Bowel cancer is third most common cancer in the western world. About one-thirds of bowel cancer occur in the rectum.
The biological behavior of rectal adenocarcinoma is different from extra-rectal colonic cancers with wide heterogeneity
in outcomes of tumour classified within same clinical stage. Locally advanced rectal cancer (LARC) has significant risks for
both local recurrence and distant metastases. Despite advances in imaging, staging, surgical technique, chemotherapy and
radiotherapy, there has been little improvement in overall survival, treatment related morbidity and quality of life. Therefore,
there is an urgent need to stratify rectal cancers further than standard staging to help individualise treatment option and improve
outcomes. Some aspects of clinical behavior of rectal cancer can be explained by the embryonic origin and anatomy of the rectum,
and micromorphological features of rectal adenocarcinomas. Over recent years, vast majority of research has focused on analysis
of molecular pathways involved in rectal cancer cell cycle and spread to establish markers predicting response to neoadjuvant
treatment and over all prognosis. For the purpose of this review,a comprehensive literature search of artciles published in English
language was undertaken theough popular databases (PubMed, Medline, Web of Knowledge and Scopus). The biomarkers of
rectal cancer could be widely divined into (i) Markers predicting inhernt tumours behavior and (ii) markers predicting response
to therapy. The former include aneuploidy, P53/P21 pathway, Bcl-2/Bax pathways, DNA repair mechanism etc whereas later
involve Ki-67 proliferative index, EGFR and angiogenesis (VGEF, MVD). A detailed review of aach markers, their advantages
and drawbacks is discussed.
Aftab Khan has completed his medical degree from University of Palacky in the Czech Republic at the age of 24 and has completed basic surgical
training in the UK and became member of Royal College of Surgeons in Edinburgh (MRCS-Ed) in 2006. Currently he is a part-time research student
at University College London, investigation biological behavior of rectal cancers in response to neoadjuvant chemoradiotherapy. He is the Director
of Coloproctology Journal Club, an online platform to promote evidence based surgery. He has published and presented in several national and
international scientific meetings and served on editorial board of surgical journals.
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