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Optimization of the adenoma detection rate (ADR), inversely proportional to the risk of interval colorectal cancer, is a major objective in colorectal cancer (CRC) screening. Achieving optimal ADR involves not only adherence to best practice guidelines but also benefits from technological advancements and developments in endoscope technology. Best practices with demonstrated positive impact on ADR include ensuring strict adherence to a residue-free diet for at least 24 hours (by increasing patient awareness or even offering "pre-packaged diets"), promoting split-dose bowel preparation, scheduling dedicated and sufficiently long operating sessions, systematically using a washing pump, maintaining an adequate colon exploration time, and performing a double exploration of the right colon, preferably with cecal retrovision. Adhering to these best practices enables achieving high-quality patient preparation, completeness of colonoscopies, and ultimately a sufficiently high ADR. On the other hand, optimization devices developed in recent years, which have shown their effectiveness in numerous randomized studies, must now be implemented in routine practice. These three different types of optimization devices are caps (enabling exploration of a larger surface area of colonic mucosa), artificial intelligence (AI) that enhances endoscopist vigilance, and image contrast enhancement devices that make a barely visible flat polyp more visible. The combined use of these three highly complementary devices appears optimal. The gradual shift toward routine practice of optimized screening colonoscopy using these devices will undoubtedly lead to an increase in the minimum required ADR, well beyond the currently recommended rate of 25% in the target population for CRC screening. [ABSTRACT FROM AUTHOR]

Long-term aspirin therapy may be of preventive interest in the development of colorectal cancer (CRC), both in secondary prevention to avoid recurrence after resection, and in tertiary prevention to limit metastatic spread and consolidate response to treatment. However, long-term prescription of aspirin can be associated with adverse effects, including an increased risk of bleeding. Against this backdrop, international trials are currently underway to determine the efficacy of aspirin, particularly in adjuvant treatment in combination with chemotherapy after surgery. A few months ago, the initial results of the ASCOLT study reported at the European Oncology Congress (ESMO) were negative, with no argument for a favorable effect of aspirin intake after CRC surgery on specific mortality. However, sub-group analyses according to PIK3CA mutation have not yet been communicated. The question of the benefit of aspirin in CRC prevention therefore remains open. [ABSTRACT FROM AUTHOR]

Résumé Introduction - Le gène TP53 a fait l’objet de très nombreux travaux. Sa nature polymorphe et son rôle central dans la régulation du cycle cellulaire ont mis en évidence son potentiel de gène candidat dans la susceptibilité et la survenue de différents cancers. Bien que plusieurs polymorphismes du gène TP53 aient été étudiés comme facteurs de risque pour différents cancers, le plus largement étudié est le polymorphisme Arg72Pro (rs1042522), à l’origine d’une substitution d’une Arginie (Arg) en Proline (Pro) ou inversement, connu pour ses différentes fonctions biologiques. Notre objectif est d’explorer la participation du polymorphisme (SNP) Arg72Pro du gène TP53, dans l’expressivité du cancer colorectal (CCR) et du carcinome basocellulaire (CBC) dans une population de l’Ouest Algérien. Matériels et Méthodes - Le déséquilibre de transmission allélique de ce SNP a été réalisé sur une population constituée de 116 individus atteints de CCR, 50 sujets atteints de CBC et enfin une population contrôle constituée de 121 individus sains, par la technique de Biologie Moléculaire PCR/RFLP (Polymerase Chain Reaction/ Restriction Fragment LengthPolymorphism). Résultats - L’association du marqueur Arg72Pro avec le CBC a montré une augmentation significative de l’allèle Pro chez les cas par rapport aux contrôles (54% vs 46%, OR=8,85 [4,98-16,03], p0.05). Conclusion - Le polymorphisme Arg72Pro du gène TP53 peut être considéré comme marqueur de risque pour le CBC mais pas pour le CCR. Abstract Duchenne Muscular Dystrophy (DMD) is the most common and severe form of muscular dystrophy, reaching one out of every 5000 male births in the world population. It is characterized by progressive muscular degeneration from a young age and leads to serious failures of the body which lead to the death of the patient. The gene responsible for DMD is located on chromosome X. It encodes a membrane cytoskeleton protein»the dystrophin». The alterations affecting this gene are essentially deletions with a proportion of 65%. That’s why we have interested to develop in our laboratory a technique that will allow us to detect this type of mutations in 5 sporadic cases with Duchenne myopathy from West Algeria. The study consisted in amplifying by PCR multiplex that cover 19 exons of the DMD gene most commonly deleted. This study allowed us to reveal two different deletions, the first involving the promoter of the gene and the second one the exon 43. These first results confirm the data reported in the literature which classify these two regions as deletion hotspots. The results obtained represent a first in the western Algerian and could lead to the generalization of genotypic diagnosis and genetic counseling with a view to improve the care of patients in Algeria.

Résumé Objectif - L’accumulation des variants génétiques participe au processus impliqué dans le risque de développer le cancer colorectal (CCR). Plusieurs études ont exploré la corrélation entre les polymorphismes 6986A>G du gène CYP3A5 (CYP450) (rs776746) appartenant à la famille des cytochromes P450 et 3435C>T du gène adénosine triphosphate–binding cassette B1 (ABCB1) (rs1045642). L’objectif de cette étude est la recherche d’éventuelles associations entre les polymorphismes rs776746 et rs1045642, et la survenue du cancer colorectal dans une population de l’Ouest Algérien. Méthodes - La cohorte était composée de 99 patients atteints de CCR et 101 contrôles. Les polymorphismes CYP3A5 c.6986A>G et ABCB1 c.3435 >T ont été identifiés par la technique de discrimination allélique par PCR quantitative en temps réel. Les résultats ont été analysés par le calcul de l’odd ratio (OR) avec un intervalle de confiance à 95%. Résultats - L’étude cas-témoins a montré que la distribution des fréquences alléliques et génotypiques de ces polymorphismes entre les deux groupes (cas et témoins) ne présentait aucune différence statistiquement significative. Conclusion - Ce travail nous a permis de conclure qu’il n’existait aucune relation d’association entre ces polymorphismes et la survenue du CCR dans notre population. Abstract Objective - The accumulation of genetic variants participates in the process involved in the risk of developing colorectal cancer (CRC). Several studies have explored the correlation between the 6986A> G polymorphisms of the CYP3A5 (CYP450) gene (rs776746) belonging to the cytochrome P450 and 3435C> T family of the adenosine triphosphate-binding cassette B1 (ABCB1) gene (rs1045642). The objective of this study is to investigate a possible association of rs776746 and rs1045642 polymorphisms with the occurrence of colorectal cancer on a population of western Algeria. Methods - The cohort consisted of 99 CRC patients and 101 controls. The CYP3A5 c.6986A> G and ABCB1 c.3435> T polymorphisms were identified by the allelic discrimination by quantitative real-time PCR technique. The results were analyzed by calculating the odd ratio (OR) with a 95% confidence interval. Results - This case-control study didn’t show any statistically significant difference in allelic and genotypic frequencies of these polymorphisms between the two groups (case and control). Conclusion - This work allowed us to conclude that there was no association between these polymorphisms and the occurrence of CRC in our population.

Colorectal cancer is the third leading cause of cancer deaths worldwide, and its incidence is rising. Colonoscopy prevents the onset of colorectal cancer and reduces associated mortality, thanks to the endoscopic resection of polyps, particularly adenomatous polyps. However, adenomatous polyps are not the only type of polyp, and their resection can vary according to several factors: size, shape, degenerative aspect, suspicion of submucosal invasion, etc. Significant technical advances (endoscopic submucosal dissection, artificial intelligence, etc.) have been made in recent years. Where do we stand? It is essential to use the appropriate classification tools to characterize colonic polyps in order to best guide the type of resection. [ABSTRACT FROM AUTHOR]

Colorectal cancer is a major public health problem and is the 4th most common cancer in the world. 75% of patients have a surgical resection, the only way to obtain a cure. Most recurrences are metastatic (80%) and occur within the first three years after surgery. An increasing number of recurrences are being treated with curative intent, which justifies appropriate post-operative monitoring. Physical examination, abdominal ultrasound and chest X-ray are the reference examinations for postoperative monitoring in France. They should be repeated regularly: every 3 months for 3 years, then every 6 months for 2 years. CEA testing is no longer recommended according to recent data (national French recommendations, Grade B), apart from monitoring of its post-operative normalization. Post-operative endoscopic surveillance is recommended at 1 year, then at 3 years and at 5 years if normal. If the initial colon examination is incomplete, a colonoscopy should be done within 6 months of surgery. Screening for and treating functional digestive sequelae is an essential part of follow-up. [ABSTRACT FROM AUTHOR]

