Colorectal cancer clinical presentation

The MSI is used as a diagnostic criterion of replication errors caused by various mutations in at least five mismatch repair genes (Lynch and Smyrk, 1996). Therefore, MSI analysis is useful in clinical practice to identify patients with hereditary nonpolyposis colorectal cancer. Raedle et al. (1999) have presented a rapid DNA extraction method (rapid microsatellite analysis) for analyzing replication errors in paraffin-embedded tissues. 

Taylor I, Garcia-Aguilar J and Goldberg S (eds) (1999) Chapter 2 Clinical presentation. In Colorectal Cancer Fast Facts. Oxford Health Press, pp. 1 6-20. 

In this new class of platinum complexes some examples do not present the necessary cis configuration with respect to the chlorines. Oxaliplatin has been approved for clinical use in France and China for colorectal cancer. The interest in developing platinum complexes that bind to DNA in a fundamentally different manner to cisplatin is an attempt to overcome the resistance pathways that have evolved to eliminate the drug. 

Worldwide, hospitals that do not use these species can no longer be found [48] and their usefulness continues to grow. CM-Platin 1 is routinely used for treatment of testicular, ovarian, and non-small-cell lung cancers, and its use is increasing in the treatment of head and neck tumors and those of the bladder [45]. Besides CM-platin, the less aggressive carboplatin 2 and oxaliplatin 3 were later introduced, the latter specifically for treatment of colorectal cancers. At the present time, a dozen other Pt complexes are in advanced clinical trials, and three derivatives (nedaplatin, loboplatin, and heptaplatin) are in clinical use although less universally so [48]. 

In general, the ideal patient for SIRT has liver-dominant disease only (Table 2.7.3). Extrahepatic disease may be present, but should not determine the patient s survival. Atypical example of this situation is a patient with hepatic breast cancer metastases - a rising indication beside the approved indications in HCC and colorectal cancer metastases - where often additional bone metastases are present but under clinical control by a bisphosphonate and hormone therapy for example. Nevertheless, one must always be aware that SIRT is a hepatic-directed treatment that does not affect extrahepatic disease (Fig. 2.7.1). 

However, in the absence of known prognostic factors, and with the exception of breast cancer, to date there are very few data to draw firm conclusions regarding the role of microspheres for non-colorectal, nonneuroendocrine cancer-related hepatic metastases. Thus, although it may become a promising component of overall treatment, it cannot be generalized and at present should be individualized based on the patient s clinical course and by the biologic behaviors of the specific malignancy. 

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