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Barrett's oesophagus and squamous cell cancer of the oesophagus. (A) Endoscopic image of Barrett's oesophagus visible as a salmon‐coloured metaplastic epithelium (columnar) replacing the normal bright‐pink epithelium of the distal oesophagus (squamous). (B) Endoscopic image of an early squamous cell carcinoma in the oesophagus visible as an unstained area after Lugol's iodine staining (asterisk). Patients provided their written consent for the images to be used for educational purposes.
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Early detection, including cancer screening and surveillance, is emerging as one of the most important topics in modern oncology. As symptomatic presentation remains the predominant route to cancer diagnosis, there is a growing interest in developing techniques to detect the disease at an early, curative stage. Moreover, growing understanding of ca...
Citations
... As more and more diverse probes with high sensitivity as well as specificity had been studied and constructed, molecular imaging technology has developed in a sustained and stable state in recent years. Consequently, there is no denying that molecular imaging probes occupy a significant position for tumor early diagnosis and early warning of metastasis [7,16,22]. ...
Malignant tumors have been one of the major reasons for deaths worldwide. Timely and accurate diagnosis as well as effective intervention of tumors play an essential role in the survival of patients. Genomic instability is the important foundation and feature of cancer, hence, in vivo oncogene imaging based on novel probes provides a valuable tool for the diagnosis of cancer at early-stage. However, the in vivo oncogene imaging is confronted with great challenge, due to the extremely low copies of oncogene in tumor cells. By combining with various novel activatable probes, the molecular imaging technologies provide a feasible approach to visualize oncogene in situ, and realize accurate treatment of tumor. This review aims to declare the design of nanoprobes responded to tumor associated DNA or RNA, and summarize their applications in detection and bioimaging for tumors. The significant challenges and prospective of oncogene-targeting nanoprobes towards tumors diagnosis are revealed as well.
... Early diagnosis of cancer can provide more options for treatment strategies for patients, thus improving patient survival and reducing the consumption of healthcare resources. In addition, identifying cancer from benign tumors and distinguishing between different types of malignant tumors are also crucial for disease control [160]. Therefore, many studies have attempted to use liquid biopsy as a routine method for the clinical diagnosis of RCC (Table 1). ...
Renal cell carcinoma (RCC) is a major pathological type of kidney cancer and is one of the most common malignancies worldwide. The unremarkable symptoms of early stages, proneness to postoperative metastasis or recurrence, and low sensitivity to radiotherapy and chemotherapy pose a challenge for the diagnosis and treatment of RCC. Liquid biopsy is an emerging test that measures patient biomarkers, including circulating tumor cells, cell-free DNA/cell-free tumor DNA, cell-free RNA, exosomes, and tumor-derived metabolites and proteins. Owing to its non-invasiveness, liquid biopsy enables continuous and real-time collection of patient information for diagnosis, prognostic assessment, treatment monitoring, and response evaluation. Therefore, the selection of appropriate biomarkers for liquid biopsy is crucial for identifying high-risk patients, developing personalized therapeutic plans, and practicing precision medicine. In recent years, owing to the rapid development and iteration of extraction and analysis technologies, liquid biopsy has emerged as a low cost, high efficiency, and high accuracy clinical detection method. Here, we comprehensively review liquid biopsy components and their clinical applications over the past 5 years. Additionally, we discuss its limitations and predict its future prospects.
... In other words, it is not necessary to examine additional genes in the field of clinical practice for CRC when the sample type used for examination is stool instead of blood (61,62). For example, assays that aim to determine early alterations in gene expression in stool specimens due to malignancy, appear to be a promising alternative to the detection methods currently used (23,63). In fact, stool specimens have been used as a representative of CRC manifestations for a number of years (30,64,65). ...
Colorectal cancer (CRC) is the most common gastrointestinal malignancy worldwide. The poor specificity and sensitivity of the fecal occult blood test has prompted the development of CRC-related genetic markers for CRC screening and treatment. Gene expression profiles in stool specimens are effective, sensitive and clinically applicable. Herein, a novel advantage of using cells shed from the colon is presented for cost-effective CRC screening. Molecular panels were generated through a series of leave-one-out cross-validation and discriminant analyses. A logistic regression model following reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry was used to validate a specific panel for CRC prediction. The panel, consisting of ubiquitin-conjugating enzyme E2 N (UBE2N), inosine monophosphate dehydrogenase 1 (IMPDH1), dynein cytoplasmic 1 light intermediate chain 1 (DYNC1LI1) and phospholipase A and acyltransferase 2 (HRASLS2), accurately recognized patients with CRC and could thus be further investigated as a potential prognostic and predictive biomarker for CRC. UBE2N, IMPDH1 and DYNC1LI1 expression levels were upregulated and HRASLS2 expression was downregulated in CRC tissues. The predictive power of the panel was 96.6% [95% confidence interval (CI), 88.1-99.6%] sensitivity and 89.7% (95% CI, 72.6-97.8%) specificity at a predicted cut-off value at 0.540, suggesting that this four-gene panel testing of stool specimens can faithfully mirror the state of the colon. On the whole, the present study demonstrates that screening for CRC or cancer detection in stool specimens collected non-invasively does not require the inclusion of an excessive number of genes, and colonic defects can be identified via the detection of an aberrant protein in the mucosa or submucosa.