Serrated polyposis syndrome (SPS) is the most common, yet underdiagnosed, colonic polyposis syndrome. The diagnosis is made in the presence of multiple serrated polyps (hyperplastic polyps, sessile serrated polyps and traditional serrated adenomas) based on predefined criteria by the WHO in 2019. Without treatment, it is associated with a higher risk of colorectal cancer. In this review, we will discuss the endoscopic diagnosis of serrated polyps, the latest criteria for the diagnosis of SPS and the latest recommendations for the management of this polyposis. [ABSTRACT FROM AUTHOR]

Colonoscopy is not the absolute weapon against colorectal cancer (CRC): 2% to 10% of patients diagnosed with CRC have had a colonoscopy within three years. Post-colonoscopy CRC (PCCRC), diagnosed within a short time after colonoscopy, is most often preventable, associated with factors related to the patient (age, high fecal hemoglobin concentration, high-risk polyp(s) or inflammatory bowel disease (IBD)), to the tumor (proximal location), and most of all to the endoscopist (low cecal intubation rate, withdrawal time, adenoma and proximal serrated lesions detection rates). Their nomenclature is standardized, distinguishing interval PCCRC, diagnosed before the recommended surveillance interval, from non-interval PCCRC, diagnosed at or after the recommended interval or in the absence of a recommended interval. A possible missed lesion at initial colonoscopy is by far the most common plausible explanation, followed by a likely incompletely resected lesion. Their prevalence, as assessed by the PCCRC-3y rate, varies widely among studies: from 4% to 8% in 2 meta-analyses of pooled studies, to 20% to 40% in IBD. Although often MMR deficient and CpG island methylator phenotype high, they do not seem to have a specific mutational profile. No endoscopist is immune: the risk of PCCRC must therefore be mentioned to the patient during the consultation prior to colonoscopy and included in the information leaflet provided. The prevention of PCCRC relies on a high level of quality of the initial examination, meeting more demanding criteria than those of the current recommendations. [ABSTRACT FROM AUTHOR]

Bilobar hepatic metastases from colorectal cancer pose a problem in terms of management, with curative surgery often requiring several stages. The purpose of our study was to evaluate laparoscopic approach with portal vein ligation in the first step of two-stage hepatectomy in the treatment of patients with synchronous liver metastases from colorectal cancers (SLMCRC). We conducted a single-center retrospective study from August 2016 to January 2020. It included patients with SLMCRC requiring two-stage curative surgery due to insufficient future liver remnant volume (FRL). The primary endpoint was to evaluate postoperative morbidity and mortality following first step laparoscopy at 30 days. The secondary endpoints were to evaluate conversion rate, FRL hypertrophy following laparoscopic portal vein ligation, postoperative morbidity and mortality of 2nd step of two-stage hepatectomy and finally treatment completion rate. We included six patients (4 men and 2 women) with a mean age of 64 (44-72) years. The first step of surgery consisted of a laparoscopic colonic resection associated with right portal vein ligation in 5 patients and left portal vein ligation in one patient. The postoperative morbimortality was zero. The conversion rate was zero. After portal vein ligation, 5 of the 6 patients had significantly enlarged FRL, with a mean gain in FRL volume of 59.48% (31.02%-68.71%). Two of the six patients had severe morbidity after 2nd step hepatectomy (Clavien IIIb). All patients completed the treatment. [ABSTRACT FROM AUTHOR]

Colorectal cancer is one of the most frequently diagnosed cancers in France and worldwide, with a peak incidence in patients over 70 years old, whose life expectancy is increasing. Long excluded from therapeutic trials, elderly patients are now the focus of special attention and dedicated studies. However, as treatment algorithms for metastatic colorectal cancer become increasingly complex, it is clear that a significant percentage of elderly colorectal cancer patients may not be optimally treated. The aim of this article is to review what is known about the treatment of metastatic colorectal cancer in the elderly and to discuss recent and ongoing advances. [ABSTRACT FROM AUTHOR]

The article offers information on several articles related to oncology published in different periodicals. Topics include meta-analysis on psychosocial interventions aimed at improving cancer-related fatigue and ways to minimize such as art therapies and cognitive therapies; meta-analysis focusing effectiveness of telemedicine interventions for colorectal cancer patients and importance of specialized nursing care to address the unique challenges faced by cancer patients.

The article offers oncology news briefs as of July 2023. Topics include Australian study SCORE explore potential for shared care between oncologists and general practitioners for post-treatment follow-up of colorectal cancer patients; study from the University of California, Davis found strong link between bone biomarkers and prostate cancer survival, and a research focuses on targeting mitochondrial metabolism to suffocate glioblastoma cells.

This article aimed to review third line therapeutic to review third line therapeutic options in patients with metastatic colorectal cancer, therapeutic strategies in the event of metastatic gastric cancer and first line treatments for metastatic pancreatic cancer. Following the results of the SUNLIGHT study, the trifluridine/tipiracil plus bévacizumab combination should become the new third line standard for metastatic colorectal cancers. Performing multiple tumor biopsies to assess several biomarkers (HER2, dMMR/pMMR, CPS, Claudine 18.2) essential for choosing the best first-line therapeutic combination is becoming essential in gastric cancers. In patients with metastatic pancreatic cancer, the NAPOLI-3 study is positive and positions the NALIRIFOX protocol as a new option of choice in 1st line. In these same patients, in the absence of a validated predictive biomarker, the interest of a sequential strategy with alternation of two chemotherapy protocols continues to be evaluated in ongoing phase 2 studies. [ABSTRACT FROM AUTHOR]

The 2022 edition of ESMO in Paris was attended by more than 20,000 congress participants. Colorectal cancer and hepatobiliary tumours were the subject of important communications that could change our practices. Immunotherapy is now validated as a first-line treatment for hepatocellular carcinoma and cholangiocarcinoma. It could even eventually become the pre-operative -standard for MSI colorectal cancer. Targeted therapies are not to be outdone with a new option in metastatic colorectal cancer refractory to standard chemotherapy. In cholangiocarcinoma after the good results of non-selective FGFR2 inhibitors such as pemigatinib ; RLY-4008 (which is an irreversible selective FGFR2 inhibitor) seems very promising to limit toxicity and -resistance to treatment. The OCCLURANDOM trial confirms the interest of internal vectorised radiotherapy for well differentiated pancreatic endocrine tumours. Finally, an oral gamma-secretase inhibitor targeting the Notch pathway, nirogacestat, made a remarkable entry into a novel phase III trial in the management of desmoid tumours. [ABSTRACT FROM AUTHOR]

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Microsatellite Instability (MSI) phenotype is related to a deficiency in the DNA mismatch repair system (dMMR) and is observed in 5 % of metastatic colorectal cancers (mCRC). The dMMR/MSI phenotype should be routinely tested in all CRCs regardless of stage. Two complementary techniques with a high concordance (90-97%) are used to determine the dMMR/MSI status of a tumour: immunohistochemistry (IHC) and Polymerase Chain Reaction (PCR). Since 2020 and the presentation of the results of the phase III KEYNOTE 177 study, pembrolizumab is the new standard of care for patients with dMMR/MSI mCRC in first-line. Currently, there is no validated combination of chemotherapy ± targeted therapy with immune checkpoint inhibitors (ICIs) in the management of dMMR/MSI mCRC, and it is not known whether the combination of chemotherapy with ICIs can be beneficial. It is also not known whether a combination of two ICIs is more effective than monotherapy. Several phase III trials are underway to answer these questions. Despite the high response rate and durable efficacy of first-line anti-PD1 therapy, 30-50% of patients with dMMR/MSI mCRC progress either initially or secondarily. There is currently no clinically validated predictive biomarker of resistance to anti-PD1 anti-CTLA4 in these patients. In the event of early progression on ICIs, the possibility of pseudoprogression or misdiagnosis of dMMR/MSI status should be assessed. To date, there are no data on the use of ICIs in the adjuvant setting for resected dMMR/MSI CC. However, data are accumulating on the efficacy of neoadjuvant ICIs in CC, with studies showing two-thirds of patients with a complete pathological response (pCR), which could lead to the development of "Watch-and-Wait" strategies in the future. [ABSTRACT FROM AUTHOR]

Cancer of the colon (colorectal cancer, or CRC) is the third most frequent malignancy in the world and the fourth leading cause of cancer-related death. Recent research has focused on the link between high-risk human papillomavirus (HPV) infections and the onset/development of several different types of cancer in humans. As a result, scientists are now paying more attention to HPV and CRC. In a variety of malignant tumors, P63 is overexpressed. This includes non-Hodgkin lymphoma and breast carcinoma, as well as lung, bladder, and prostate cancers. However, in accordance with the existence of many P63 isoforms in malignant tumors, the actions of P63 in these malignancies remain a source of debate. P63 immunohistochemistry expression in CRC tissues is being investigated as a possible etiological link between high-risk HPV types and CRC. This retrospective study intended to investigate if there was an etiological link between high-risk HPV types and CRC. It has utilized 92 chosen formalin-fixed and paraffin-embedded tissue block samples. The collected samples were divided into 62 blocks of colorectal adenocarcinoma mass tissues and 30 non-malignant colorectal tissues used as a control group. Chromogenic in situ hybridization (CISH) was employed to discover HPV DNA16/18 in colorectal tissues. The overall proportion of positive HPV16/18 DNA- CISH detection in the mass CRC group was 44.4%, whereas HPV16/18 DNA was obtained at 80.0% in the non-malignant control group. The overall proportion of positive P63-ISH detection in the CRC group was also 70.4%, whereas P63 was 73.3% in the non-malignant control group. The link between HPV infection and P63 expression in CRC might point to the importance of these molecules in the progression of CRC.

