Recent progress in diagnosis and treatment of rectal cancer]

Rectal cancer is an emerging health issue in Korea because its incidence is rapidly increasing with changes in life styles and diets. The optimal treatment of rectal cancer is based on multimodality. Among them, surgical treatment is the corner-stone. In the past, local recurrence rate has been reported as high as 30-40%, but the concept of total mesorectal excision (TME) lowered the rate of local recurrence down to less than 10%. TME focuses on sharp pelvic dissection and complete removal of rectal cancer with surrounding mesorectum inside the rectal proper fascia. TME is now considered as a standard procedure for surgical treatment of mid and low rectal cancer. With the introduction of pelvic magnetic resonance imaging (MRI) for preoperative staging of rectal cancer, risk factors for local recurrence can be predicted before surgery to distinguish patients who are in high risk for recurrence that requires preoperative neoadjuvant chemoradiation therapy. Early rectal cancer was assessed by transrectal ultrasonography (TRUS) and endorectal MRI with coil. Transanal local excision can be applied with anal sphincter preservation safely. Neoadjuvant chemoradiation therapy was performed in patients with locally advanced rectal cancer, and this resulted in tumor size reductions and histopathologic downstaging effect. As far as the quality of life is concerned, sexual and voiding function are much improved by techniques preserving nerve. Many experts have dealt with challenging practical problems of managing rectal cancer from diagnosis to quality of life. This issue contains recent progresses in the diagnosis and treatment of rectal cancer which will serve as a comprehensive reference for those who manage rectal cancer in their medical practice.     

Recent advances in gastric cancer early diagnosis

Gastric cancer(GC) remains an important cause of cancer death worldwide with a high mortality rate due to the fact that the majority of GC cases are diagnosed at an advanced stage when the prognosis is poor and the treatment options are limited. Unfortunately, the existing circulating biomarkers for GC diagnosis and prognosis display low sensitivity and specificity and the GC diagnosis is based only on the invasive procedures such as upper digestive endoscopy. There is a huge need for less invasive or non-invasive tests but also highly specific biomarkers in case of GC. Body fluids such as peripheral blood, urine or saliva,stomach wash/gastric juice could be a source of specific biomarkers, providing important data for screening and diagnosis in GC. This review summarized the recently discovered circulating molecules such as microRNAs, long non-coding RNAs, circular RNAs, which hold the promise to develop new strategies for early diagnosis of GC.     

DNA甲基化在结直肠癌及癌前病变早期诊断中的研究进展

结直肠癌预后取决于诊断时的肿瘤分期, 因此早诊早治显得尤为重要, 目前应用较多的结直肠癌筛查手段存在不同程度的局限性。在结直肠癌的发展过程中伴随DNA异常甲基化, DNA甲基化检测特别是多基因联合检测在相关研究中显示出不俗的筛查潜力, 有望成为结直肠癌早期筛查的新型无创检测手段。本文综述了DNA甲基化在结直肠癌及其癌前病变早期筛查中的研究进展。     

遗传性非息肉病性结直肠癌临床分子诊断的研究进展

遗传性非息肉病性结直肠癌(hereditary nonpolyposis colorectal cancer,HNPCC)是一种由于错配修复基因(mismatch repair gene,MMR)突变导致的常染色体显性遗传性疾病,占结直肠癌的5%-15%.研究显示,与HNPCC发生相关的错配修复基因有hMSH2、hMLH1、hMSH6、hPSM1和hPSM2.HNPCC肿瘤具有发病早、近段结肠多见、原发癌多见、肠外肿瘤多见、病理以黏液腺癌为主的特点.到目前为止,HNPCC的诊断主要依赖病史及相关遗传检测结果.对于符合Amsterdam Ⅱ或Bethesda标准的结直肠癌患者应进行微卫星不稳定(microsatellite instability,MSI)和免疫组织化学错配修复蛋白的检测,继而进行错配修复基因等种系突变检测.     

糖尿病性视网膜病变的早期诊断与药物治疗进展

目前,中国人口老龄化问题日益严重。其中,糖尿病性眼病成为了老年人致盲的主要原因之一。但是很多眼病如增殖性糖尿病性视网膜病变（PDR）,糖尿病性黄斑水肿（DME）等发病机制都尚未明确,很多老年人由于科普知识不够发现时为时已晚。所以对于糖尿病性眼病的早期诊断和有效治疗尤其关键。本文就糖尿病性视网膜病变（DR）的相关早期诊断和最新治疗进展作一简要评述。     

大肠癌研究现状

1流行病学大肠癌是常见的恶性肿瘤之一,全世界范围内大肠癌的发病率男女均处于恶性肿瘤的第3位。西方发达国家,大肠癌发病率处于第2位,2003年美国大肠癌新发展病例数和死亡率均居第3位。据国际癌症研究组织(IARC)提供的数据显示,亚洲地区,尤其是经济发达地区,其大肠癌的发生率也迅速增长,     