... The recent progress in the knowledge of the molecular landscape of GC provides great potential for facilitating new screening modalities for early cancer diagnosis. For example, specific somatic mutations occurring in cancerous tissue can be potentially targeted and detected by polymerase chain reaction-based technologies [62]. Circulating tumor DNA (ctDNA) is an example of such a tumor biomarker that can be identified within a simple blood sample. ...
Background:
Gastric cancer (GC) remains the fifth most common cancer and the third most common cause of cancer-related death globally. In 2022, GC fell into the scope of the updated EU recommendations for targeted cancer screening. Given the growing awareness of the GC burden, we aimed to review the existing screening strategies for GC in high-risk regions and discuss potentially applicable modalities in countries with low-to-intermediate incidence.
Methods:
The references for this Review article were identified through searches of PubMed with the search terms "gastric cancer", "stomach cancer", "Helicobacter pylori", and "screening" over the period from 1995 until August 2022.
Results:
As Helicobacter pylori (H. pylori)-induced gastritis is the primary step in the development of GC, the focus on GC prevention may be directed toward testing for and treating this infection. Such a strategy may be appealing in countries with low- and intermediate- GC incidence. Other biomarker-based approaches to identify at-risk individuals in such regions are being evaluated. Within high-incidence areas, both primary endoscopic screening and population-based H. pylori "test-and-treat" strategies represent cost-effective models.
Conclusions:
Given the significant variations in GC incidence and healthcare resources around the globe, screening strategies for GC should be adjusted to the actual conditions in each region. While several proven tools exist for accurate GC diagnosis, a universal modality for the screening of GC populations remains elusive.
... Cancer has become one of the leading causes of mortality in the world. Single-drug therapy has difficulty achieving high efficacy [1]. As a result, combination drug delivery has been widely used in cancer treatment. ...
Conventional antitumor chemotherapeutics generally have shortcomings in terms of dissolubility, selectivity and drug action time, and it has been difficult to achieve high antitumor efficacy with single-drug therapy. At present, combination therapy with two or more drugs is widely used in the treatment of cancer, but a shortcoming is that the drugs do not reach the target at the same time, resulting in a reduction in efficacy. Therefore, it is necessary to design a carrier that can release two drugs at the same site. We designed an injectable pH-responsive OE peptide hydrogel as a carrier material for the antitumor drugs gemcitabine (GEM) and paclitaxel (PTX) that can release drugs at the tumor site simultaneously to achieve the antitumor effect. After determining the optimal gelation concentration of the OE polypeptide, we conducted an in vitro release study to prove its pH sensitivity. The release of PTX from the OE hydrogel in the medium at pH 5.8 and pH 7.4 was 96.90% and 38.98% in 7 days. The release of GEM from the OE hydrogel in media with pH of 5.8 and 7.4 was 99.99% and 99.63% in 3 days. Transmission electron microscopy (TEM) and circular dichroism (CD) experiments were used to observe the microstructure of the peptides. The circular dichroism of OE showed a single negative peak shape when under neutral conditions, indicating a β-folded structure, while under acidic conditions, it presented characteristics of a random coil. Rheological experiments were used to investigate the mechanical strength of this peptide hydrogel. Furthermore, the treatment effect of the drug-loaded peptide hydrogel was demonstrated through in vitro and in vivo experiments. The results show that the peptide hydrogels have different structures at different pH values and are highly sensitive to pH. They can reach the tumor site by injection and are induced by the tumor microenvironment to release antitumor drugs slowly and continuously. This biologically functional material has a promising future in drug delivery for combination drugs.
... Recently, the detection rates for early stage esophageal cancer have increased as endoscopic technologies for cancer screening have improved [1,2]. Superficial esophageal cancer is potentially curable by endoscopic resection (ER) unless it reaches the muscularis mucosae (m3) and submucosa (sm) because subsequent lymph node recurrence occurs in 18% and 50% of patients with m3 and sm diseases, respectively [3]. ...
