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Current status of tumor markers in large bowel cancer

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Abstract

The aim of a primary screening system is to detect premalignant lesions and carcinomas when amenable to “curative” surgery. Although a number of “classical” tumor markers have acquired potential for clinical management, none is presently adequate for presymptomatic diagnosis or screening. In colorectal carcinoma, the screening potential of carcinoembryonic antigen (CEA), the gastrointestinal-related antigen, CA19-9, and other more recently characterized “biochemical markers” is virtually nonexistent, even in patients at high risk to develop the disease.

Promising new leads are beginning to emerge from somatic cell genetic and molecular biological approaches. In common with other epithelial neoplasms, perturbations in oncogene expression have been demonstrated in colorectal cancers, and probably reflect important events in malignant transformation and progression. Studies of oncogene expression have, however, not yet yielded clinically useful information.

Recently, an intensive search for specific chromosomal and gene abnormalities in the hereditary colon cancer syndromes led to the location of the familial adenomatous polyposis (FAP) gene at chromosome 5q21–q22. Significant is that the loss of alleles on chromosome 5 has also been observed in the tumor cells of at least 20% of sporadic colon cancer patients. This type of association between constitutional genetic change and genetic aberration in the cells of sporadic tumors is reminiscent of other malignant diseases with a genetic component (e.g., retinoblastoma and Wilms' tumor).

The disclosure of the FAP gene might ultimately provide a basis for the presymptomatic or prenatal diagnosis of FAP as well as some forms of sporadic colorectal cancer; however, it can be anticipated that other markers linked to colorectal cancer susceptibility genes will eventually be discovered, with potentially wider application in presymptomatic diagnosis and screening.

Résumé

Le but d'un système de dépistage primaire est de détecter des lésions pré-malignes et malignes susceptibles d'être traitées chirurgicalement de façon “curative.” Bien qu'un certain nombre de marqueurs tumoraux “classiques” soient utiles dans la surveillance du traitement, aucun ne s'est encore montré capable de servir pour le diagnostic ou dépistage précoce. En ce qui concerne le cancer colorectal, la valeur de l'antigène carcinoembryonnaire (ACE), de l'antigène gastrointestinal (CA19-9), et d'autres “marqueurs biochimiques” plus récents, est virtuellement non-existante, même chez des patients à haut risque.

Des progrès nouveaux ont été accomplis, en génétique cellulaire somatique et en chimie moléculaire. Comme pour d'autres épithéliomes, des perturbations de l'expression oncogénique ont été mis en évidence dans les cancers colorectaux, et reflètent probablement un événement important dans la transformation maligne. Cependant, les études d'expression oncogène n'ont pas encore fourni de renseignement cliniquement utiles.

Récemment, une étude de recherche pour mettre en évidence des anomalies génétiques et chromosomiques spécifiques dans le syndrome de cancer colique familial a amené à découvrir le gène de la polypose familiale (GPF) au niveau du duodénum (5q21–q22). La perte d'allèles du chromosome 5 a été observée dans les cellules tumorales chez au moins 20% des patients présentant un cancer colique sporadique. Le type d'association, c'est à dire, entre un changement génétique constitutionnel et un changement acquis, rappelle ce que l'on observe dans d'autres cancers (par exemple rétinoblastome et tumeur de Wilms).

La découverte d'un GPF peut éventuellement servir de base au diagnostic pré-symptomatique ou pré-natal pour cette maladie, voire même pour quelques cas sporadiques. Cependant, on pense que d'autres marqueurs liés au cancer colorectal seront découverts et auront une plus large application dans le dépistage précoce présymptomatique.

Resumen

El propósito de un sistema primario de tamizaje para detección de cáncer es identificar las lesiones premalignas y los carcinomas susceptibles de cirugía “curativa.” Aunque algunos de los marcadores tumorales “clásicos” han logrado reconocida aplicación en el manejo clínico, ninguno es de utilidad para propósitos de diagnóstico en la fase presintomática o para tamizaje. En el caso del carcinoma colorrectal, la capacidad de tamizaje del antígeno carcinoembriónico (ACE), del antígeno relacionado con cáncer gastrointestinal, CA19-9, y de otros “marcadores bioquímicos” recientemente identificados es virtualmente nula, aún en pacientes con alto riesgo de desarrollar enfermedad.

Algunas perspectivas promisorias han comenzado a emerger a partir de enfoques de biología molecular y genética. Como fenómeno común con otros neoplasmas epiteliales, se han demostrado alteraciones en la expresión oncogénica de los cánceres colorrectales que probablemente son reflejo de eventos importantes en el proceso de transformación maligna y progresión de la enfermedad. Sin embargo, los estudios de expresión oncogénica aún no aportan información que sea de utilidad clínica.

Recientemente una investigación intensa en búsqueda de alteraciones cromosónicas y genéticas en los sindromes de cáncer colónico hereditario ha logrado establecer la ubicación del gen de la poliposis adenomatosa familiar en el cromosoma 5q21–q22. Como un hecho significante, la pérdida de alelas en el cromosoma 5 tambien ha sido observado en las células tumorales de por lo menos 20% de los pacientes con cáncer de colonesporádico. Este tipo de asociación entre el cambio genético constitucional y la aberración en las células de los tumores esporádicos es reminiscente de otras enfermedades neoplásicas con componente genético (por ejemplo, el retinoblastoma y el tumor de Wilms).

El descubrimiento del gen de la poliposis adenomatosa familiar provee un fundamento para el diagnóstico presintomático o prenatal de esta entidad, así como de ciertas formas de cáncer colorrectal esporádico. Sin embargo, se puede predecir que otros marcadores ligados a los genes de susceptibilidad del cáncer colorrectal, con una más amplia capacidad de aplicación en el diagnóstico presintomático y en el tamizaje, habrán de ser eventualmente descubiertos.

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  1. Paterson Institute for Cancer Research, Christie Hospital, UK

    Michael Moore Ph.D., D.Sc., F.R.C.Path., David J. Jones M.D., F.R.C.S. (Eng. and Edin.), Philip F. Schofield M.D., F.R.C.S. (Eng.) & David G. Harnden Ph.D., F.R.C.Path, F.R.S.E.

  2. Department of Surgery, Holt Radium Institute, Manchester, England, UK

    Michael Moore Ph.D., D.Sc., F.R.C.Path., David J. Jones M.D., F.R.C.S. (Eng. and Edin.), Philip F. Schofield M.D., F.R.C.S. (Eng.) & David G. Harnden Ph.D., F.R.C.Path, F.R.S.E.

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Moore, M., Jones, D.J., Schofield, P.F. et al. Current status of tumor markers in large bowel cancer. World J. Surg. 13, 52–59 (1989). https://doi.org/10.1007/BF01671154

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