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Purpose of review Despite the large investment of resources from screening, the fact that colorectal cancer remains the second leading cause of cancer deaths among Americans underscores the need for alternative strategies. Thus, a major clinical and research imperative is personalize clinical care, while focusing on risk stratification for screening, surveillance, chemoprevention, and therapeutic intervention. Recent findings A complicating factor that colorectal cancer is biologically heterogeneous for at least four consensus molecular subtypes presents clear challenges for developing robust molecular biomarkers. Summary The purpose of the review is to discuss the genetics and molecular biology of colonic neoplasia, high and low penetrance, and racial disparities in colonic neoplasia. Finally, we put forth the emerging concept of greater genomic landscape and the idea of chromatin protection therapy as a novel adjuvant to chemotherapy.

We previously reported that analysis of histologically normal intestinal epithelium for spectral slope, a marker for aberrations in nanoscale tissue architecture, had outstanding accuracy in identifying field carcinogenesis in preclinical colorectal cancer models. In this study, we assessed the translatability of spectral slope analysis to human colorectal cancer screening.Subjects (n = 127) undergoing colonoscopy had spectral slope determined from two endoscopically normal midtransverse colonic biopsies using four-dimensional elastic light-scattering fingerprinting and correlated with clinical findings.Four-dimensional elastic light-scattering fingerprinting analysis showed the submicron particles size progressively shifted toward larger sizes in subjects harboring neoplasia. There was a corresponding decrease in spectral slope values from the endoscopically normal mucosa in subjects harboring adenomas (n = 41) and advanced adenomas (n = 10), compared to neoplasia-free subjects (P/= 0.00001). These factors did not appear to be confounded by either age or adenoma location. For detecting advanced adenomas, spectral slope had a negative and positive predictive value of 95 percent and 50 percent respectively.We demonstrate, for the first time, that spectral slope in "normal" mucosa can accurately risk-stratify patients for colonic neoplasia. This proof of concept study serves to underscore the promise of four-dimensional elastic light-scattering fingerprinting analysis for colorectal cancer screening.

Gene-environment interactions in hereditary nonpolyposis colorectal cancer: potentiation of colon cancer risk by tobacco use and HMLH-1 mutations

Increasing incidence of right sided colon carcinoma in a suburban population from 1994 to 2001

Purpose: No tumor marker has been shown to be useful in screening for pancreatic cancer. CA 19–9 is a widely used serological marker for pancreatic cancer, however, its role in screening and establishing the diagnosis of early stage disease is limited. Recently, syndecan-1 has been shown to be overexpressed early in pancreatic carcinogenesis. This transmembrane heparan sulfate-bearing proteoglycan can regulate adhesion, migration, and growth factor activity, processes critical to the early metastatic potential of pancreatic cancer. Syndecan-1 is frequently shed into the blood from malignant tissues. Indeed, serological assessment of this cell surface proteoglycan has been shown to be a useful marker in the diagnosis/prognosis in lung cancer and myeloma. Therefore, we hypothesized that serum syndecan-1 levels would be an accurate marker for pancreatic cancer.

Downregulatation of syndecan-1 in colon cancer cells: a potential mechanism for anti-proliferative and anti-invasive effects of NSAIDS