Review

Field cancerization in the GI tract

† Author for correspondence

Email the corresponding author at trevor.graham@cancer.org.uk

Centre for Digestive Diseases, Blizard Institute of Cell & Molecular Science, Barts & the London School of Medicine & Dentistry, London, UK

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Nicholas A Wright

Histopathology Laboratory, Cancer Research UK London Research Institute, 44 Lincoln’s Inn Fields, London, WC2A 3LY, UK

Centre for Digestive Diseases, Blizard Institute of Cell & Molecular Science, Barts & the London School of Medicine & Dentistry, London, UK

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Published Online:8 Aug 2011https://doi.org/10.2217/fon.11.70

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Abstract

The widely accepted paradigm for tumorigenesis begins with rate-limiting mutations in a key growth control gene resulting in immediate lesion growth. Tumor progression occurs as cells within the tumor acquire additional carcinogenic mutations. However, there is clear evidence that the road to cancer can begin long before the growth of a clinically detectable lesion – indeed, long before any of the usual morphological correlates of preneoplasia are recognizable. Field cancerization, the replacement of the normal cell population by a histologically nondysplastic but protumorigenic mutant cell clone, underlies the development of many cancer types, and in this article we review field cancerization in the GI tract. We present the evidence that field cancerization can underpin tumorigenesis in all gastrointestinal compartments, discuss the homeostatic mechanisms that could permit clone spread and highlight how an understanding of the mechanisms driving field cancerization is a means to study human stem cell biology. Finally, we discuss how appropriate recognition of the role of field cancerization in tumorigenesis could impact patient care.

Keywords:

Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

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The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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