Assessment of cumulated genetic alterations in colorectal cancer

Widespread genetic alterations are a common feature of most colorectal cancers. While specific recurrent alterations may reveal the involvement of a gene or set of genes in the biology of the disease, the cumulated genomic damage is likely to reflect the biological history of the neoplastic cells. Furthermore, the functional implications behind many of these genetic changes may show the evolutionary potential of the neoplastic cells. Different approaches, ranging from the gross determination of total nuclear DNA content to cytogenetic and molecular approaches, reveal different types of chromosomal and subchromosomal alterations and have been applied to measure generalized genomic damage in colorectal carcinomas. High levels of genomic damage usually appear associated with increased aggressiveness in colorectal cancer, and the use of different assessments of genomic damage as independent prognostic factors has been proposed. Therefore, appropriate definition of the extent of cumulated alterations and their functional consequences may be of interest in the understanding and management of cancer. The different methodologies and clues to the interpretation and integration of the results obtained with each technique are discussed in this review.