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Category: Volume 06 Issue 01 January 2018
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Title: Comparison of Stage IV Colonic Carcinoma in Right Side to Left Side by Prognostic Markers like her-2-neu, p53 and KRAS Mutation

Authors: Dr Pranita Mohanty, Dr Shirin Dasgupta, Dr Debahuti Mohapatra,  Dr Soumya Surath Panda

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i1.163

Abstract

Backgrounds: Colorectal carcinomas vary considerably throughout the world, being one of the leading cancer sites in the developed countries. Colorectal cancer (CRC) is the third most commonly diagnosed cancer globally, accounting for 10.0% of all new cancer cases. Here, difference in expression of p53, Her-2-neu, K-RAS and prognosis along with survival of stage IV both right and left sided colon cancers were evaluated. 

Methods and Materials: One year retrospective study of stage IV carcinoma colon cases was studied in our institute; separated as right and left side colonic carcinoma. Immunohistochemistry of p53, Her-2-neu and KRAS mutation study by RT-PCR was done on their respective blocks and the results were compared; prognosis studied by follow up of the patients for 1 year.

Results: A total of 512 histopathologically confirmed cases of colon carcinoma were screened and paraffin block of 15 cases of stage IV colon carcinoma elaborately studied by routine Haematoxylin & Eosin stain. Followed by IHC (P53 and Her 2/Neu), RT PCR study (K ras mutation) were carried out. Among them 6 were right and rest 9 were left side colon carcinoma.

Right sided cases constituted 3 adenocarcinoma NOS (p53, Her 2 neu positive) 2 mucin secreting adenocarcinoma (p53 positive  her 2 neu negative) and 1 signet ring cell adenocarcinoma (p53 positive Her 2 neu negative). Left sided cases constituted 5  adenocarcinoma NOS( p53 positive Her 2 neu negative), 2  mucin secreting( p53 positive  Her 2 neu negative) and 2  signet ring cell ( p53 , Her 2 /neu negative). K ras mutation was positive in 67% right sided and 40%left sided colonic cancers. Following up, 83% of  right sided cancer patients were dead and 17% living whereas in left sided cancers, 67% were living  responding well to chemotherapy.

Conclusion: Anti-epidermal growth factor receptor monoclonal antibody treatment (targeted therapy), with cetuximab and panituzumab is more effective in left side colonic carcinoma than right side.

Keywords: EGFR, Right sided, left sided, KRAS, P53, Her 2 /neu.

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Corresponding Author

Dr Pranita Mohanty

Associate Professor, Department of Pathology,

IMS and SUM Hospital, Bhubaneswar