Mutations in APC, Kirsten-ras, and p53—alternative genetic pathways to colorectal cancer

Gillian Smith, Francis A. Carey, Julie Beattie, Murray J. V. Wilkie, Tracy J. Lightfoot, Jonathan Coxhead, R. Colin Garner, Robert J. C. Steele, C. Roland Wolf

    Research output: Contribution to journalArticlepeer-review

    382 Citations (Scopus)


    Colorectal cancer is one of the most significant causes of cancer death. A genetic model for colorectal cancer has been proposed in which the sequential accumulation of mutations in specific genes, including adenomatous polyposis coli (APC), Kirsten-ras (K-ras), and p53, drives the transition from healthy colonic epithelia through increasingly dysplastic adenoma to colorectal cancer. We have characterized tumor mutation spectra in a large cohort of colorectal cancer patients. In marked contrast to the predictions of the sequential model of mutation accumulation, only 6.6% of tumors were found to contain mutations in APC, K-ras, and p53, with 38.7% of tumors containing mutations in only one of these genes. The most common combination of mutations was p53 and APC (27.1%), whereas mutations in both p53 and K-ras were extremely rare. Statistical analysis (two-sided Fisher's exact test) confirmed that mutations in K-ras and p53 co-occurred less frequently than expected by chance (P < 0.01, Fisher's exact test). This finding suggests that these mutations lie on alternate pathways of colorectal tumor development. The heterogeneous pattern of tumor mutations in our patient cohort suggests that multiple alternative genetic pathways to colorectal cancer exist and that the widely accepted genetic model of cancer development is not representative of the majority of colorectal tumors.
    Original languageEnglish
    Pages (from-to)9433-9438
    Number of pages6
    JournalProceedings of the National Academy of Sciences of the United States of America
    Issue number14
    Publication statusPublished - 2002


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