Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the fourth leading cause of cancer death in the world, accounting for about 1.4 million new cases and almost 700,000 deaths in 2012. The clinical outcome and the tumor progression are now considered the result of a balance between the invasiveness of the tumor and the immune response of the patient against the tumor. The immune system has the ability to control and shape cancer through a mechanism called immunoediting, which include elimination, equilibrium, and escape. The consensus Immunoscore is a scoring system that outlines the density of CD3+ and CD8+ T-cell effectors existent in the tumor and its invasive margin. The pre-existing intra-tumoral immunity could be enhanced and activated by immunotherapy. Immunoscore could be a good prognostic marker, by identifying patients at high risk of tumor recurrence and stratifying patients who could benefit from adjuvant therapies. Human surfaces and cavities are populated by numerous microbial communities, and they play an indispensable role in human health, as they interact with the immune system. The authors made a literature revision concerning the role of Immunoscore and microbiome in colorectal cancer.
Part of the book: Multidisciplinary Approach for Colorectal Cancer
Bone metastases are more common than primary bone cancers, especially in adults. Bone is the third most common organ affected by metastases, from many types of solid cancers but especially those arising in the breast and prostate. Besides the impact on survival, bone metastases may have a big impact on morbidity and represents a significant healthcare burden. Skeletal-related events (SREs) include pain, pathologic fracture, spinal cord compression, and hypercalcemia and can cause a deterioration of the quality of life. Detection of bone metastases is essential for accurate staging and optimal treatment; however, there is no consensus or standard approach for diagnosis, so the choice of imaging should be guided by clinical presentation. Treatment goals may consist of controlling pain and other symptoms, preserving and restoring function, minimizing the risk of SREs, stabilizing the skeleton, and enhancing local tumor control. Therapeutic options include pain management/analgesia, osteoclast inhibitors, systemic anticancer therapy, radiation therapy, bone-targeting radiopharmaceutical therapy, surgery, and/or image-guided thermal ablation. The choice of treatment is influenced by factors like symptoms, impact on quality of life, performance status, estimated life expectancy, goals of treatment, and preferences of care.
Part of the book: Bone Tumours