Pathways of Colorectal Carcinogenesis and Their Clinical Implications

Colorectal cancer (CRC) is ranked fourth among causes of cancer mortality in Colombia and in the world, for both genders; it is therefore regarded as a public health issue. CRC's phenotype and genotype are highly heterogeneous, a fact related to the various carcinogenic pathways described, and which is also implicated in the different progression mechanisms and the aggressiveness of the disease. The classic pathways, suppressive and mutable, are characterized by a series of genetic alterations related to phenotype changes in the morphologic progression of the adenoma-carcinoma sequence. The alternate pathways, originated by BRAF and KRAS gene mutations, are linked to the serrated polyp progression to carcinoma. Knowledge of these pathways is very important in achieving a fuller understanding of the disease and for broadening the study of mechanisms for its control; these include: early diagnosis, treatment and follow-up.