[Colorectal cancer: diagnostic paths on the basis of international guidelines] Tumore del colon retto: percorsi diagnostici sulla base di linee guida internazionali

The colorectal cancer (CCR) is still one of the most important neoplastic pathologies whose mortality and metastatic progression is strictly connected to the structural and biological characteristics of the primary tumor. Compared with an overall increase in incidence, there has been a reduction in mortality by almost 35 percent in the last two decades. These features are undoubtedly due to the significant progress of predictive and preventative medicine that employs several new diagnostic tools and surgical exploration devices (i.e. endoscopy) allowing earlier diagnosis and intervention on patient injuries; in this way, the neoplastic transformation of dysplastic and polyposis lesions and invasiveness of the tumoral mass can be prevent. In particular, the review describes the progress achieved in the screening population programs. Of considerable importance is fecal occult blood test (SOF) survey, which allows the identification of areas of minimal bleeding in the gastroenteric district, hiding a putative neoplastic process. SOF has been highly successful in recent times and has allowed, in Regions where the screening process is applied, to significantly reduce the risk of metastatic disease and the associated mortality rate. Another important forward step is the use of new molecular techniques that allow to analyze mutations and epigenetic lesions of genes involved in the pathogenic mechanism of tumor induction (fecal DNA analyses) as a high sensitivity and specificity instrument for the detection of micro-cracks cancer. Is also discussed, according to the evidence-based medicine principles, the role played by serological markers like CEA and Ca 19.9 which represent prediction and prognostic values in the follow-up and monitoring of the therapeutic success.