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Serrated adenocarcinoma is a form of bowel cancer that grows out of sessile serrated polyps rather than ordinary adenomas, keeping their saw-tooth pattern. Most cases carry a KRAS or BRAF mutation and the BRAF-mutant ones are often mismatch-repair deficient. It is treated like other bowel cancer, with the BRAF and mismatch repair results guiding drugs when it has spread.
The WHO classification recognises serrated adenocarcinoma as a colorectal adenocarcinoma type with serrated glands, eosinophilic cytoplasm and vesicular nuclei, arising through the serrated pathway of sessile serrated lesions and traditional serrated adenomas (Nagtegaal 2020). In 42 serrated adenocarcinomas, KRAS and BRAF mutations were present in 45 and 33 percent against 27 and 0 percent of non-serrated carcinomas; BRAF mutation was specific for serrated adenocarcinoma and marked a subset with gene methylation and a tendency to microsatellite instability, while the high KRAS rate suggests many KRAS-mutant colorectal cancers arise from serrated precursors (Histopathology 2011). In 89 cases KRAS mutation (42.7 percent) was more prevalent than BRAF (25.8 percent), MGMT loss was more frequent than in conventional carcinoma (50.6 against 25.3 percent), and most serrated adenocarcinomas were microsatellite stable, differing from sporadic MSI-high carcinomas (International Journal of Cancer 2012).
How it differs from its parent: its precursor is the sessile serrated lesion rather than the adenoma, so it is the histology behind the right-sided BRAF-mutant and CpG island methylator cancers on the colorectal and BRAF pages, and its KRAS-mutant, microsatellite-stable majority has a worse outlook than the MSI-high minority.
How common: no registry share was found in the sources read.
Treatment: as the colorectal page by stage, BRAF, RAS and mismatch repair status (encorafenib with cetuximab for BRAF V600E metastatic disease; checkpoint inhibitors for MSI-high); there is no trial in the histology.
The defining series compared 42 and 89 serrated adenocarcinomas with conventional carcinomas (Histopathology 2011; International Journal of Cancer 2012); no registry share was found in the sources read, and the serrated pathway is thought to account for a larger share of colorectal cancer than the strictly defined histology.
Right-sided tumours behave differently from left-sided and rectal ones; the colon drains along its mesenteric vessels, the rectum into the mesorectum and pelvic side wall.
Same organ: Colon cancer (adenocarcinoma of the colon), Mucinous adenocarcinoma of the colon and rectum, Signet ring cell carcinoma of the colon and rectum, Medullary carcinoma of the colon, Peritoneal mesothelioma, Colorectal cancer, Rectal cancer, Mismatch-repair deficient (MSI-high) colorectal cancer, BRAF V600E-mutant colorectal cancer, HER2-amplified colorectal cancer, KRAS G12C-mutant colorectal cancer, Early-onset colorectal cancer (under 50), Anal cancer (squamous cell carcinoma), Appendiceal cancer and pseudomyxoma peritonei, Small intestine cancer (small bowel adenocarcinoma), Small intestinal neuroendocrine tumours, Anal high-grade squamous intraepithelial lesions (precursor), Localised anal squamous cell carcinoma (stage I to III), Metastatic and recurrent anal squamous cell carcinoma, Low-grade appendiceal mucinous neoplasm and pseudomyxoma peritonei, Appendiceal adenocarcinoma (mucinous and non-mucinous, including signet ring cell), Goblet cell adenocarcinoma of the appendix, Localised small bowel adenocarcinoma (stage I to III, resected), Advanced and metastatic small bowel adenocarcinoma
Treated as the colorectal page by stage and molecular status: encorafenib with cetuximab for BRAF V600E metastatic disease, checkpoint inhibitors for MSI-high disease.
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Query for this cancer: (TITLE:"Serrated adenocarcinoma of the colon and rectum" OR ABSTRACT:"Serrated adenocarcinoma of the colon and rectum" OR TITLE:"Serrated adenocarcinoma" OR ABSTRACT:"Serrated adenocarcinoma" OR TITLE:"Serrated pathway colorectal cancer" OR ABSTRACT:"Serrated pathway colorectal cancer" OR TITLE:"Colorectal carcinoma arising from a sessile serrated lesion" OR ABSTRACT:"Colorectal carcinoma arising from a sessile serrated lesion") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Serrated adenocarcinoma of the colon and rectum, not a curated reading list.
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Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
Reactions around the moment a drug is given: chills, fever or breathlessness from antibodies (infusion reactions), true allergy (hypersensitivity, rarely anaphylaxis), and leakage of a damaging drug into tissue around the vein (extravasation).
Skin reactions from cancer drugs, ranging from the acne-like rash that nearly everyone on an EGFR inhibitor gets (a sign the drug is working) to painful nail-fold infections, itching, and rare severe blistering reactions.
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