Molecular pathologic and MRI investigation of the prognostic and redictive importance of extramural VEnous invasion in rectal cancer
The treatment for rectal cancer has improved significantly over the last 25 years, however, recent advances in radiology, surgery and cancer treatment mean that we are in an exciting position to improve results further. More accurate diagnostic techniques are allowing us to gain significant amounts of information on tumour characteristics at an early stage. Yet we do not fully understand what these tumour characteristics mean in the long term and how best to tailor patients’ treatments in order to mitigate these factors. One of these characteristics which we do know that leads to a worse prognosis is called extramural venous invasion (EMVI), whereby some of the cancer cells spread into the nearby blood vessels. Although we are now able to accurately identify this phenomenon using MRI scans, it is not clear as to what effect standard treatments have on this. We believe that the presence of this feature in rectal cancer leads to it having a distinct genetic make-up.
More recently, new analytic techniques are becoming available for gene and molecular analysis in cancers. Using these techniques, it is possible to identify differences in the genetic profiles between EMVI positive and EMVI negative adenocarcinoma in rectal cancer. A better understanding of the molecular differences between these two tumour subtypes may enable the subsequent integration of molecular information into prognostication, and development of objective molecular-pathologically based treatment algorithms. This information may also uncover novel therapeutic targets, and have wider biological utility.
Patients who decide to enrol in the study will not have to undertake any additional procedures or treatments outside their planned care. We will compare their MRI scan before and after chemoradiotherapy. We will use new analytical techniques to assess the underlying genetic and molecular profiles of the biopsies and surgery specimens to identify differences. We will continue to monitor the progress of the patients and disease progression through their visits to the outpatient department.
By identifying the differences in the make-up of those cancers that demonstrate EMVI and those that do not, we will be able to target treatments at these differences and thus reduce the effect it has on the long term prognosis. By using the longer term data on how patients’ progress compared to what is happening to the degree of EMVI, we will be able to identify those patients which may benefit from further treatment after their surgery and more frequent follow-up.
Link to UKCRN.
References
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Talbot, I.C., et al., The clinical significance of invasion of veins by rectal cancer. The British journal of surgery, 1980. 67(6): p. 439-42.
Smith, N.J., et al., MRI for detection of extramural vascular invasion in rectal cancer. AJR. American journal of roentgenology, 2008. 191(5): p. 1517-22.
Baumhoer, D., et al., Impact of using elastic stains for detection of venous invasion in the prognosis of patients with lymph node negative colorectal cancer. International journal of colorectal disease, 2010. 25(6): p. 741-6.