Résumé: Les métastases cérébrales de cancers digestifs sont surtout issues de primitifs colorectaux et œsogastriques. Leur incidence augmente avec l'allongement de la survie globale au stade métastatique. À l'exception du bilan d'extension des tumeurs neuroendocrines de grade 3, aucune imagerie cérébrale n'est recommandée dans le suivi des cancers colorectaux et œsogastriques. Dans certaines situations, une imagerie cérébrale peut être proposée, notamment chez les patients avec cancers œsogastriques métastatiques depuis plus d'un an ou cancers colorectaux métastatiques depuis plus de trois ans. Sont ici rapportés les profils cliniques et biologiques des cancers colorectaux et œsogastriques particulièrement pourvoyeurs de métastases cérébrales. Ce sont principalement les cancers avec surexpression de HER2 , les cancers du rectum KRAS mutés avec métastases pulmonaires et les cancers de l'œsophage localement avancés. Leur prise en charge est guidée par les recommandations de l'ESMO 2021 et la discussion du dossier du patient en réunion de concertation pluridisciplinaire de neuro-oncologie. La chirurgie peut être proposée en cas de lésion unique. Les indications de la radiothérapie encéphalique in toto sont maintenant restreintes aux indications strictement palliatives puisqu'une radiothérapie stéréotaxique peut être envisagée jusqu'à dix lésions cérébrales. Le score clinique GI-GPA, validé et facilement accessible, permet d'estimer l'espérance de vie du patient et par conséquent d'orienter la prise en charge. Brain metastases from digestive cancers are essentially secondary to colorectal and oesogastric primary tumours. The incidence of this metastatic site increases along with the overall survival of metastatic digestive cancers. Excepted upon diagnosis of grade 3 neuro-endocrine tumours, no brain imaging is recommended in the follow-up of colorectal and oesogastric cancers. In some clinical situation, brain imaging can be prescribed, namely in patients with metastatic oesogastric cancers over one year follow-up and those with metastatic colorectal cancers over three years follow-up. Are reported here clinical and biological profiles of patients with colorectal or oesogastric cancer especially prone to brain metastases. They are cancer with HER2 overexpression, KRAS mutated rectal cancer with lung metastases and locally advanced esophagus cancer. Patient management should follow the 2021 ESMO guidelines and must be discussed in a neuro-oncology tumor board. Surgery can be considered in case of unique lesion. Indications of whole brain radiotherapy are restricted to strictly palliative situations since stereotactic radiotherapy is considered up to ten brain lesions. The GI-GPA, a valid and easily accessed score, estimates the patient's lifespan thus helping to orientate the management of brain metastases from gastro-intestinal cancers. [ABSTRACT FROM AUTHOR]

Résumé: En France, le cancer colorectal (CCR) correspond au cancer digestif le plus fréquent et représente la deuxième cause de mortalité par cancer. Bien que des progrès thérapeutiques considérables aient été réalisés grâce à l'avènement des thérapies ciblées et plus récemment de l'immunothérapie, le CCR dans sa forme métastatique (CCRm) reste un enjeu majeur de santé publique. Dès la première ligne palliative, le choix de la stratégie thérapeutique sera fonction des souhaits et de la condition du patient mais dépendra aussi du profil moléculaire tumoral, à savoir : le statut du gène RAS tumoral, la recherche d'une mutation BRAF (5-10 %) et la recherche d'une instabilité des microsatellites (MSI) dans la tumeur (15 %). À la progression, les stratégies de seconde ligne seront également fonction du profil moléculaire tumoral mais seront aussi dépendantes de la stratégie de première ligne administrée : nécessité du maintien d'une pression anti-angiogénique en cas d'exposition préalable au bévacizumab, discussion d'un accès à une immunothérapie chez un patient avec tumeur MSI naïf de ce traitement, cas des tumeurs MSS et BRAF mutées pour lesquelles une double inhibition anti- BRAF /anti-EGFR doit être proposée. À l'heure actuelle, les autres cibles moléculaires récemment explorées (surexpression HER2, gène de fusion NTRK) n'ont pas leur place dans les stratégies thérapeutiques de seconde ligne palliative. Dans le cadre du CCRm, bien choisir la seconde ligne palliative en fonction du profil moléculaire tumoral et du traitement reçu en première ligne est déterminant pour permettre aux patients d'obtenir les meilleurs espoirs de survie. In France, colorectal cancer (CRC) is the most common digestive cancer and the second most common cause of cancer-related death. Although considerable therapeutic progress has been made with the advent of targeted therapies and more recently immunotherapy, metastatic CRC (mCRC) remains a major public health issue. In first line treatment, the choice of therapeutic strategy will depend on the patient's wishes and condition, but will also depend on the tumor's molecular profile, i.e., the status of the tumor's RAS gene , BRAF mutation (5-10%) and the detection of microsatellite instability (MSI) in the tumor (15%). At progression, second-line strategies will also depend on the molecular profile of the tumor but will also depend on the first-line treatment administered: the maintenance of anti-angiogenic pressure in case of previous exposition to bevacizumab, discussion of access to immunotherapy in patients with MSI tumors who did not receive it in first-line, and the case of MSS and BRAF-mutated tumors for which dual anti-BRAF/anti-EGFR inhibition must be proposed. At the moment, the other molecular targets recently explored (HER2 overexpression , NTRK fusion gene) have no place in second-line treatment. In mCRC, the correct choice of second-line therapy, based on the molecular profile of the tumor and the treatment received in the first line, is crucial to ensure that patients have the best possible chance of survival. [ABSTRACT FROM AUTHOR]

Résumé: L'ADN tumoral circulant (ADNtc) correspondant aux fragments d'ADN libérés par les cellules tumorales dans la circulation sanguine. Plus de 6 000 articles ont été consacrés à ce biomarqueur au cours des dix dernières années dont près de 1 000 sur la thématique du cancer colorectal (CCR). Ce regain d'intérêt a notamment été suscité par une meilleure compréhension dans la physiopathologie de ce biomarqueur et l'avènement des progrès technologiques nécessaires à sa détection. Le rationnel à l'utilisation d'ADNtc est en effet considérable puisque cette « biopsie liquide » permet d'étudier une large gamme d'altérations génétiques de façon rapide et non invasive. Cette biopsie liquide offre en outre l'avantage de pouvoir être répétée dans le temps et de représenter l'ensemble de l'hétérogénéité spatio-temporelle néoplasique. Dans ce contexte, l'ADNtc se positionne comme un biomarqueur candidat idéal qui pourrait être utilisé à chaque étape du parcours de soins en oncologie. De nombreuses études ont ainsi montré l'intérêt potentiel de l'ADNtc dans des domaines aussi variés que le dépistage, l'utilisation à visée pronostique, la détection de la maladie résiduelle ou la détection d'altérations génétiques prédictives de l'efficacité du traitement. L'enjeu dans les années à venir concernera l'intégration en routine de ce biomarqueur pour adapter la prise en charge des patients dans nos filières de soins. Les résultats des études interventionnelles utilisant ce biomarqueur comme outil décisionnel de la stratégie thérapeutique sont attendus avec impatience. L'objectif de cette mise au point est de réaliser une synthèse des connaissances autour de l'ADNtc tant dans ses conditions de détection que de ses principales applications cliniques centrées autour du cancer colorectal (CCR). Circulating tumor DNA (ctDNA) corresponds to the fragments of DNA released by tumor cells into the bloodstream. More than 6,000 articles have been devoted to this biomarker over the past ten years, including nearly 1,000 about colorectal cancer (CRC). This renewed interest has been aroused in particular by a better understanding of the pathophysiology of this biomarker and the advent of the technological progress necessary for its detection. The rationale for the use of ctDNA is indeed considerable since this "liquid biopsy" makes it possible to study a wide range of genetic alterations in a rapid and non-invasive way. This liquid biopsy also offers the advantage of being able to be repeated over time and representing the neoplastic spatio-temporal heterogeneity. In this context, ctDNA is positioned as an ideal candidate biomarker that could be used at each stage of the oncology care pathway. Numerous studies have thus shown the potential interest of ctDNA in many areas such as screening, prognostic tool, detection of residual disease or genetic alterations predictive of treatment efficacy. The current challenge in the next years will concern the routine integration of this biomarker to adapt the care of our patients. The results of interventional studies using this biomarker as a decision-making tool for therapeutic strategy are eagerly awaited. The aim of this review is to report a synthesis of knowledge around ctDNA in CRC in terms of detection conditions and main clinical applications. [ABSTRACT FROM AUTHOR]

