A report on Colorectal cancer

Location and appearance of two example colorectal tumors
Longitudinally opened freshly resected colon segment showing a cancer and four polyps. Plus a schematic diagram indicating a likely field defect (a region of tissue that precedes and predisposes to the development of cancer) in this colon segment. The diagram indicates sub-clones and sub-sub-clones that were precursors to the tumors.
Colon cancer with extensive metastases to the liver
Relative incidence of various histopathological types of colorectal cancer. The vast majority of colorectal cancers are adenocarcinomas.
Micrograph of colorectal adenocarcinoma, showing "dirty necrosis".
A diagram of a local resection of early stage colon cancer
A diagram of local surgery for rectal cancer
Colon and rectum cancer deaths per million persons in 2012

Development of cancer from the colon or rectum (parts of the large intestine).

- Colorectal cancer
Location and appearance of two example colorectal tumors

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A coronal CT scan showing a malignant mesothelioma
Legend: → tumor ←, ✱ central pleural effusion, 1 & 3 lungs, 2 spine, 4 ribs, 5 aorta, 6 spleen, 7 & 8 kidneys, 9 liver

Cancer

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Group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body.

Group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body.

A coronal CT scan showing a malignant mesothelioma
Legend: → tumor ←, ✱ central pleural effusion, 1 & 3 lungs, 2 spine, 4 ribs, 5 aorta, 6 spleen, 7 & 8 kidneys, 9 liver
Symptoms of cancer metastasis depend on the location of the tumor.
The GHS Hazard pictogram for carcinogenic substances
Share of cancer deaths attributed to tobacco in 2016.
The incidence of lung cancer is highly correlated with smoking.
Cancers are caused by a series of mutations. Each mutation alters the behavior of the cell somewhat.
The central role of DNA damage and epigenetic defects in DNA repair genes in carcinogenesis
Chest X-ray showing lung cancer in the left lung
Three measures of global cancer mortality from 1990 to 2017
Engraving with two views of a Dutch woman who had a tumor removed from her neck in 1689
University of Florida Cancer Hospital
CancerTreeMammal
An invasive ductal carcinoma of the breast (pale area at the center) surrounded by spikes of whitish scar tissue and yellow fatty tissue
An invasive colorectal carcinoma (top center) in a colectomy specimen
A squamous-cell carcinoma (the whitish tumor) near the bronchi in a lung specimen
A large invasive ductal carcinoma in a mastectomy specimen

Early detection through screening is useful for cervical and colorectal cancer.

Colonoscopy being performed

Colonoscopy

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Endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus.

Endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus.

Colonoscopy being performed
A container of PEG (polyethylene glycol or macrogol) with electrolyte used to clean out the intestines before certain bowel exam procedures such as a colonoscopy.
Schematic overview of colonoscopy procedure
Polyp is identified.
A sterile solution is injected under the polyp to lift it away from deeper tissues.
A portion of the polyp is now removed.
The polyp is fully removed.

It can provide a visual diagnosis (e.g., ulceration, polyps) and grants the opportunity for biopsy or removal of suspected colorectal cancer lesions.

The three most common sites of intestinal involvement in Crohn's disease (left) compared to the areas affected by colitis ulcerosa (right).

Crohn's disease

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Type of inflammatory bowel disease that may affect any segment of the gastrointestinal tract.

Type of inflammatory bowel disease that may affect any segment of the gastrointestinal tract.

The three most common sites of intestinal involvement in Crohn's disease (left) compared to the areas affected by colitis ulcerosa (right).
An aphthous ulcer on the mucous membrane of the mouth in Crohn's disease.
A single lesion of erythema nodosum
Endoscopic image of colon cancer identified in the sigmoid colon on screening colonoscopy for Crohn's disease
NOD2 protein model with schematic diagram. Two N-terminal CARD domains (red) connected via helical linker (blue) with central NBD domain (green). At C-terminus LRR domain (cyan) is located. Additionally, some mutations which are associated with certain disease patterns in Crohn's disease are marked in red wire representation.
Distribution of gastrointestinal Crohn's disease.
Endoscopic image of Crohn's colitis showing deep ulceration
CT scan showing Crohn's disease in the fundus of the stomach
Endoscopic biopsy showing granulomatous inflammation of the colon in a case of Crohn's disease.
Section of colectomy showing transmural inflammation
Resected ileum from a person with Crohn's disease

Bowel obstruction may occur as a complication of chronic inflammation, and those with the disease are at greater risk of colon cancer and small bowel cancer.