Background and purpose
To assess the long-term outcomes of a multimodal approach for maximum esophagus preservation in operable patients with endoscopically unresectable stage I thoracic esophageal squamous cell carcinoma (ESCC).
Materials and methods
The medical records of patients with stage I thoracic ESCC treated with our protocol between 1992 and 2005 were retrospectively reviewed. Our protocol consisted of neoadjuvant concurrent chemoradiotherapy, followed by either additional definitive chemoradiotherapy for good responders (CRT group) or surgery for moderate or poor responders (CRT-S group) after an interim appraisal.
Results
A total of 51 patients were analysed. The median age of the patients was 67 years. The median follow-up period was 124.8 months. After the interim assessment, 49 and 2 cases were assigned to the CRT and CRT-S groups, respectively. In the intent-to-treat analyses, overall survival (OS), disease-free survival (DFS), cumulative incidence for death from esophageal cancer, and that for loss of esophageal function were 78.9%, 53.5%, 10.5%, and 20.4% at 5 years, and 55.2%, 27.8%, 18.2%, and 22.9% at 10 years, respectively. Grade 3 late toxicities occurred with the following incidences: esophageal stenosis in 1 case, esophageal ulcer in 1 case, and pericardial effusion in 2 cases. No grade 4 or higher toxicities were observed.
Conclusion
Long-term survival and esophagus preservation outcomes were favorable, with acceptable toxicities. Our results suggest that CCRT is an alternative treatment for majority of operable patients with endoscopically unresectable stage I thoracic ESCC in combination with salvage therapy.
... Clinical oncologists can also use these markers to determine whether adjuvant treatment is needed. Owing to various genetic and phenotypic alterations that have been reported in ESCA, gene biomarkers have gradually become a cost-effective and precise method for predicting the prognosis of ESCA patients [4]. However, polymorphisms of genes and tumor heterogeneity mean that single-gene biomarkers are inadequate [5]. ...
Esophageal cancer (ESCA) is a leading cause of cancer-related mortality, with poor prognosis worldwide. DNA damage repair is one of the hallmarks of cancer. Loss of genomic integrity owing to inactivation of DNA repair genes can increase the risk of cancer progression and lead to poor prognosis. We aimed to identify a novel gene signature related to DNA repair to predict the prognosis of ESCA patients. Based on gene expression profiles of ESCA patients from The Cancer Genome Atlas and gene set enrichment analysis, 102 genes related to DNA repair were identified as candidates. After stepwise Cox regression analysis, we established a five-gene prognostic model comprising DGCR8, POM121, TAF9, UPF3B, and BCAP31. Kaplan-Meier survival analysis confirmed a strong correlation between the prognostic model and survival. Moreover, we verified the clinical value of the prognostic signature under the influence of different clinical parameters. We found that small-molecule drugs (trametinib, selumetinib, and refametinib) could help to improve patient survival. In summary, our study provides a novel and promising prognostic signature based on DNA-repair-related genes to predict survival of patients with ESCA. Systematic data mining provides a theoretical basis for further exploring the molecular pathogenesis of ESCA and identifying therapeutic targets.
... The risk of developing GC in patients who eradicated Hp was 34% lower than that in patients without Hp eradication (6). The epidemiological data of gastric cancer varies greatly due to the implementation of early screening and surveillance of GC using endoscopy and biomarkers (8,9). For example, endoscopic screening greatly aids in the detection of early GC and prevents the progression of GC by removing precursor lesions, such as high-grade or low-grade dysplasia (9). ...
... The epidemiological data of gastric cancer varies greatly due to the implementation of early screening and surveillance of GC using endoscopy and biomarkers (8,9). For example, endoscopic screening greatly aids in the detection of early GC and prevents the progression of GC by removing precursor lesions, such as high-grade or low-grade dysplasia (9). Despite this background, there is little evidence on whether the incidence of GC and other epidemiological characteristics were altered over the past several decades. ...
Background: Limited evidence exists on the incidence of gastric cancer (GC), and contradictory results exist for the prognosis of GC based on the Lauren classification. We analyzed the incidence and survival of GC based on the Lauren classification.
Methods: The Surveillance, Epidemiology, and End Results (SEER) database from 1975 through 2015 was used to identify all patients with surgically resected, histologically diagnosed intestinal or diffused-type GC. Propensity score matching was used to analyze the association between the Lauren classification type and prognosis.