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: La radioembolisation des métastases hépatiques de cancer colorectal, ou radiothérapie interne sélective, est une technique qui consiste à délivrer par l'artère hépatique des microsphères chargées d'yttrium-90 radioactif, directement au sein des métastases hépatiques. L'effet thérapeutique de la radioembolisation est lié à la radiothérapie interne et non à l'embolisation. Elle nécessite plusieurs étapes rigoureuses, faisant intervenir des radiologues interventionnels, des médecins nucléaires, des radiopharmaciens et des radiophysiciens : une étape de simulation aux macroaggrégats d'albumine humaine, la dosimétrie, et la phase de traitement. La radio-embolisation est disponible en France depuis une dizaine d'années. Elle a été validée chez les patients ayant des métastases hépatiques exclusives réfractaires aux traitements systémiques, dans quelques études de faibles effectifs, permettant son remboursement par l'assurance maladie dans cette indication. De récentes grandes études de phase III ont évalué cette technique associée à la chimiothérapie, dès la première et deuxième ligne. En dépit d'une activité antitumorale évidente, permettant une amélioration du contrôle local, ces études n'ont en revanche pas permis de montrer un bénéfice en survie globale. Une amélioration des techniques de dosimétrie, une meilleure sélection des patients et des combinaisons avec des traitements susceptibles d'apporter des effets biologiques synergiques pourraient à l'avenir faire reconsidérer la place de la radioembolisation dans les lignes précoces de traitement. Radioembolization of colorectal cancer liver metastases, or selective internal radiation therapy, is a technique that consists of delivering radioactive yttrium-loaded microbeads through the hepatic artery directly into the liver metastases. The therapeutic effect of radioembolization is related to the internal radiotherapy and not to the embolization. It requires several rigorous steps, involving interventional radiologists, nuclear physicians, radiopharmacists and radiophysicists: A simulation step with albumin macroaggregates, dosimetry, and the treatment phase. Radioembolization is available in France for about ten years. It has been validated in patients with exclusive liver metastases and refractory to systemic treatments in few studies with small population, allowing its reimbursement in this indication. Recent large phase III studies have evaluated this technique in combination with chemotherapy, in 1st and 2nd line of treatment. Despite clear antitumor activity, showing an improvement in local control, these studies did not show any benefit in overall survival. Improved dosimetry techniques, better patient selection, and combinations with treatments likely to have synergistic biological effects could lead to reconsideration of the role of radioembolization in early-line treatment. [ABSTRACT FROM AUTHOR]

Background: Updating French clinical guidelines for diagnostic and management of ulcerative colitis is needed due to the emergence of new treatments and treatment goals. Methods: On behalf of the Groupe d'Etudes Therapeutiques des Affections Inflammatoires du Tube Digestif (GETAID), French clinical guidelines were updated through a validated process of adaptation of clinical guidelines from international Gastroenterology societies and French consensus meetings. Results: French clinical guidelines for the diagnostic and management of ulcerative colitis were drafted by 16 GETAID members and reviewed by 6 members of the GETAID, the Association Nationale des Hépato-gastroentérologues des Hôpitaux généraux (ANGH) and the Club de Réflexion des Cabinets et Groupes d'Hépato-Gastroentérologie (CREGG), graded according to the level of Evidence and the level of agreement by 68 experts from the latter three societies. The present guidelines focused on classification, diagnosis, histopathology, extra-intestinal manifestations, dysplasia and colorectal cancer, pouchitis, medical management of active disease and maintenance therapy. Conclusion: This paper provides updated and useful guidelines for French gastroenterologists to diagnose and treat patients with ulcerative colitis. [ABSTRACT FROM AUTHOR]

Obesity and malnutrition are subjected to comprehensive studies as risk factors in the pathogenesis of colorectal cancer (CRC). Nevertheless, the most recent scientific evidence revealed that a number of issues associated with risk impact processes remain to be clarified. The aim of the current review is to discuss the action mechanisms of obesity and malnutrition, their effect in the prediagnosis and later phases of CRC, with emphasis on concomitant oxidative stress. The relationship obesity-CRC is considered in three aspects: low-grade inflammation and role of adipocytokines, development of metabolic syndrome, lipid peroxidation and oxidative stress. Malnutrition effect is discussed in two aspects – metabolic dysregulation and oxidative stress. Data are presented on the specificity of action of the two risk factors referring to the periods of disease course. Oxidative stress is a characteristic indicator of obesity, malnutrition and CRC. This fact enables us to recommend its inclusion together with nutritional status indicators in CRC screening.

Duchenne Muscular Dystrophy (DMD) is the most common and severe form of muscular dystrophy, reaching one out of every 5000 male births in the world population. It is characterized by progressive muscular degeneration from a young age and leads to serious failures of the body which lead to the death of the patient. The gene responsible for DMD is located on chromosome X. It encodes a membrane cytoskeleton protein»the dystrophin». The alterations affecting this gene are essentially deletions with a proportion of 65%. That’s why we have interested to develop in our laboratory a technique that will allow us to detect this type of mutations in 5 sporadic cases with Duchenne myopathy from West Algeria. The study consisted in amplifying by PCR multiplex that cover 19 exons of the DMD gene most commonly deleted. This study allowed us to reveal two different deletions, the first involving the promoter of the gene and the second one the exon 43. These first results confirm the data reported in the literature which classify these two regions as deletion hotspots. The results obtained represent a first in the western Algerian and could lead to the generalization of genotypic diagnosis and genetic counseling with a view to improve the care of patients in Algeria.

Objective - The accumulation of genetic variants participates in the process involved in the risk of developing colorectal cancer (CRC). Several studies have explored the correlation between the 6986A> G polymorphisms of the CYP3A5 (CYP450) gene (rs776746) belonging to the cytochrome P450 and 3435C> T family of the adenosine triphosphate-binding cassette B1 (ABCB1) gene (rs1045642). The objective of this study is to investigate a possible association of rs776746 and rs1045642 polymorphisms with the occurrence of colorectal cancer on a population of western Algeria. Methods - The cohort consisted of 99 CRC patients and 101 controls. The CYP3A5 c.6986A> G and ABCB1 c.3435> T polymorphisms were identified by the allelic discrimination by quantitative real-time PCR technique. The results were analyzed by calculating the odd ratio (OR) with a 95% confidence interval. Results - This case-control study didn’t show any statistically significant difference in allelic and genotypic frequencies of these polymorphisms between the two groups (case and control). Conclusion - This work allowed us to conclude that there was no association between these polymorphisms and the occurrence of CRC in our population.

Résumé: Les traitements par inhibiteur de point de contrôle immunitaire (ICI) ont récemment montré leur efficacité dans le traitement des cancers œsogastriques, colorectaux dMMR/MSI et des carcinomes hépatocellulaires (CHC). Plusieurs autorisations de mise sur le marché européennes ont été récemment obtenues pour le traitement des cancers de l'œsophage, colorectaux dMMR/MSI et des CHC, d'autres demandes ont été soumises concernant les adénocarcinomes gastriques. Des réponses prolongées sont observées en proportion variable selon la localisation et la biologie tumorale. La tolérance des ICI en monothérapie est globalement meilleure que celle de la chimiothérapie. Le niveau d'expression de PD-L1 dans la tumeur est un facteur prédictif d'efficacité dans certaines tumeurs. Les ICI n'ont pas montré d'efficacité dans le traitement de certaines tumeurs notamment les cancers colorectaux pMMR/MSS et les adénocarcinomes du pancréas. De nouvelles questions de stratégie thérapeutique apparaissent avec l'introduction de cette classe thérapeutique, notamment les traitements après échappement à une immunothérapie ou l'identification des patients qui présentent une résistance primaire aux ICI. Enfin, de nouvelles combinaisons d'immunothérapie sont à l'étude dans le traitement des cancers réfractaires aux ICI. Recently, immune checkpoint inhibitor (ICI) treatments have been shown to be effective in the treatment of esogastric, dMMR/MSI colorectal cancers and hepatocellular carcinomas (HCC). Several European marketing authorizations have recently been obtained for the treatment of esophageal, colorectal dMMR/MSI and HCC cancers, other applications have been submitted concerning gastric adenocarcinomas. Sustained responses are observed in varying proportions depending on the location and the tumor biology. The tolerance of ICI monotherapy is overall better than that of chemotherapy. The level of PD-L1 expression in the tumor is a predictor of efficacy in some tumors. ICIs have not been shown to be effective in the treatment of certain tumors, including pMMR/MSS colorectal cancers and adenocarcinomas of the pancreas. New questions of therapeutic strategy appear with the introduction of this therapeutic class, in particular treatments after escape from immunotherapy or the identification of patients who have primary resistance to ICI. Finally, new combinations of immunotherapy are being studied in the treatment of cancers refractory to ICI. [ABSTRACT FROM AUTHOR]

