Colorectal Cancer (CRC) is the 3rd most commonly occurring cancer world-wide. The past two decades of intense research have indeed advanced our understanding of the genetics underlying the formation of an adenoma (benign tissue) and carcinoma (cancerous tissue) of CRC, albeit utilizing mainly unmatched patient cohorts of adenoma and carcinoma. However, although key driver DNA variants that distinguishes both entities have been well established in the field, the determinant and earliest variant that selects an adenoma to progress to a carcinoma remains unknown. Mamlouk et. al. investigated this with a unique cohort of matched patient samples consisting of polyps carrying adenomas captured at the transition stage to carcinoma. We identified that key alterations in TP53 and chromosome 20 gain are early events driving the progression towards carcinoma. They were not only found shared between adenoma-carcinoma pairs, but also, distinguished low-grade from more high-grade adenoma. This highlights the major finding of the publication that the molecular progression, that is DNA alterations such as mutations and copy number changes, are uncoupled from the histological progression within these tumors. We further expanded on the heterogeneity present within the polyps by performing clonal deconvolution analysis using mutational data from multi-regional tissue isolation. We showed that selective pressure occurs at both adenoma and carcinoma tissue and subclonal populations are further evident within adenoma tissue long after its progression to a carcinoma.
Mamlouk, S., Simon, T. et al., Malignant transformation and genetic alterations are uncoupled in early colorectal cancer progression
https://bmcbiol.biomedcentral.com/articles/10.1186/s12915-020-00844-x