M. Azzam Kayasseh,Dubai,UAE
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- Augusta Rose
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2 Thanks A Lot Prof. Linda + Prof. Ernst
3 #drkayasseh_crc_rsm
4 Twenty World Areas
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8 Age-Standardized CRC Incidence Rates by Sex GLOBOCAN 2008
9 Age-Standardized CRC Incidence Rates by Sex GLOBOCAN 2012 (IARC)
10 WEO Colorectal Cancer (CRC) Screening Committee Meeting Goals of the meeting: To update the attendees on recent advances in CRC screening To seek advice and comments from membership on future initiatives To reach consensus on controversial areas
11 #CRC_RSM Clinical Scores Biomarkers Scores Imaging Scores Histological Scores Therapeutic Response Rate Scores
12 #CRC_RSM Clinical Scores Biomarkers Scores Imaging Scores Histological Scores Therapeutic Response Rate Scores Low Risk Group High Risk Group
13 #Personalised_Medicine
14 Risk Stratification Approach Care Planning Statistical Modeling Clinical Review Threshold Modeling Service Evaluation
15 #CRC_MDA MultiDisciplinary Approach Patient and Family Medical Oncologist Surgical Oncologist Oncology Nurses ColoRectal Endoscopist Radiation Oncologist Statistical Inssurance Experts Pathological Oncologist
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18 Risk Stratification Module CRC is one of the most Treatable, Beatable and Preventable Cancers in the world : #CRC_Genetic_Pathogenesis, #CRC_Diet_Relationship, #CRC_Gut_Microbiota_Relationship, #CRC_Environment_Relationship; Many useful Risk Stratification Plans.
19 Risk Stratification Module To Ensure Appropriate Screening,Surveillance and Prognosis Personalized health care interventions are the Future Medicine in our daily clinical practice. #Personalized_Medicine #Future_Medicine
20 Optimizing #CRC Management Treat To Target = T2T Strategy Physician Patient Medicine #Personalized_Awareness #Personalised_Medicine
21 #drkayasseh_crc_rsm Risk Stratification is unmet needed by MultiDisciplinary Approach (#MDA) to aim Medical Decision Making (#MDM) in the Screening, Surveillance and Prognosis. Risk Stratification Module(#RSM) : Cost Effective High Quality Good Value
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24 #CRC_RSM Clinical Scores Biomarkers Scores Imaging Scores Histological Scores Risk Factors Family Hx S+S Chronic Dis. Genetic, Molecular, Serological Radiological Endoscopic In-vivo In-vitro Therapeutic Response Rate Scores Endoscopic Resection Surgical Resection Drug Therapy
25 CRC - Risk Stratification Module Clinical Scores Assess for Symptoms (rectal bleeding) Assess for Signs (unexplained iron def. anemia) Bethesda Criteria Revised Amsterdam criteria
26 #CRC_Clinical_Risk_Factors Certain Medical Conditions Smoking,Alcohol Diabetes Obesity Lack of exercise Diet Age Genetic
27 Revised Amsterdam criteria There should be at least three relatives with an HNPCCassociated cancer (colorectal cancer, cancer of the endometrium, small bowel, ureter, or renal pelvis) One should be a first degree relative of the other two At least two successive generations should be affected At least one should be diagnosed before age 50 Familial adenomatous polyposis should be excluded in the colorectal cancer case(s) if any Tumors should be verified by pathological examination
28 Biomarkers Scores Genetic Scores Molecular Scores Serological Scores
29 CRC - Risk Stratification Module Genetic Scores Genetic testing for hereditary CRC : APC gene mutations MMR gene mutations (MLH1, MSH2, MSH6, PMS2) Genetic testing for targeted cancer therapy of CRC : KRAS, BRAF, PIK3CA mutations Genetic testing for individualized chemotherapy of CRC: AKT1, UGT1A1, DPYD, MTHFR, ERCC1, XRCC1 and GSTP1 gene polymorphism
30 #CRC_Tumorigenesis Molecular pathways The chromosomal instability (APC) pathway The mutator phenotype/mismatch repair (MMR)pathway Hypermethylation phenotype (CIMP+) pathway
31 Genetic Biomarkers for Detection
32 Genetic Biomarkers for Detection a Numbers in parentheses represent prevalence of genetic mutations reported *. b Specimens listed are those in which the assay for mutations can be performed *Chung C. C. The genetic basis of colorectal cancer: insights into critical pathways of tumorigenesis. Gastroenterology, 119: , 2000
33 Common methylated genes (and loci*) identified at the histologic steps of the CRC The genes may be involved in the initiation of CRC Those genes may play a role in the progression and metastasis of CRC Victoria Valinluck Lao et al,nat Rev Gastroenterol Hepatol. ; 8(12):
34 Genetic module #CRC tumorigenesis LOH: loss of heterozygosity; DCC: deleted in colon cancer gene; APC: adenomatous polyposis coli gene; ACF: aberrant crypt foci; MMR: DNA mismatch repair enzyme. Modified from: Lynch, JP, Hoops, TC. The genetic pathogenesis of colorectal cancer. Hematol Oncol Clin North Am 2002; 16:775.
35 Specific genetic changes are thought to drive the transformation Response to therapy Disease progression
36 CRC - Risk Stratification Module Endoscopic Scores
37 Imaging Enhanced Endoscopy
38 Imaging Enhanced Endoscopy Detection/ Characterization Classification Histological confirmation ChromoEndoscopy Virtual Endoscopy CLE Paris Vienna
39 Novel Pit Pattern Identifies the Precursor of CRC Derived From Sessile Serrated Adenoma (SSA)
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43 Vienna Classification
44 CRC Staging AJCC Cancer Staging Manual Edge SB, et al. AJCC cancer staging manual
45 PROGNOSTIC VALUE OF MARKERS IN STAGE II AND III TUMOURS The prognostic value of these markers (looked at in isolation univariate analysis) varies according to the stage of disease, which has implications for how studies of biomarkers are designed and reported Arnaud Roth, presented at ASCO 2009
46 TNM Classification
47 NICE Classification Type 1 Type 2 Type 3
48 CRC - Risk Stratification Module Therapeutic Response Rate Scores Therapeutic Scores
49 Therapeutic Scores Endoscopic Resection Targeted Therapy Molecular Imaging(CLE) with Cetuximab Genetic testing for individualized chemotherapy
50 Tumour Sub-Stage with Survival Rates These relative survival figures, based on expanded SEER data and presented according to AJCC substaging for stage II and III colon cancers, indicate flaws in our current understanding of how colorectal cancer behaves SEER Surveillance, Epidemiology and End Results. (SB Edge, DR Byrd, CC Compton et al. (eds) (2010) AJCC Cancer StagingManual, 7th edn.)
51 #CRC_T1 (M1,M2,M3) Surgical Resection Direct Approach Method Open Approach Polypectomy Laparoscopic Approach EMR Submucosal Endoscopic Approach ESD
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53 Endoscopic Therapeutic Scores EMR ESD
54 #CRC_RSM Clinical Scores Biomarkers Scores Imaging Scores Histological Scores Therapeutic Response Rate Scores
55 #CRC_RSM Clinical Scores Biomarkers Scores Imaging Scores Histological Scores Therapeutic Response Rate Scores Low Risk Group High Risk Group
56 #CRC_RSM Clinical Scores Biomarkers Scores Imaging Scores Histological Scores Risk Factors Family Hx S+S Chronic Dis. Genetic, Molecular, Serological Radiological Endoscopic In-vivo In-vitro Therapeutic Response Rate Scores Endoscopic Resection Surgical Resection Drug Therapy
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58 @dubaiendoscopyforum
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