Introduction. Surgical injury can stimulate tumor growth in metastatic colorectal cancer (mCRC), due to mitochondrial dysfunction. The objective of the study was to analyze the clinical significance of the molecular marker of 8-hydroxydeoxyguanosine and the oncological influence of the liver parenchyma warm ischemia on the prognosis of mCRC. Materials and methods. The study involved 89 CRC patients with metachronous metastatic liver disease treated in The National Cancer Institute of the Ministry of Health, Kyiv, Ukraine, from 2015 till 2018, and 19 conditionally healthy donors. 8-Hydroxy-deoxyguanosine (8-OHdG) level in the urine of patients with mCRC was determined. Urine sampling was done 24-hours before and on day 3 after surgery. Measurements of the marker of oxidative DNA damage were repeated three times. The state of the hepatocyte detoxification energy system, the levels of superoxide radicals (O2-) in the tumour tissue were determined by electron paramagnetic resonance (EPR) and Spin Trapping Technology. Results. The urinary 8-OHdG level of donors was within 0.24±0.063 nM/kg ∙ day, whereas before the resection and on day 3 after the R0-resection of liver in mCRC patients it was 3.42±0.18 nM/kg∙day and 2.12±0.08 nM/kg∙day (p < 0.05), respectively. On day 1 after the liver resection with a total duration of warm ischemia period < 30 min and > 30 min have had marker at level 2.108 ± 0.13 nM/kg∙day and 2.9883 ± 0.159 nM/kg∙day (p < 0.0001), respectively. The volume of metastatic tissue (Vmts) significantly and directly increased the level of urine 8-OhdG. The duration of surgical intervention (resection t) and duration of warm liver ischemia (t ischemia) significantly increased urine level of 8-OhdG. Conclusions. R0-resection of liver metastases in mCRC patients decreases urine 8-OHdG level after surgery. Warm liver ischemia during the Pringle maneuver (≥ 40 min), surgical intervention duration (≥ 300 min) and metastatic tissue volume (≥ 12 cm3) in liver parenchyma in mCRC patients significantly increase urine 8-OHdG levels. The level of 8-OHdG correlates with the extent of organ resection, duration of ischemia, volume of post-resection liver tissue, volume of metastases and rate of superoxide radicals’ generation.

Colorectal cancer represents one of the most common malignancies reported worldwide, associated with an increased risk of hepatic metastases development. Historically, the development of liver metastases from colorectal cancer has been associated with extremely poor rates in terms of survival. Improvement of the surgical techniques, as well as of the perioperative outcomes, in association with the development of new chemotherapeutic agents lead to a better survival; however, in certain cases with unresectable liver metastases, association of chemotherapy and resection can be no longer feasible due to the extent of the disease. In such cases liver transplantation has been proposed with promising results. However, this therapeutic strategy is only indicated when the absence of extrahepatic disease is documented. This is a literature review of the largest studies which focused on the topic of liver transplantation for unresectable liver metastases from colorectal cancer.

Résumé: Le cancer colorectal (CCR) constitue un problème de santé publique en France, il est métastatique dans la moitié des cas (synchrones dans 25 % des cas). Dès le début de la prise en charge, outre le diagnostic histologique positif et le bilan d'extension standard, il est important de déterminer le profil clinique du patient (état général, comorbidités), la résécabilité des métastases et la biologie moléculaire (RAS , BRAF , MSI) de la tumeur. Ces éléments vont nous guider dans le choix de la stratégie thérapeutique de première ligne mais également des lignes ultérieures. Dans cet article, nous décrivons les différentes stratégies thérapeutiques en fonction du profil du patient et de la tumeur, ainsi que la place des nouveaux traitements dans ces stratégies (anti-BRAF, anti-HER2, immunothérapie et inhibiteurs de NTRK) et le rôle prometteur de l'ADN tumoral circulant dans le suivi de la maladie, la réponse au traitement et l'orientation thérapeutique. Grâce aux progrès thérapeutiques et à la biologie moléculaire qui a permis un affinement du diagnostic, on peut parler aujourd'hui d'un traitement personnalisé du CCR au vue de la grande hétérogénéité de ces tumeurs, avec en corollaire une amélioration de la survie des patients qui atteint aujourd'hui 30 mois de médiane. Colorectal cancer (CRC) constitutes a public health problem in France, it is metastatic in half of the cases (synchronous in 25% of cases). From the start of treatment, in addition to the positive histological diagnosis and the standard extension assessment, it is important to determine the patient's clinical profile, the resecability of the metastases, the molecular biology of the tumor ; all this elements guide us in the choice of the therapeutic strategy in first line, but also the in the more advanced lines. In this article, we describe the different therapeutics strategies according to the patient and tumor profiles, but also the place of new treatments in this strategy (BRAF inhibitor, anti-HER2, immunotherapy and NTRK inhibition) and the role of circulating tumor DNA in the treatment monitoring, evaluation of tumor response and therapeutic choice. Thanks to therapeutic advances and molecular biology, which allow a diagnostic refinement, today we can talk about personalized treatment of CRC given the great heterogeneity of these tumors, with an improvement in patient survival which reach a median of 30 months. [ABSTRACT FROM AUTHOR]

Résumé: Pour améliorer la prévention des cancers, la nutrition dans son ensemble (alimentation, consommation d'alcool, activité physique, surpoids/obésité) est un des facteurs essentiels sur lesquels il est possible d'agir. Les médias diffusent régulièrement des messages sur le sujet, parfois erronés, et la littérature scientifique regorge de données, parfois contradictoires. Des expertises collectives nationales (Institut National du Cancer et Réseau National Nutrition Cancer) et internationales (World Cancer Research Fund et Centre International de Recherche sur le Cancer) permettent de faire régulièrement le point des avancées scientifiques en respectant une méthodologie rigoureuse et élaborer des recommandations basées sur des niveaux suffisants de preuve scientifique. Dans le cas du cancer colorectal, plusieurs facteurs nutritionnels ont ainsi été identifiés comme associés au risque de survenue de ce cancer avec un niveau de preuve « convaincant » ou « probable » : le surpoids et l'obésité, les boissons alcoolisées, la consommation de viandes rouges ou de viandes transformées. À l'inverse, certains facteurs auraient un rôle protecteur : l'activité physique, les aliments riches en fibres et les produits laitiers. Des données scientifiques probantes manquent encore pour confirmer le rôle d'autres facteurs. Suivre les recommandations émises par le Haut Conseil de la Santé Publique et l'Institut National du Cancer pourrait permettre de diminuer le développement de plus de la moitié des cancers colorectaux. Diffuser ces messages auprès des professionnels de Santé et de la population est donc essentiel. In order to improve cancer prevention, nutrition (including: diet, alcohol consumption, physical activity, body fatness) is one of the key factors that can be modified. The media regularly broadcast messages on the topic, sometimes erroneous and the scientific literature is full of data, but sometimes contradictory also. National and international collective expertises regularly review scientific advances using a rigorous methodology to enable recommendations to be made based on sufficient levels of scientific evidence. In the case of colorectal cancer, several nutritional factors have been identified as associated with the risk of developing this cancer with a level of evidence defined as "probable" or "convincing": overweight and obesity, consumption of red and of processed meats, alcoholic beverages. On the other hand, some factors would have a protective role: physical activity, foods containing fibre and dairy products. There is still a lack of scientific evidence to confirm the role of other factors. To follow the recommendations of the French High Council of Public Health and the French National Cancer Institute could reduce the development of more than half of colorectal cancers. Spreading these messages to health professionals and to the public is therefore essential. [ABSTRACT FROM AUTHOR]

