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Colorectal cancer (CRC) can only be cured by complete resection of the tumour. Primarily unresectable metastases of the liver are treated by chemotherapy to achieve down-sizing of metastasis and curative resection. Chemotherapy can affect tumour-free healthy liver tissue and lead to histopathological and functional changes summarised as "chemotherapy-associated steatohepatitis" (CASH). We have evaluated a histopathological scoring system for CASH and searched for preoperative risk factors for the development of CASH. Liver alterations such as CASH were more pronounced when patients received chemotherapy, especially when treated with oxaliplatin. A higher BMI, male sex and elevated serum transaminases were risk factors for the development of CASH. Patients with a higher CASH score, reflecting more advanced changes in liver tissue, had a higher serum peak bilirubin level postoperatively. We did not find a higher morbidity or mortality in patients with a more severe liver damage measured by the CASH score., (© Georg Thieme Verlag KG Stuttgart · New York.)

Colorectal carcinomas are the third most common malignant tumours worldwide with an incidence of 570,000 per year. According to their molecular mechanisms, sporadic colorectal carcinomas can be divided into two different phenotypes. The genetic phenotype, 50 to 70 % of all sporadic colorectal carcinomas, is characterised by a chromosomal instability (CIN) with the classical adenoma-carcinoma sequence due to alteration of the APC-betacatenin pathway with p53 mutations, SMAD alterations and LOH (loss of heterozygositiy) of 5q, 17 p 18q. On the other, the CpG island methylator phenotype (CIMP+) was described with an epigenetic inactivation of tumour suppressor genes that are typically inactivated by germline mutations in familiar cancer syndromes, e. g., Rb, VHL, hMLH1, p16 or BRCA. Colorectal carcinomas of the CIMP+ type often show a high microsatellite instability (MSI+) caused by aberrant promoter methylation of the missmatch repair gene hMLH1. Further CIMP+ are located in the proximal right-side colon and show a poor grading with mucinous or signet-cell differentiation.