COLORECTAL CANCER - EPIDEMIOLOGICAL PERSPECTIVES IN THE ONCOGENETIC CONTEXT

The neoplastic pathology is one of the challenges of modern medicine, both in terms of epidemiology (morbidity, mortality and risk factors), as well as in terms of prevention, diagnosis or treatment. The progress of knowledge regarding risk factors and the identification of new diagnosis or therapy methods in the management of patients with colorectal cancer have led to a series of approach changes which create new perspectives not only for those affected by the disease, but also for their families. Risk factors for CRC include: modifiable factors (endogenous and exogenous factors) and non-modifiable factors (genetic factors). The risk of an individual belonging to the general population to develop CRC at a certain point in life is of 5%, while the risk of a subject with Lynch syndrome may reach 70-80%. The genes which potentially increase the risk of CRC include: MMR, MLH1, MSH2, MSH6 (high-penetrance genes) and APC, BRAF, CTNNB1 / beta-catenin, FBXW7, KRAS, PIK3CA, SRC and P53 (low-penetrance genes). The most used methods of screening for the general population are: the HEMOCCULT test, the colonoscopy and the flexible sigmoidoscopy, while for the groups at risk (with one or more risk factors) these include: the oncogenetic investigation (including the assessment of family history of familial adenomatous polyposis (or FAP), attenuated FAP (AFAP), hereditary nonpolyposis CRC (HNPCC), personal history of colorectal cancer or adenoma, chronic ulcerative colitis and Crohn’s disease and molecular testing of individuals with risk factors).