Also, the four main molecular groups as classified by the Consensus Molecular Subtypes (CNS 2020) will be analyzed. More specifically: 1. CMS1 (immune 15%, MSI, CpG island methylator phenotype (CIMP), BRAF mutation, hypermutated- immune activated, mainly in the right side of the colon), 2. CMS2 (Canonical 40%, MSS, Chromosomal Instability (CIN), Wnt/MYC activation, EGFR dependence- immune desert, mainly in the left side of the colon), 3. CMS3 (Metabolic 13%, CIN-MSI mixed, metabolic dysregulation, KRAS mutations- immune mixed, mainly in the right side of the colon), 4. CMS4 (mesenchymal 25%, MSS, CIN, stromal infiltration, TGF-β, angiogenesis- immune suppressed, both sides are affected).

Surgery for Colon Cancer – Prof. Dervenis Christos

• Cancer that begins in the colon (bowel or large intestine) or rectum is known as colorectal cancer
  • - The colon is about 5 feet long.
  • - Colorectal cancer can occur any section of the colon or the rectum.

• It is not known exactly what causes colorectal cancer
  • - But there are risk factors that increase chances for colorectal cancer:
    • •  Some risk factors cannot be changed---age, personal and family history
    • •  Some risk factors can be changed or eliminated---tobacco use, obesity, inactivity

• Early stages of colorectal cancer may have NO signs or symptoms.

• If signs and symptoms are present, they may include:
• - Bleeding from the rectum or blood in the stool
• - Marked change in bowel habits
• - Abdominal mass
• - Abdominal cramps or pain
• - Iron deficiency anemia that is not due to other conditions

• Tests used to look for colorectal cancer:
• - Colonoscopy
• - Flexible Sigmoidoscopy
• - Fecal Occult Blood Test (FOBT)
• - Double contrast barium enema

• Treatment is based on an oncological surgical resection (based on the location) following by chemotherapy (depending on the stage)