الفهرس 
Introduction and aim of the studyOnly 14 pages are availabe for public view
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Abstract
Aim of the work is to evaluate the clinicoepidemiological aspect and histopathological features of CRC and their prognostic significance and correlation with the microsattellite instability in the resected tumor specimens. Patients and methods:<>This prospective non-randomized study was conducted in Gastro-Entrology Center , Mansoura University on one hundred and five CRC patients during the period between March 2004 and July 2006.ninty patients underwent surgical resection and fifteen patients had palliative procedures, Histopathological and immunohistochemical examination of the resected tuor specimens was done. Results: The mean age of CRC in our study patients was 50±12.6 years with the peak incidence in the sixth decade. of the patients fulfilled the Amesterdam criteria for HNPCC. Among the colorectum, rectal carcinoma was the commonest site with fifty one patients (48.5%)). While in colonic cancer distal colon was represented by (33.3%) of patients which is double the incidence of the proximal colon cancers (17.2%). Adenocarcinoma was the commonest pathological type (61%) followed by mucoid and signet ring carcinoma. Ducks C tumors still represent the majority of cases in Egypt however the incidence of Ducks A tumors tend to increase in the last years. Sensitivity of CEA as CRC tumour marker using a cut off point of 5 ngm/ml was low (34.2%) the incidence of CEA level above normal was in tumors proximal to the splenic flexure, poorly differentiated tumors, distant metastasis and higher tumor stages. Immunhistochemical examination of the reseted specimens for microsattelite instability in MSH2 gene revealed that they represented (18.9%) of the patients, eleven(64.7%) males and seven (35.3%) females with the majorty (25%) in the sixth decade of life. Distributed in proximal colon, distal colon and rectum as (70%), (9%) and (21%) respectively There was low incidence (36%) of lymph node metastasis in patients with microsattelite instability. There was no statistical significant relation between patients survival and age (p value .36) or sex (p value .386) The lower the tumor stage the better the patient outcome using either Ducks Asteller Coller or TNM stages. On the other hand –ve lymph node stauts and lower tumor stage had a strong influence on patient good outcome. Pre-operative CEA level with a cut off point at 5ng/ml had a statistically insignificant relation with patients survival or outcome (p value .213 and .4) respectively, however CEA level in the same patients taken two to three weeks after surgery had a more significant association with the patients outcome and survival (p value .004). Patients with negative MSH2 had a statistically significant better survival and outcome than patients with positive MSS . Conclusion: Colorectal carcinoma is more common in the sixth decade of life with mild female predominance. Adenocarcinoma is the commonest pathological type. Most of the patients in our locality present with an advanced stages of the disease which had a strong influence on patients outcome and survival. CEA level taken two weeks after surgery is a much dependable prognostic factor that preoperative level using a cutoff point of 5 ngm/ml. Immunohistochemichal examination revealed that tumors with microsattelite instability which had –ve expression of the MSH2 gene had a highly significant statistical better outcome and survival. It is necessary to have a current screening program every five years beginning at age of fifty for asymptomatic persons at average risk for colorectal carcinoma by regular examination either by endoscopic examination, occult blood in the stool. These tools become mandatory especially for patients with symptoms of colonic problem even in the absence of family history of the disease for earlier diagnosis and improved outcome.