Endoscopic image of sigmoid colon of patient with familial adenomatous polyposis

Familial adenomatous polyposis

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Autosomal dominant inherited condition in which numerous adenomatous polyps form mainly in the epithelium of the large intestine.

Autosomal dominant inherited condition in which numerous adenomatous polyps form mainly in the epithelium of the large intestine.

Endoscopic image of sigmoid colon of patient with familial adenomatous polyposis
CHRPE - Congenital hypertrophy of the retinal pigment epithelium
Micrograph of a tubular adenoma, the colorectal cancer precursor most commonly associated with FAP
Colectomy specimen showing numerous polyps throughout the large bowel

While these polyps start out benign, malignant transformation into colon cancer occurs when they are left untreated.

Endoscopic image of a colon affected by ulcerative colitis. The internal surface of the colon is blotchy and broken in places. Mild-moderate disease.

Ulcerative colitis

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Long-term condition that results in inflammation and ulcers of the colon and rectum.

Long-term condition that results in inflammation and ulcers of the colon and rectum.

Endoscopic image of a colon affected by ulcerative colitis. The internal surface of the colon is blotchy and broken in places. Mild-moderate disease.
Classification of colitis, often used in defining the extent of involvement of ulcerative colitis, with proctitis (blue), proctosigmoiditis (yellow), left sided colitis (orange) and pancolitis (red). All classes extend distally to the end of the rectum.
Gross pathology of normal colon (left) and severe ulcerative colitis (right), forming pseudopolyps (smaller than the cobblestoning typically seen in Crohn's disease), over a continuous area (rather than skip lesions of Crohn's disease), and with a relatively gradual transition from normal colon (while Crohn's is typically more abrupt).
Aphthous ulcers involving the tongue, lips, palate, and pharynx.
Pyoderma gangrenosum with large ulcerations affecting the back.
Endoscopic image of ulcerative colitis affecting the left side of the colon. The image shows confluent superficial ulceration and loss of mucosal architecture. Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge.
H&E stain of a colonic biopsy showing a crypt abscess, a classic finding in ulcerative colitis
Colonic pseudopolyps of a person with intractable UC, colectomy specimen
Biopsy sample (H&E stain) that demonstrates marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and architectural distortion of the crypts.

Complications may include abnormal dilation of the colon (megacolon), inflammation of the eye, joints, or liver, and colon cancer.

Diagram of stomach, intestines and rectum in the average human

Gastrointestinal tract

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Tract or passageway of the digestive system that leads from the mouth to the anus.

Tract or passageway of the digestive system that leads from the mouth to the anus.

Diagram of stomach, intestines and rectum in the average human
Illustration of the small intestine

Gastrointestinal cancer may occur at any point in the gastrointestinal tract, and includes mouth cancer, tongue cancer, oesophageal cancer, stomach cancer, and colorectal cancer.

Polyp of sigmoid colon as revealed by colonoscopy. Approximately 1 cm in diameter. The polyp was removed by snare cautery.

Colorectal polyp

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Polyp occurring on the lining of the colon or rectum.

Polyp occurring on the lining of the colon or rectum.