内镜下诊治大肠早期癌的进展

近年来随着内镜诊断和治疗技术提高,尤其色素内镜、放大内镜、超声内镜、宽带成像内镜和内镜下黏膜切除术（EMR）、内镜下黏膜下层剥离术（ESD）等技术应用,在日本发现许多小于1cm甚至0．5cm内小的或微小癌的病灶,在内镜下表现为单纯平坦Ⅱb或单纯凹陷Ⅱc的表现,在病理上表现为denovo即没有腺瘤病变的早期癌肿,这对大肠癌的发生学上提出了一个耘的概念,作为消化及消化内镜的医务工作者提出新的课题,故很有必要对其进一步探讨。     

放大内镜下大肠黏膜腺管开口分型对早期大肠癌检出的意义

目的 评价腺管开口分型对早期大肠癌及癌前病变检出的临床价值.方法 回顾2004年11月至2007年8月结肠镜检查,采用内镜下黏膜染色技术,结合放大内镜及实体镜观察腺管开口分型并与病理诊断对照,腺管开口分型采用工藤进英分型标准.结果 结肠镜检杳大肠病变共1496个,非肿瘤性病变占30.6%(458/1496),各类型腺瘤占43.9%(657/1496),大肠癌占25.5%(381/1496).早期大肠癌61个;大肠侧向发育型肿瘤36个,直径10～62 mm,其中Ⅱ型3个,Ⅲ1.型14个,Ⅳ型17个,Ⅴ型2个.管状腺瘤中以低级别上皮内瘤变居多,占87.5%(363/415);管状绒毛状腺瘤高级别上皮内瘤变占40.7%(61/150);绒毛状腺瘤腺管开口以Ⅳ型为主,高级别上皮内瘤变达85.7%(42/49).结论 大肠腺管开口分型对于判断肿瘤性、非肿瘤性病变以及早期大肠癌的检出有重要意义,对及时进行内镜治疗或手术切除具有一定的临床指导意义.     

老年胰腺癌诊治的新进展

胰腺癌的发病率逐年上升,上海市区1999年增至10.1/10万人,其中老年胰腺癌患者的比例上升起了重要作用.     

SEPT9在结直肠癌早期检测中的研究进展

SEPT9是13个Septin同源基因家族之一,参与调控众多过程,包括细胞分裂、细胞极化、细胞迁移以及线粒体分裂等。研究表明在众多肿瘤中,SEPT9都发挥着作用,尤其在结直肠肿瘤研究领域,外周血SEPT9基因甲基化检测更是研究热点,其检测的敏感度和特异度相对于其他糖蛋白肿瘤标志物、粪便隐血试验和粪便免疫化学测试等更具有优势,相对于结直肠镜等侵入性检查更节约成本,同时有着更好的依从性。本文对SEPT9的功能、与结直肠癌之间的关系以及对结直肠肿瘤的筛查及诊断价值做一综述。     

体质量指数与结直肠癌相关性的研究现状

结直肠癌(colorectal cancer,CRC)是消化系统常见的严重危害人们健康的杀手,全球每年约有120万新发病例,其中中国约有13万.随着我国社会经济发展和饮食结构的改变,CRC的发病率和死亡率呈逐年上升趋势,且平均发病年龄低于西方国家约20岁,居所有恶性肿瘤中的第2位,在中国发达地区已经接近西方发达国家.CRC的发病是多种因素综合作用的结果,近四分之一的CRC患者可以通过良好的生活习惯来避免患病.目前全球有2/3的成年人正在与超重和肥胖做斗争.近期大量研究表明,高体质量指数(body mass index,BMI)与结直肠癌的发病具有一定关系.本文就BMI与CRC相关性的研究现状作一综述.     

多基因甲基化检测对结直肠癌早期诊断的意义

目的 通过对结直肠癌（CRC）组织中多基因甲基化水平的检测,探讨多基因甲基化对CRC早期诊断的意义.方法 选取25例CRC患者胃镜采集标本组织,通过甲基化特异性PCR（MSP）检测CRC和炎性组织中甲基化水平,分析其与CRC患者临床各指标的关系.结果 在CRC患者中,APC、P16、MLH1、DCC甲基化率分别为52.0%（13/25）、32.0%（8/25）、44.0%（11/25）、60.0%（15/25）.炎性组织中仅有1例DCC甲基化异常表达,甲基化率为10.0%（1/10）,甲基化阳性率显著高于炎性组织（P＜0.05）,4种基因甲基化联合检测诊断CRC的阳性率为92.0%（23/25）,高于单个基因检测的甲基化阳性率,差异有统计学意义（P＜0.01）.结论 APC、P16、MLH1、DCC基因在CRC患者中甲基化水平异常表达,联合检测APC、P16、MLH1、DCC可能作为CRC早期诊断的标志物.     

Recent progress in targeting cancer

In recent years, numerous new targets have been identified and new experimental therapeutics have been developed. Importantly, existing non-cancer drugs found novel use in cancer therapy. And even more importantly, new original therapeutic strategies to increase potency, selectivity and decrease detrimental side effects have been evaluated. Here we review some recent advances in targeting cancer.