{
 "id": "074019cb-a9f4-47ef-80c0-80367a653174",
 "disease": {
  "id": "H00020",
  "names": [
   "Colorectal cancer"
  ],
  "dbLinks": {
   "icd10": [
    "C18",
    "C19",
    "C20"
   ],
   "mesh": [
    "D015179"
   ]
  },
  "category": "Cancer",
  "description": "Colorectal cancer (CRC) is the second largest cause of cancer-related deaths in Western countries. CRC arises from the colorectal epithelium as a result of the accumulation of genetic alterations in defined oncogenes and tumour suppressor genes (TSG). Two major mechanisms of genomic instability have been identified in sporadic CRC progression. The first, known as chromosomal instability (CIN), results from a series of genetic changes that involve the activation of oncogenes such as K-ras and inactivation of TSG such as p53, DCC/Smad4, and APC. The second, known as microsatellite instability (MSI), results from inactivation of the DNA mismatch repair genes MLH1 and/or MSH2 by hypermethylation of their promoter, and secondary mutation of genes with coding microsatellites, such as transforming growth factor receptor II (TGF-RII) and BAX. Hereditary syndromes have germline mutations in specific genes (mutation in the tumour suppressor gene APC on chromosome 5q in FAP, mutated DNA mismatch repair genes in HNPCC)."
 },
 "article": {
  "id": "24037561",
  "text": "BACKGROUND:\nIncreasing evidence suggests that diabetes mellitus (DM) is associated with increased cancer incidence and mortality. Several mechanisms involved in diabetes, such as promotion of cell proliferation and decreased apoptosis, may foster carcinogenesis. This study investigated the association between DM and cancer incidence and cancer-specific mortality in patients with breast and colorectal carcinoma.\n\nMETHODS:\nA meta-analysis of controlled trials, prospective cohort studies and pooled cohort studies published after 2007 was conducted. Embase, PubMed and the Cochrane Library were searched. Summary hazard ratios (HRs) were calculated using a random-effects model. Sensitivity and subgroup analyses were performed to adjust for confounders, mode of DM assessment and follow-up time.\n\nRESULTS:\nTwenty studies were included to investigate the association between DM and breast and colorectal cancer incidence and cancer-specific mortality. The studies predominantly comprised patients with type II DM. The overall HR for breast cancer incidence was 1·23 (95 per cent confidence interval 1·12 to 1·34) and that for colorectal cancer was 1·26 (1·14 to 1·40) in patients with DM compared with those without diabetes. The overall HR was 1·38 (1·20 to 1·58) for breast cancer- and 1·30 (1·15 to 1·47) for colorectal cancer-specific mortality in patients with DM compared with those without diabetes.\n\nCONCLUSION:\nThis meta-analysis indicated that DM is a risk factor for breast and colorectal cancer, and for cancer-specific mortality."
 },
 "questions": [
  {
   "id": "821c8fe4-809d-4e4a-9a81-0533ec758d0f",
   "text": "What are the risk factors of Colorectal Cancer?",
   "answers": [
    {
     "answer_start": 990,
     "text": "patients with type II DM"
    },
    {
     "answer_start": 1173,
     "text": "patients with DM"
    },
    {
     "answer_start": 1456,
     "text": "DM"
    },
    {
     "answer_start": 46,
     "text": "diabetes mellitus (DM)"
    }
   ]
  }
 ]
}