Polyp of sigmoid colon as revealed by colonoscopy. Approximately 1 cm in diameter. The polyp was removed by snare cautery.
Incidences and malignancy risks of various types of colorectal polyps.
Microvesicular hyperplastic polyp. H&E stain.
Microvesicular hyperplastic polyp. H&E stain.
Traditional serrated adenoma. H&E stain.
Gross appearance of a colectomy specimen containing two colorectal polyps and one invasive colorectal carcinoma
Micrograph of a tubular adenoma, the most common type of dysplastic polyp in the colon.
Micrograph of a sessile serrated adenoma. H&E stain.
Micrograph of a Peutz–Jeghers colonic polyp – a type of hamartomatous polyp. H&E stain.
Micrograph of a tubular adenoma – dysplastic epithelium (dark purple) on left of image; normal epithelium (blue) on right. H&E stain.
Micrograph of a villous adenoma. These polyps are considered to have a high risk of malignant transformation. H&E stain.
Paris classification of colorectal neoplasms.<ref>{{cite book|title=Colonoscopy and Colorectal Cancer Screening: Future Directions|author=Luis Bujanda Fernández de Piérola, Joaquin Cubiella Fernández, Fernando Múgica Aguinaga, Lander Hijona Muruamendiaraz and Carol Julyssa Cobián Malaver|contribution=Malignant Colorectal Polyps: Diagnosis, Treatment and Prognosis|year=2013|doi=10.5772/52697|isbn=9789535109495}} Creative Commons Attribution 3.0 License</ref>

Untreated colorectal polyps can develop into colorectal cancer.

Micrograph showing inflammation of the large bowel in a case of inflammatory bowel disease. Colonic biopsy. H&E stain.

Inflammatory bowel disease

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Group of inflammatory conditions of the colon and small intestine, Crohn's disease and ulcerative colitis being the principal types.

Group of inflammatory conditions of the colon and small intestine, Crohn's disease and ulcerative colitis being the principal types.

Micrograph showing inflammation of the large bowel in a case of inflammatory bowel disease. Colonic biopsy. H&E stain.
Associated loci pane. Pink genes are in IBD associated loci, blue are not.

Many studies identified that microRNAs dysregulation involved in IBD and to promote colorectal cancer.

Front of abdomen, showing the large intestine, with the stomach and small intestine in gray.

Large intestine

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Last part of the gastrointestinal tract and of the digestive system in vertebrates.

Last part of the gastrointestinal tract and of the digestive system in vertebrates.

Front of abdomen, showing the large intestine, with the stomach and small intestine in gray.
Illustration of the large intestine.
Inner diameters of colon sections
Colonic crypts (intestinal glands) within four tissue sections. The cells have been stained to show a brown-orange color if the cells produce the mitochondrial protein cytochrome c oxidase subunit I (CCOI), and the nuclei of the cells (located at the outer edges of the cells lining the walls of the crypts) are stained blue-gray with haematoxylin. Panels A, B were cut across the long axes of the crypts and panels C, D were cut parallel to the long axes of the crypts. In panel A the bar shows 100 µm and allows an estimate of the frequency of crypts in the colonic epithelium. Panel B includes three crypts in cross-section, each with one segment deficient for CCOI expression and at least one crypt, on the right side, undergoing fission into two crypts. Panel C shows, on the left side, a crypt fissioning into two crypts. Panel D shows typical small clusters of two and three CCOI deficient crypts (the bar shows 50 µm). The images were made from original photomicrographs, but panels A, B and D were also included in an article and illustrations were published with Creative Commons Attribution-Noncommercial License allowing re-use.
Histological section.
Colonoscopy image, splenic flexure,
normal mucosa. You can see spleen through it : the black part
Micrograph of normal large instestinal crypts.
Anatomy of normal large intestinal crypts
Intestines
Colon. Deep dissection. Anterior view.

Bacteroides are implicated in the initiation of colitis and colon cancer.

The simplified structure of beta-catenin.

Catenin beta-1

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Protein that in humans is encoded by the CTNNB1 gene.

Protein that in humans is encoded by the CTNNB1 gene.

The simplified structure of beta-catenin.
Partners competing for the main binding site on the ARM domain of beta-catenin. The auxiliary binding site is not shown.
Simplified structure of the beta-catenin destruction complex. Note the high proportion of intrinsically disordered segments in the axin and APC proteins.
The moonlighting of beta-catenin.
Beta-catenin level regulation and cancer.

Mutations and overexpression of β-catenin are associated with many cancers, including hepatocellular carcinoma, colorectal carcinoma, lung cancer, malignant breast tumors, ovarian and endometrial cancer.