الفهرس 
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Abstract
Colorectal cancer is considered one of the most common malignancies worldwide. It ranks as the first common digestive malignancy in Egypt and the fifth of all types of cancer. Despite high prevalence and advances in detection and treatment, colorectal cancer is a leading cause of cancer related deaths globally.
Understanding the mechanisms behind the invasive and metastatic abilities of the colorectal cancer represent a fundamental step in the improvement of treatment strategies and patient survival.
Epithelial mesenchymal transition is crucial in providing cancerous cells with mobility and invasiveness whether local or to distant organs. In addition, maintenance of stemness characteristics with self-renewal abilities ensures successful establishment of metastatic foci.
Twist-1 is considered one of EMT key regulatory factor. It plays a vital role in suppressing the expression of genes coding for adhesion molecules and up-regulating meschymal gene expression , thereby enhances tumor cell invasiveness and aggression.
Cancer stem cells were identified in various types of tumors including colorectal carcinoma. Many CSC markers were investigated. CD44 represents a main colorectal CSC marker that carries potential prognostic and therapeutic values.
The present study was conducted to evaluate the immunohistochemical expression of Twist-1 as an EMT marker along with the assessment of CD44 as a CSC marker in colorectal carcinoma and to correlate their expression with the clinicopathological parameters and patients’ outcome.
The present study included fifty colorectal carcinoma cases submitted to the Department of Pathology, Faculty of Medicine, Alexandria University who continued a post-operative treatment and follow up duration of at least 2 years in Clinical Oncology and Nuclear Medicine department, Faculty of Medicine, Alexandria University during the period starting from January 2014 to December 2016.