Molecular and morphometric tools for next-generation pathology diagnosis of colon carcinoma

Yael Fisher, Dov Hershkovitz*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Colorectal carcinoma (CRC) is a common malignancy associated with considerable morbidity and mortality. While CRC affects a single organ, it is quite a heterogeneous disease. Good diagnostic tools are required to determine patients’ prognosis and to choose the most effective treatment option. In the past, diagnosis was based solely on morphological features of the tumor which were evaluated by pathologists using light microscopy. These morphological parameters include architectural abnormalities, cytological and nuclear changes, invasion into vascular structures, tumor budding, and the presence of intra-epithelial inflammatory infiltrate. In the last decade, with the development of better DNA sequencing technologies and improved understanding of the molecular basis of cancer, genetic tools have been incorporated into the routine clinical and pathological practice. These include tests for point mutations in oncogenes such as KRAS, NRAS, BRAF and PIK3CA, which have prognostic and treatment decision implications, as well as tests for defects in DNA mismatch repair genes. More recently, it was demonstrated that molecular tests based on RNA expression patterns might provide useful information that can help guide patients’ management. In the present review we discuss the morphologic and molecular parameters relevant to the management of CRC patients. Additionally, we suggest how a combination of both tools might be useful for addressing some newer concepts in cancer biology, such as intra-tumor heterogeneity and nuclear structure alterations.

Original languageEnglish
Pages (from-to)426-432
Number of pages7
JournalIsrael Medical Association Journal
Volume18
Issue number7
StatePublished - Jul 2016
Externally publishedYes

Keywords

  • Colorectal carcinoma (CRC)
  • Intra-tumor heterogeneity
  • KRAS
  • Morphometry
  • Pathology

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