Colorectal adenomas and colorectal cancer are identified and removed from individuals’ bowels by endoscopy. These removed adenomas are currently assessed for the risk of future colorectal adenomas and cancer, by assessing their size, cell shape, morphology and number. As individuals with colorectal adenomas that are larger, villous, abnormal cell shape and multiple are deemed higher risk for future precursor lesions and colorectal cancer. Individuals classified as high risk, are surveilled more frequently by endoscopy to identify colorectal adenomas and cancer as early as possible. However not all people who are high or low risk for future adenomas and colorectal cancer are identified correctly with this current method of precursor lesion risk stratification. This is important as colorectal cancer incidence and mortality is significantly reduced by removal of adenomas and endoscopy is invasive and costly.
During this project a retrospective case control study will be carried out in NHS Trust hospitals, using routinely collected archival bowel tissue samples. Molecular differences will be measured and compared in people with colorectal adenomas at high and low risk for future adenomas and colorectal cancer; with the aim of identifying more sensitive molecular biomarkers for risk stratification and prevention. A risk prediction model will be developed, taking into account individuals’ molecular and personal characteristics gathered from the literature and case control study. This model will be used to predict which individuals with colorectal adenomas have a high risk of future adenomas and colorectal cancer. This will potentially enable patients to undergo further tailored surveillance and future preventive diagnosis and treatment.
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