Résumé: La radiothérapie interne sélective (RIS) hépatique utilise des microsphères d'Yttrium90 injectées dans l'artère hépatique, qui émettent un rayonnement β et permettent de traiter les métastases hépatiques de cancer colorectal (MHCCR). La RIS se déroule en deux procédures distinctes : un temps préparatoire et la phase de traitement. L'objectif de la dosimétrie personnalisée est d'être le plus tumoricide possible, mais sans risquer l'insuffisance hépato-cellulaire. La tolérance de la RIS est excellente dans la majorité des cas. Selon le TNCD, la RIS est indiquée en situation palliative en cas de maladie hépatique prédominante (≤ 5 lésions extra-hépatiques n'engageant pas le pronostic vital) ; en pratique lorsqu'un traitement par TAS-102 ou régorafenib est discuté. Nous résumons ici la littérature disponible concernant la RIS qui a permis son remboursement, mais aussi les résultats obtenus dans la prise en charge des MHCCR dans des situations plus précoces. Selective internal radiation therapy (SIRT) uses microspheres of 90Yttrium injected into the hepatic artery, which emit β radiation and make it possible to treat liver metastases of colorectal cancer (LMCRC). SIRT is schedulled in two distinct procedures: a work-up and a treatment phase. The goal of personalized dosimetry is to be as tumoricidal as possible and to avoid liver function deficiency. The tolerance of SIRT is excellent in the majority of cases. According to the TNCD, the SIRT is indicated in a palliative situation in patients with LMCRC and a predominant liver disease (≤ 5 non-life-threatening extrahepatic lesions); in practice when treatment with TAS-102 or Regorafenib is discussed. Here, we review the available data concerning the SIRT which allowed its reimbursement, but also the results obtained in the management of MHCCR in earlier treatment lines. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is a major global public health problem. Folate metabolism is involved in DNA synthesis, repair and methylation. Methylenetetrahydrofolate reductase (MTHFR) is a key enzyme in folate metabolism. Common MTHFR C677T polymorphism was correlated to CRC. This case-control study was conducted to analyze the association between this polymorphism and the risk of sporadic CRC in a Moroccan population. The study involved 76 patients with sporadic colorectal cancer confirmed histologically and 182 patients (control group) without a history of cancer. Deoxyribonucleic acid (DNA) was isolated from peripheral blood and genotypes were determined using PCR-RFLP. The risk of association was estimated using odds ratio (OR) with 95% confidence interval. Genotype frequency of MTHFR in patients and in the control group was CC 34.1%, CT 56.6%, TT 9.21%, CC 51.6%, CT 42.8% and TT 6% respectively. CT genotype and its combination with TT genotype and allele T were associated with an increased risk of CRC and with an OR of 2.02 (with 95% confidence interval [CI]: 1.14-3.58, p = 0.01), 2.05 (95 % CI: 1.18-3.58, p= 0.01) and 1.61 (95% CI: 1.07-2.40, p=0.02). Homozygous TT weren't a protection factor in our study, with an OR of 2.30 (95% CI: 0.81-6.52, p = 0.11). There was a statistically significant association between the MTHFR C677T variant and the risk of occurrence of sporadic colorectal cancer in the studied population. [ABSTRACT FROM AUTHOR]

The fear that the medical oncologist may have is that HIPEC integrated into a multidisciplinary care pathway will negatively impact the treatments that will follow. This fear is largely related to the side effects, which are themselves dependent on the medication used. Cisplatin, most frequently used for epithelial ovarian cancers, has essentially renal toxicity, which can be avoided by the use of sodium thiosulfate. Oxaliplatin induces more severe toxicities post surgery than mitomycin C in colorectal cancers. However, the data from randomized trials are reassuring for the medical oncologist concerning the course of postoperative treatment, as long as HIPEC is performed according to a standardized protocol, within trained teams, and after multidisciplinary discussion concerning its modalities., (Copyright © 2023 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

After more than a decade of good results using the combination of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal carcinosis of colorectal origin, the PRODIGE7 study, which specifically evaluated the role of HIPEC, failed to show any superiority in terms of overall and disease-free survival for the CRS+HIPEC combination compared with CRS alone. This study constituted a radical change in the knowledge and therapeutic attitudes observed to date. After reviewing the literature and the consensus of national and international experts, a synthesis is provided, together with an outlook on the questions raised and the therapeutic trials and innovations of the near future. An analysis of recent advances due to the advent of a new technique, PIPAC, is also proposed, as well as a review of current therapeutic trials in this field., (Copyright © 2023. Published by Elsevier Masson SAS.)

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INTRODUCTION: Surgical treatment of colorectal cancer (CRC) in elderly patients has improved, but data on the tolerability and benefits of adjuvant and palliative chemo-therapy in this growing population remains scarce. METHODS: we conducted a retrospective study to compare chemotherapy-associated toxicities in CRC patients aged = 70 years and = 70 years at Tygerberg Hospital (South Africa). We also assessed tumor-related mortality, progression free survival (PFS), and overall survival (OS) including predictive factors of OS. RESULTS: a total of 50 patients received either adjuvant or palliative chemotherapy. There was no difference in overall toxicity between the two groups. Out of the 50 patients, 8 (16%) had Grade 3-4 toxicity. 4 of these patients made up 15% of the =70 years age group, whereas the other 4 made up 17% of the = 70 years age group. The mean follow-up time was 47.5 months (95% CI 41.5 - 53.5 months). The 5-year over-all survival rate for Stage II and III patients 70 years and = 70 years were 80.9% and 69.5%, respectively, and not significantly different (P = 0.52). Furthermore, the 5-year progression-free survival rates of the = 70 and = 70 age groups were 70.7% and 58.8%, respectively, and also not statistically significantly different (P = 0.49). For Stage IV patients, there were no significant differences in survival between the two age groups.

INTRODUCTION: The burden of colorectal carcinoma (CRC), once considered rare in Africa, may be changing with the disease being increasingly diagnosed and there is a suggestion that age and race influence tumour behaviour. To describe the clinicopathological spectrum of CRC among the different population groups and age groups in a South African setting. METHODS: analysis of prospectively collected data from an on-going colorectal cancer database, including demographics, clinical presentation, site, staging and grading on all patients enrolled over an 18-year period. RESULTS: a total of 2232 patients with CRC were accrued over the study period (Africans, 798; Indians, 890; Coloureds, 104; and Whites, 440). Mean age was 57.7 (SD 14.4) but varied considerably by race (p = 0.001) and Africans were significantly younger. Young adults (aged =40 years) totalled 305 and older patients (aged 40 years) totalled 1927. The proportion of young patients (40 years old) was 28%, 7%, 9% and 3% among Africans, Indian, Coloured and White patients respectively. There were minimal variations in anatomical sub-site distribution. There was no difference in staging regardless of age and race. Tumour stage was similar in all population groups as well as in older and young adults. Mucinous differentiation was more common in Africans and in young patients and poor differentiation was more common in African patients. Africans had a significantly lower resection rate compared to the other population groups (p =0.001). Younger patients had a significantly lower resection rate compared to the other population groups (p = 0.001). CONCLUSION: African patients were the youngest compared to the other population groups. Mucinous differentiation predominated in Africans and young adults and poor differentiation predominated in Africans, resection rate was lower for African patients and in young patients.

Introduction: colonoscopy is a safe and effective means of visual inspection of the large bowel from the distal rectum to the caecum. There is a paucity of data on this procedure in Ghana. The only data in literature are from Kumasi and Accra. This paper reviews the indications and findings of lower gastrointestinal endoscopy (LGIE) in Eastern Regional Hospital, Koforidua, GhanMethods: a retrospective study was undertaken on patients who underwent colorectal endoscopy between January 2019 and December 2019.Results: one hundred and six (106) LGIE procedures were performed. Sixteen patients had flexible sigmoidoscopy and the rest had full colonoscopy. Of those who had colonoscopy, caecal intubation rate was 86.2%. Males were 69 and mean age 56.67 ± 16.48. The most common primary indication was bleeding per rectum. The most common primary endoscopic finding was haemorrhoids (54.17%) followed by colorectal tumors (15.0%). 11.6% of the patients had normal endoscopic findings. A diagnosis of haemorrhoids was made in 61.6% of those presented with bleeding per rectum as an indication and was the commonest cause of lower gastrointestinal bleeding (LGIB).Conclusion: the commonest indication for colonoscopy was rectal bleeding, while the most frequent pathology was haemorrhoids. The proportion of our patient population found to have a colorectal tumor or polyps was not insignificant. Screening program for colorectal cancer in Ghana should be considered.

With the deepening of tumor research, the concept of the tumor microenvironment has gradually come into people’s view. A significant characteristic of the microenvironment is hypoxic. A large number of vitro experiments have confirmed that hypoxic environments can induce angiogenesis, anti-apoptosis, changes in drug sensitivity, and tumor metastasis. Now, chemosensitivity tests are all carried out under normoxic conditions. Therefore, some scholars have pointed out that if it is possible to simulate the hypoxic state of the tumor microenvironment during the chemosensitivity tests in vitro, it may be able to match better the effect of chemotherapeutic drugs on killing tumor cells in vivo. This study clarified the differences in the chemosensitivity for colorectal cancer cells in normoxic and hypoxic environments. The result of CCK-8 detections has shown that the toxicity of drugs to cells is much higher under normoxic conditions. To further figure out the different mechanisms of the chemotherapy drugs under normoxic and hypoxic conditions, we conducted cellular uptake analysis and western blot, which demonstrated that the uptake of Doxorubicin in normoxic cells was significantly higher than that in hypoxic cells. While the result of the western blot has shown that the expression of VDAC (Voltage-dependent anion channel) and cleaved caspase-3 is higher under normoxic conditions. This study provides a specific basis for future research on the chemosensitivity of chemotherapy drugs in hypoxic environments.

