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Aetiology of colorectal cancer and relevance of monogenic inheritance
  1. M Ponz de Leon1,
  2. P Benatti1,
  3. F Borghi1,
  4. M Pedroni1,
  5. A Scarselli1,
  6. C Di Gregorio2,
  7. L Losi3,
  8. A Viel4,
  9. M Genuardi5,
  10. G Abbati1,
  11. G Rossi1,
  12. M Menigatti1,
  13. I Lamberti1,
  14. G Ponti1,
  15. L Roncucci1
  1. 1Dipartimento di Medicine e Specialità Mediche, Università di Modena e Reggio Emilia, Modena, Italy
  2. 2Divisione di Anatomia Patologica, Ospedale di Carpi, Modena, Italy
  3. 3Dipartimento di Anatomia Patologica e di Medicina Legale, Università di Modena e Reggio Emilia, Modena, Italy
  4. 4Divisione di Oncologia Sperimentale 1, Centro Oncologico, Aviano (PN), Italy
  5. 5Istituto di Genetica Medica, Università Cattolica del Sacro Cuore, Roma, Italy
  1. Correspondence to:
    Professor M Ponz de Leon
    Medicina I, Policlinico, via del Pozzo 71, 41100 Modena, Italy;


Background and aims: Although diet and lifestyle are associated with the development of colorectal malignancies, the only clearly identified aetiological factors in colorectal cancer are inheritance (hereditary non-polyposis colorectal cancer (HNPCC) and familial polyposis), inflammatory bowel diseases, papillomavirus, and acquired immunodeficiency syndrome (AIDS). Our aim was to determine what proportion of colorectal neoplasms could be attributed to these specific factors.

Patients and methods: Data from a colorectal cancer registry were analysed over a 15 year period, during which nearly 2500 cases were recorded. In patients with suspected HNPCC, microsatellite instability and immunohistochemical expression of proteins encoded by the main DNA mismatch repair genes were assessed. In families with unstable neoplasms, constitutional mutations of the mismatch repair genes hMSH2, hMLH1, and hMSH6 were evaluated by single strand conformation polymorphism analysis and sequencing.

Results: Inflammatory bowel diseases, familial polyposis, and AIDS were rare causes of colorectal cancer (three, three, and one case, respectively). Anal squamous carcinoma developed in 27 patients (1.0%) and could be attributed to papillomavirus infection. In 58 patients (from 34 families) a clinical diagnosis of HNPCC was established (2.4%). In total, cases with a known aetiology were 92 (3.7% of all patients). Microsatellite instability was detected in 15 cancers from HNPCC families, and germline mutations in six families (12 patients, 0.5% of the total). Families with unstable tumours, with or without mutations, were clinically similar, suggesting the involvement of the mismatch repair system even when mutations were not detected.

Conclusions: The study suggests that the aetiology of colorectal malignancies remains elusive in the large majority of cases. Among specific causes, HNPCC represents the most frequent. However, with a population based approach, constitutional mutations of the main genes involved in HNPCC can be detected in only 20% of cases.

  • colon cancer
  • rectum
  • hereditary non-polyposis colorectal cancer
  • inflammatory bowel disease
  • HNPCC, hereditary non-polyposis colorectal cancer
  • FAP, familial adenomatous polyposis
  • IBD, inflammatory bowel disease
  • AIDS, acquired immunodeficiency syndrome
  • HIV, human immunodeficiency virus
  • HPV, human papillomavirus
  • MSI, microsatellite instability
  • PCR, polymerase chain reaction

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