الفهرس 
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Abstract
Colon cancer is the fourth most frequent cancer in the world, but rectal cancer is the eighth most common cancer overall. Behind lung cancer, colorectal carcinomas (CRC) are the second most deadly cancer in the world and the third most common cancer for which a diagnosis is made. They cause 10% of all cancer diagnoses as well as 9.4% of cancer deaths.
According to WHO statistics, colon cancer is the tenth most common cancer in Egypt. 2.7% of all cancer cases and 2.4% of all cancer-related deaths are caused by it. The sixteenth most frequent cancer, representing 1.2% of all cancer cases and 0.98% of all cancer-related deaths, is rectal cancer. (CRC) Both are Egypt’s sixth-most prevalent cancers. With high Age-standardized incidence rates (ASR) in females of 3.3 compared to men of 3.2, colon cancer is more common than rectal cancer.
The development of CRC is complex and involves a wide range of causes and processes, most of which include interactions between genetic and environmental factors. One of the most common malignancies for which modifiable causes may be found and avoided is CRC. Risk factors for CRC may be divided into those that can be changed and those that cannot.
There are significant risk factors that influence the advice for screening and raise the chance of developing CRC. Age, genetic CRC, inflammatory bowel disease, and prior abdominal-pelvic radiation for any cancer are among these risk factors. There are risk variables that can be altered but do not have an impact on screening programs. Obesity, inactivity, cigarette usage, excessive alcohol use, and processed meat intake are among them. Other variables, which are regarded as preventive factors, may aid in lowering the chance of developing CRC. They include a fiber-rich diet, exercise, calcium and vitamin D intake, coffee use, and certain medications including NSAIDS and postmenopausal hormone medications.
There are two mechanisms that can lead to the development of cancer stem cells (CSCs), the first being the carcinogenic mutation of normal stem cells, which results in unchecked cell proliferation, and the second being the dedifferentiation of regular cancer cells and their conversion into stem cell-like cells. CSCs are a class of cells that have the ability to self-renew, proliferate indefinitely, differentiate in multiple directions, and stimulate the growth of tumors.
Colorectal CSCs are recognized by a variety of cell surface markers, including as CD44, CD133, CD24, EpCAM, LGR5, and ALDH. Due to their strong tumorigenicity, chemo- and radio-resistance, they play a vital role in the spread and recurrence of colorectal cancer as well as disease-free survival.
The 70 tissue blocks of primary colorectal adenocarcinoma and the corresponding lymph node metastases were included in the current study. They were randomly selected from the pathology department archive at Minia University Hospital and private pathology laboratories between April 2018 and June 2022. Of these, 75.7% were adenocarcinomas, NOS, while 10% were mucinous adenocarcinomas and 14.3% were signet ring adenocarcinomas. gathering clinical and pathological information about patients from pathology reports. Sections were exposed to the following after being extracted from these cases: 1. Hematoxylin and eosin, to identify tumor necrosis, lymphovascular invasion, perineural invasion, and tumor infiltrating lymphocytes.
2. The investigation of ALDH1A1 and CD44 immunohistochemistry expression in each instance.
The expression of ALDH1A1 was shown to be significantly correlated with tumor grade, advanced tumor stage, PDC grade lymphovascular invasion, tumor infiltrating lymphocytes, and tumor necrosis.
The independent relationship between positive ALDH1A1 expression and poor prognostic factors, such as high tumor grade, advanced tumor stage, lymphovascular invasion, PDCs grade, and tumor necrosis, was confirmed by multivariate regression analysis, indicating that ALDH1A1 expression plays a role in tumor aggressive behavior.
A statistically significant correlation between CD44 expression and tumor grade, PDC grade, advanced tumor stage, lymph node metastases, LVI and tumor necrosis has been found.
There is no connection between CD44 and the patient’s age, gender, tumor location, size, histological type, or perineural invasion that is noteworthy.
The independent relationship between positive expression and poor prognostic variables, such as high tumor grade, lymphovascular invasion, advanced tumor stage, and grade, was verified by multivariate regression analysis, indicating the importance of expression in tumor aggressive behavior.
The combined expression of both markers and additional clinicopathological information were shown to be statistically significantly correlated.
In conclusion, high levels of ALDH1A1 and CD 44 expression may be indicative of a bad prognosis in individuals with colorectal cancer. ALDH1A1 and CD 44 both have important roles to play in the development, aggressiveness, invasion, and spread of CRC.