Molecular genetics of colorectal carcinoma.

The molecular genetics of colorectal carcinoma are among the best understood of any common human cancer. Reported molecular genetic abnormalities involve tumor-suppressor genes that undergo inactivation (e.g., apc, mcc, dcc, p53, and possibly genes on chromosomes 8p, 1p, and 22q) and dominant-acting oncogenes (e.g., ras, src, and myc). Multiple clonal genetic abnormalities accumulate during the development of colorectal carcinoma in adenomas. Altered DNA methylation is an early event, and the specific genetic alterations occur in a preferential order. However, the clinical application of molecular genetics in patients who are at risk for or have colorectal carcinoma is in its infancy. Patients with a predisposition to colorectal carcinoma caused by inheritance of familial adenomatous polyposis can be identified by genetic analysis of the apc gene on chromosome 5q21. In patients who undergo curative resection of colorectal cancer, deletion of the p53 gene on chromosome 17p, deletion of the dcc gene on 18q, and high fractional allelic loss (fraction of nonacrocentric autosomal arms with deletion) in the primary tumor appear to indicate an increased likelihood of occult disseminated disease and thus a poor prognosis. Additional studies are needed to establish the role of the molecular genetics of colorectal carcinoma in the management of patients who are at risk for or already have neoplasia of the large bowel.