Résumé: L'incidence du cancer colorectal a augmenté en France jusque dans les années 2000 puis a régulièrement diminué chez l'homme, avec une variation annuelle moyenne de – 1,4 % au cours des dix dernières années, tandis que l'incidence restait stable chez la femme. Les tendances évolutives de l'incidence pour ce cancer variaient selon la sous-localisation le long du cadre colique. La baisse d'incidence était plus importante pour les cancers du rectum que pour les cancers du côlon. Bien qu'ils restent rares, l'incidence des cancers colorectaux chez les jeunes patients de moins de 40 ans a augmenté pour les cohortes récentes. La proportion de cancers colorectaux parmi l'ensemble des cas prévalents en France était de 13 %. En 2018, 152 000 patients avaient eu un diagnostic de cancer colorectal diagnostiqués dans les cinq années précédentes. Le pronostic du cancer colorectal s'est amélioré avec le temps. La survie nette à cinq ans a augmenté de 52 % pour les cancers diagnostiqués entre 1989 et 1993 à 60 % pour ceux diagnostiqués entre 2005 et 2010. Cette tendance concernait toutes les classes d'âge mais était moins marquée pour les patients âgés de 75 ans ou plus. Les campagnes de dépistage du cancer colorectal et la mise en place récente des tests immunologiques devraient faire baisser la mortalité de ce cancer et, à terme, l'incidence également, mais sous réserve d'une participation suffisante. The incidence of colorectal cancer increased in France until the 2000s' then regularly decreased in men with a -1.4% mean annual variation over the last ten years, whereas incidence remained stable in women. Time trends in incidence for this cancer varied according to its sub location along the gut. The decrease in incidence was higher for rectal than for colon cancers. Even if rare, incidence in young patients less than 40 years increased in recent cohorts. The proportion of colorectal cancer in the overall French cancer prevalence was 13%. In 2018, 152,000 patients had a colorectal cancer diagnosed in the 5 previous years. The prognosis of colorectal cancer improved over time. Net 5-year survival increased in males from 52% for cancers diagnosed between 1989 and 1993 to 60% for those diagnosed between 2005 and 2010. This trend concerned all age classes but was less marked in patients aged 75 and over. The national colorectal screening and the introduction of recent immunological tests should decrease the mortality for this cancer and, at term, should decrease its incidence too subject to a sufficient participation. [ABSTRACT FROM AUTHOR]

Little is known about the epidemiology of digestive neuroendocrine tumours (NETs). NETs remain a rare cancer, representing 1% of all digestive cancers. In France, incidence rates are estimated to around 1.1/100,000 inhabitants in males and 0.9/100,000 in females. The incidence rates got increased over time, with probably more than 1,000 new cases per year in France. Because of their relatively good prognosis, NETs are the second more prevalent digestive cancer after colorectal cancer. Most digestive NETs are well-differentiated (WDNETs); poorly differentiated neuroendocrine carcinomas (PDNEC) account for less than 20% of the cases in most of the series. Among bowel-NETs, the most frequent anatomical localisations are colorectal and small bowel. Functional NETs are rare (<20%); most of them are carcinoids, insulinomas and gastrinomas. More than half NETs are metastatic at diagnosis, mainly in the liver. Tumour differentiation, histologic grade, anatomic site and stage are the main prognostic factors. WDNETs are slow-growing tumours (relative survival of 55% at 5 years), whereas PDNEC are highly aggressive (relative survival of 4.5% at 5 years). [ABSTRACT FROM AUTHOR]

Introduction: given its frequency and severity, colorectal cancer is a major public health problem. Diet plays a key role in preventing this type of cancer. The purpose of our study was to determine dietary risk factors for colorectal cancer in our Moroccan context. Methods: we conducted a case-control study including patients with colorectal cancer compared with controls. The statistical analysis of results was carried out using R software. Results: our study included 225 patients treated for cancer at the Mohammed VI Hospital Center and 225 controls. The average age of our study population at the time of diagnosis was 55.49±14.06 years, including 119 men (52.9%) and 106 women (47.1%) with a sex ratio of 1.12. Associations were found between the highest intakes of red meats, cold meats, sausages and the risk of colorectal cancer (p = 0.0001) with F4 (4-7 times / week) vs F1 (never ): OR = 4.4 (1.6-11.9); (p = 0.001), OR = 1.7 (0.5-5.7); (p = 0.003), OR = 5.7 (1.2-27.4)). On the other hand, consumption of fish was associated with a reduced risk of colorectal cancer (p = 0.0001; OR = 0.3 (0.11-0.7)), while consumption of poultry and grilled eggs was not associated with colorectal cancer. We also found that consumption of fresh vegetables and cooked vegetables was low in patients compared to controls (p = 0.0001). Furthermore, a high intake of black coffee was associated with a reduced risk of colorectal cancer (p = 0.0001; F4 vs F1: OR = 0.2 (0.1-0.4)). Conclusion: our study highlights that dietary changes can prevent or impede the growth of colorectal cancer. It is essential to promote balanced diet, rich in fish, vegetables, fruits and fibers without exceeding recommended levels of red meat and avoiding cold meats and sausages. [ABSTRACT FROM AUTHOR]

Résumé: Les micro-ARN (miR) sont de petits ARN simple brin. Leur rôle est de réguler la traduction d'ARN messager cible. Ils impactent ainsi le fonctionnement global de notre organisme. Leur dérégulation est impliquée dans un grand nombre de mécanismes pathologiques, notamment dans l'initiation et la progression tumorales colorectales. Il est possible de détecter les fluctuations d'expression des miR dans les tissus digestifs, le sang et les selles. Certains miR ont été identifiés comme des potentiels biomarqueurs diagnostiques et pronostiques du cancer colorectal (CCR). Leurs dérégulations participent également aux mécanismes de résistance à certains médicaments anti-tumoraux. La mesure du niveau d'expression de miR est une piste pour la recherche de biomarqueurs prédictifs de l'efficacité des traitements couramment prescrits dans le CCR. Ils sont également des cibles thérapeutiques potentielles car l'induction pharmacologique de la sur- ou sous-expression de certains miR pourrait être utilisée afin de modifier les caractéristiques des tumeurs et servir de base pour de nouvelles thérapies en oncologie. Les miR représentent des éléments-clés du développement du CCR avec des perspectives d'applications prometteuses et innovantes en pratique clinique. MicroRNAs (miR) are small single-stranded RNAs. Their role is to post-transcriptionally regulate the expression of target mRNA. They influence the homeostasis of our organism. Dysregulated expression of many miR is involved in pathogenic mechanisms, particularly colorectal cancer (CRC) initiation and development. MiR levels of expression are detected in blood, stool and digestive tissue. Therefore, certain miR can be used as diagnostic and prognostic biomarkers in CRC. Also, some dysregulated miR contribute to drug resistance. Measuring levels of expression of those miR can be used to categorize patients according to their risk of drug-resistance in order to improve their survival. Lastly, artificially modifying miR regulation can be adopted to treat CRC. MiR are key factors in CRC development and their bedside usage is promising and innovative. [ABSTRACT FROM AUTHOR]

Résumé Introduction. Des facteurs comme l’obésité et l’alimentation sont impliqués dans la carcinogenèse colique. Objectif. Une étude rétrospective cas-témoins est menée afin d’évaluer l’association de ces facteurs avec le cancer colorectal (CCR) dans une population de l’Est Algérien. Matériel et méthodes. L’enquête a été réalisée entre avril 2016 et août 2017, au niveau de l'Etablissement Public Hospitalier de Bekaria à Tébessa et des Centres Anti-Cancer de Batna et d’Annaba. Soixante quatre patients atteints de CCR âgés de 51±12 et 64 témoins dont l’âge moyen était de 51±17 ans ont été recrutés. Le questionnaire utilisé a permis de collecter les informations concernant l’âge, le sexe, les mesures anthropométriques, les habitudes alimentaires et la fréquence de consommation de quelques aliments. Résultats. Une association significative est notée entre l’obésité et la prévalence du CCR (37,5 % des patients vs 20,31 % des témoins, p=0,048). L’indice de masse corporelle (IMC) moyen des patients était plus élevé que celui des témoins. La prévalence du cancer atteint son maximum entre 50 et 59 ans. La consommation des céréales et des œufs est retenue comme facteur protecteur du CCR (p=0,046 et 0,028). Les témoins consomment plus de pâtes que les patients (P=0,054). Conclusion. Cette étude met en évidence l’association entre le cancer colorectal, l’obésité et la consommation de certains aliments chez les patients atteints de CCR. [Abstract Introduction. Factors such obesity and diet are involved in colon carcinogenesis. Objective. A retrospective case-control study was done to evaluate the association of these factors with colorectal cancer (CRC) in eastern Algeria population. Material and methods. This study was conducted between April 2016 and August 2017, at the Bekaria public hospital in Tebessa, and the Anti-Cancer Centers of Batna and Annaba. Sixty four patients with CRC aged 51±12 years and 64 controls with mean age of 51±17 years. The questionnaire used allowed to collect the following informations: age, gender, anthropometric measurements, eating habits, and consumption frequency of some foods. Results. A significant association was found between obesity and prevalence of CRC (37.5% vs 20.3%, p=0.048). The average body mass index (BMI) of patients was higher than that of the controls. The prevalence of cancer reached its maximum between 50 and 59 years old. Consumption of cereals and eggs was retained as a protective factor for CRC (p=0.046 and p=0.028). Controls consumed more pasta than CRC patients (p=0.054). Conclusion. This study highlights the association between colorectal cancer, obesity and the consumption of certain foods in patients with CRC.]