Results: The trend of total GC incidence showed an obvious decrease (APC = −1.51, 95% CI: −2.31 to −1.01) as well as that of the intestinal type (APC = −1.43, 95% CI: −2.01 to −1.12). However, we found that the relative incidence of the diffused type was increased (APC = 0.6, 95% CI: 0.41–0.82). The trend of the total incidence of GC (APC = −1.31, 95% CI: −1.91 to −1.03) and that of the intestinal type (APC = −1.11, 95% CI: −1.53 to −0.98) was decreased in 40–49-year-olds, but that of the diffused type was increased (APC = 1.5, 95% CI: 1.2–1.72). We found that trends in GC incidence exhibited a similar pattern in the regional and distant stages and showed a decrease from 1975 through 2015. However, the incidence rate of the local stage was increased, with an APC of 0.5 (95% CI: 0.3–0.7). We identified 15,989 GC cases from the SEER database, including 13,852 intestinal-type and 2,138 diffused-type cases. The 1,336 intestinal-type cases were matched with 1,336 diffused-type cases using propensity score matching (PSM), and patients with the diffused type had a better prognosis than patients with the intestinal type (HR = 0.56, 95% CI: 0.45–0.78). However, we found that patients with diffused-type GC had worse survival than patients with intestinal-type GC in the cohort from Renji Hospital (P < 0.001).
Conclusion: The total incidence of GC and that of the intestinal-type GC decreased, but the incidence of diffused-type GC increased in 40–49-year-olds. Diffused types of GCs may have a different prognosis compared to intestinal-type GCs in different patient cohorts. Nevertheless, these results should be interpreted with caution in assessing the prognosis in combination with other factors.
... In most cases, low-resolution visualization approaches, including colposcopy, endoscopy, and laparoscopy, followed by biopsy remain the gold standard for detection or monitoring high-risk patients. [11][12][13] This paradigm suffers typically both from low-sensitivity and low-specificity limitations. Low specificity is primarily an outcome of the fact that gross morphological feature changes guide the identification of tissues selected for biopsy, and benign conditions often harbor similar morphological features to early cancer changes. ...
While metabolic changes are considered a cancer hallmark, their assessment has not been incorporated in the detection of early or precancers, when treatment is most effective. Here, we demonstrate that metabolic changes are detected in freshly excised human cervical precancerous tissues using label-free, non-destructive imaging of the entire epithelium. The images rely on two-photon excited fluorescence from two metabolic co-enzymes, NAD(P)H and FAD, and have micron-level resolution, enabling sensitive assessments of the redox ratio and mitochondrial fragmentation, which yield metrics of metabolic function and heterogeneity. Simultaneous characterization of morphological features, such as the depth-dependent variation of the nuclear:cytoplasmic ratio, is demonstrated. Multi-parametric analysis combining several metabolic metrics with morphological ones enhances significantly the diagnostic accuracy of identifying high-grade squamous intraepithelial lesions. Our results motivate the translation of such functional metabolic imaging to in vivo studies, which may enable improved identification of cervical lesions, and other precancers, at the bedside.
... Digital rectal examination, occult blood in stool, tumor markers and electronic colonoscopy are the most important means for early diagnosis of CRC. None of the 3 cases presented herein was diagnosed at the early stage, due to the following reasons: (1) Lack of characteristic symptoms in the early stage of colorectal cancer [4,5] ; (2) The pilots had good physical constitution and strong disease tolerance; and (3) The troops are stationed far away from cities, where there are poor medical conditions. Therefore, Air Force physicians should be alert to early symptoms and pay attention to the digital rectal examination. ...
Background:
Colorectal cancer (CRC) could seriously threaten the physical and mental health of pilots. Shall they end their flying after treatment of CRC? With this study, we investigated the possibility of a gradual medical waiver for such pilots to fly aircrafts again after treatment of CRC.
Case summary:
We analyzed the medical waiver and clinical data of 3 pilots with CRC, who had accepted the treatment at the Department of General Surgery, Air Force Medical Center (formerly, Air Force General Hospital) between 2013 and 2018. All 3 cases underwent a series of comprehensive treatment courses, including radical resection of CRC, sequential radiotherapy, and chemotherapy. The follow-up results were satisfactory. After passing through the high-risk period of recurrence and metastasis of CRC, they all were given a medical waiver for flying again. Medical observation showed that their flying operations were safe.
Conclusion:
The CRC treatment shall follow the guidelines for diagnosis and treatment and should simultaneously protect the combating capabilities of pilots as much as possible. It is safe for pilots with CRC, who are continuously monitored under medical observation after passing through the high-risk period of recurrence and metastasis, to undertake military flight missions again.
