New insights into the earliest stages of colorectal tumorigenesis

Expert Review of Gastroenterology & Hepatology
Chelsie K SieversPerry J Pickhardt

Abstract

Tumors in the large intestine have been postulated to arise via a stepwise accumulation of mutations, a process that takes up to 20 years. Recent advances in lineage tracing and DNA sequencing, however, are revealing new evolutionary models that better explain the vast amount of heterogeneity observed within and across colorectal tumors. Areas covered: A review of the literature supporting a novel model of colorectal tumor evolution was conducted. The following commentary examines the basic science and clinical evidence supporting a modified view of tumor initiation and progression in the colon. Expert commentary: The proposed 'cancer punctuated equilibrium' model of tumor evolution better explains the variability seen within and across polyps of the colon and rectum. Small colorectal polyps (6-9mm) followed longitudinally by interval imaging with CT colonography have been reported to have multiple fates: some growing, some remaining static in size, and others regressing in size over time. This new model allows for this variability in growth behavior and supports the hypothesis that some tumors can be 'born to be bad' as originally postulated by Sottoriva and colleagues, with very early molecular events impacting tumor fitness ...Continue Reading

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Citations

Apr 2, 2020·Journal of Complementary & Integrative Medicine·Manal M El JoumaaJamilah M Borjac
Aug 4, 2020·Cancer Cell International·Fakun HuangJiaxing Wang
Feb 28, 2020·World Journal of Gastrointestinal Oncology·Alexandre Loktionov
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Jun 3, 2021·Cancers·Antonio BarbáchanoAlberto Muñoz
Nov 20, 2021·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·Scott MacDonaldMichelle Thornton

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