Résumé: Le cancer colorectal se situe au troisième rang (20 % de tous les cancers) après le cancer de la prostate et du sein, en France. Tout stade confondu, la survie à cinq ans du cancer du côlon est d'environ 60 %. Des recommandations précises sur la prise en charge des cancers colorectaux sont issues du Thésaurus National de Cancérologie Digestive (TNCD), un travail collaboratif de multiples sociétés savantes (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR (SIAD et FRI) et SNCP). Néanmoins, dans la vraie vie, un certain nombre d'erreurs sont encore faites, avec pour certaines des conséquences sur la survie ou la qualité de vie de nos malades. Les plus fréquentes sont de ne pas chercher une prédisposition génétique au cancer colorectal, de ne pas chercher de déficit en DPD, de ne pas évaluer la neuropathie induite par l'oxaliplatine à chaque cure, de traiter sans déterminer le statut mutationnel d'un cancer métastatique, d'oublier des éléments du bilan pré-thérapeutique, d'opérer trop tôt ou trop tard un cancer du rectum ou des métastases... L'objectif de cet article est de résumer de façon concise et pratique les erreurs à ne plus faire dans la prise en charge d'un cancer colorectal. Peut-être aurez-vous l'impression que nous allons enfoncer des portes ouvertes, mais c'est tout l'objectif de la formation médicale continue que de répéter les informations les plus importantes. Colorectal cancer ranks third (20% of all cancers) after prostate and breast cancer in France. At all stages, the 5-year survival of colon cancer is approximately 60%. Specific recommendations regarding the management of metastatic colorectal cancer are available in the French intergroup clinical practice guidelines (TNCD) based on a collaborative work by French societies (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR (SIAD and FRI) and SNFCP). Nevertheless, it is clear that, in real life, a number of errors are still made, with some consequences for the survival or quality of life of our patients. The most common are not to seek a genetic predisposition to colorectal cancer, not to look for DPD deficiency, not to evaluate the oxaliplatin-induced neuropathy at each cycle of treatment, to treat without determining the mutational status of a metastatic colorectal cancer, forget elements of the pre-therapeutic assessment, operated too early or too late a rectum cancer or metastasis... The purpose of this chapter is to summarize in a concise and practical way the mistakes you can no longer make in the management of colorectal cancer. You may feel that we are going to open doors, but it is the goal of Continuing Medical Education to repeat the most important information. [ABSTRACT FROM AUTHOR]

Résumé: Deuxième cause de mortalité par cancer en France, le cancer colorectal (CCR) reste une préoccupation majeure. Cette année encore, plusieurs études sont venues changer nos pratiques : La chimiothérapie adjuvante du cancer du côlon de stade III est un standard thérapeutique consistant depuis 15 ans en l'administration de FOLFOX pendant six mois. Récemment, une collaboration internationale de très grande ampleur, poolant six études prospectives (> 12 000 patients), a évalué une désescalade à trois mois de traitement. Bien que ne franchissant pas la démonstration statistique, les résultats permettent de proposer l'option d'une chimiothérapie limitée à trois mois de XELOX pour les patients les moins à risque (stade pT3N1). L'immunothérapie par inhibition des « points de contrôle immunitaire » a permis des résultats remarquables dans certains cancers (mélanomes et poumon en premier lieu). Dans le CCR, les résultats ont été très décevants sauf pour les rares formes de type MSI (avec instabilité micro-satellitaire). Pour ce sous-groupe, les taux de réponse et l'allongement de survie sont nets, de telle sorte qu'il ne semble plus envisageable de ne pas proposer ce type de traitement à ces patients au cours de leur prise en charge. Les études se multiplient et on attend avec impatience les résultats des phases III, seules habilitées à déboucher sur une autorisation de mise sur le marché. Leur efficacité semble aussi très prometteuse pour les formes localisées de CCR MSI entraînant des taux majeurs de stérilisation. La carcinose péritonéale a longtemps été considérée comme non accessible à un traitement à visée curative. La chirurgie de cytoréduction maximale, par les équipes entraînées et chez des patients sélectionnés, apporte des résultats très convaincants. En revanche, le principe de chimio-hyperthermie intrapéritonéale en fin d'intervention a échoué à démontrer son efficacité dans le premier essai disponible sur le sujet. De même, cette technique n'a pas fait la preuve de son efficacité à visée préventive chez les sujets à risque de développement de carcinose péritonéale. Second leading cause of cancer death in France, colorectal cancer (CRC) remains a major concern. This last year, several studies changed our practices: Stage III colon cancer adjuvant chemotherapy for is a standard of treatment for 15 years, with a 6 months FOLFOX chemotherapy. Recently, a very large international collaboration, pooling six prospective studies (>12,000 patients), evaluated a de-escalation to three months of treatment. Although statistical demonstration was not reached, results suggest that a chemo limited to 3-months of XELOX is an option for patients with lower risk (pT3N1 stage). Immunotherapy by inhibition of immune check points achieved remarkable efficacy in various cancers (melanoma and lung in the first place). For CRC, results are very disappointing, except for the infrequent forms of MSI-CCR (CRC with micro-satellite instability). For these patients, immunotherapy induces high rates of tumor response and prolonged survival. Such level of efficacy should not allow to treat MSI CRC patient without immunotherapy. Numerous of phase II trials confirm good results but only results of phase III trials (eagerly awaited) will lead to French approval. Furthermore, efficacy of checkpoint inhibitor immunotherapy seems to be very promising for localized forms of MSI CCR, achieving impressive levels of sterilization of the primary tumor. Peritoneal carcinomatosis has long been considered as not accessible to curative treatment. Complete cytoreductive surgery via laparoscopy, limited to selected patients in referral centers, leads to convincing results. Until now these cytoreductive surgery was followed with hyperthermic intraperitoneal chemotherapy (HIPEC). But recently, HIPEC (with oxaliplatin) failed to prove efficacy in the first prospective trial focused on this topic. Also, HIPEC did not demonstrate any efficacy as a preventing approach to prevent peritoneal carcinomatosis in subjects at risk. [ABSTRACT FROM AUTHOR]

Introduction: colorectal cancer is a true scourge and a major public health problem. The main purpose of this study was to identify the impact of socio-economic factors and education level on the onset of colorectal cancer and of diagnosis stage in the Moroccan population. Methods: we conducted a case-control study of patients treated for cancer at the Mohammed VI center from January 2015 to January 2017. We interviewed, on a prospective basis and using a structured and pre-tested questionnaire, 225 patients and 225 eligible and consenting subjects. Results: the average age of patients was 55.49± 14.06 years. In 53% of cases diagnosis was made at early-stage colorectal cancer while in 47% at advanced stage. In addition, a detailed analysis of the studied population according to the socio-economic status (SES), showed a proportion of 25.33% (patients) versus 17.33% (control) in the low SES group, while, equivalent rates (45.33% patients versus 45.33% control) in the middle SES group. In the high SES group, the rate of patients was only 16.89% patients versus 37.34% control (p = 0.0001). Education and SES were strongly correlated with diagnosis stage, with a significant difference. Then 36.44% of illiterate patients were diagnosed in advanced stage versus 5.33% of patients who had completed their secondary education level or university course (p = 0.02). Similarly 20.45% of patients with low SES were diagnosed in late stage versus 5.33% of patients with higher SES (p = 0.03). Conclusion: our results highlight that the risk of developing colorectal cancer is strongly dependent on the education and the socio-economic status of patients. A more thorough investigation is needed to clarify the causes of this inequality. [ABSTRACT FROM AUTHOR]