الفهرس 
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Abstract
Colorectal cancer (CRC) is the third most common malignancy in men and the second in women. Regular screening, early detection, and early treatment of CRC can achieve effective prevention and even cure. Despite this, 60% to 70% of CRC patients are not diagnosed until late stages, and only 11.8% of cases are detected at early stages. It is therefore urgent to reduce the rates of CRC morbidity and mortality by improving the screening rate (104).
Screening for colorectal cancer (CRC) in asymptomatic patients can reduce the incidence and mortality of CRC. In the United States, colonoscopy has become the most commonly used screening test. Adenomatous polyps are the most common neoplasm found during CRC screening. There is evidence that detection and removal of these cancer precursor lesions may prevent many cancers and reduce mortality.
Survival is strongly related to stage at diagnosis, with five-year survival rates of 89.8% for localized cases (confined to the wall of the bowel), but only 67.7% for regional disease (disease with lymph node involvement) and 10.3% for distant metastatic patients Screening and then diagnosis at an early stage can reduce the incidence of CRC in an advanced stage and hence mortality.
Thus this study was held on the steps of previous studies to assess the role of serum mSEPT9 in early detection of colorectal cancers.
This study was applied prospectively on a 90 out of 150 Egyptian patients with different demographic data presented to the Gastroentestinal department-, Oncology department or Surgery department of Menoufia university hospitals, divided in to 3groups; GI (45) CRC patients, GII: (25) patients with benign lesions, GIII: (20) healthy control (undetected lesions).
All the included patients were subjected to the following:
Full history taking with stress on history suggestive of any colonic symptoms like BPR, Spurious diarrhea and Change in bowel habits.
Through clinical examination (general, abdominal and Rectal) for organomegaly (hepatomegaly, splenomegaly), ascites, epigastric tenderness, abdominal masses, rectal bleeding or rectal mass.
Laboratory investigations including: Complete blood count, liver function, renal function, bleeding and coagulation profile, fecal occult blood test (FOBT), Carcinoembryonic antigen ( CEA ) and Methylated Septin9 (mSEPT9).
Radiological investigations: Abdominal ultrasonography and computed tomography (CT)
Pre Colonoscopic evaluation and preparation before colonoscopy (Hospitalization, resuscitation and diet preparations).
In current study, patients who diagnosed with CRC had mean age about 53.6 year which was higher than mean age of patients who diagnosed with benign lesions 47.2 year. Gender also compared but was statistically non-significant (P value =0.524).
SUMMARY
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Smoking, DM and hypertension were cofounders on increasing the risk of development of CRC (p value 0.001, 0.009, 0.002) respectively.
BMI also compared and showed that obesity increases the risk of CRC development; the mean weight for CRC group was 88.9±6.74 kg, while group (II) had lower values 81.1±6.80 kg and the lowest values was for group (III) 71.4±10.6 ( p value 0.001).
In current study, There was a statistically high significant difference between the groups regarding their symptoms and signs, 17(37.8%) patients from group (I) presented with BPR and 8(32.0%) patients from group (II) which was the main complaint in both groups ( p value 0.004).
In current study patient with Dukes stage (B) had the highest rates of CRC patients 40.0%. While patient with Dukes stage A, C, D had lower rates 8.90%, 28.9%, 22.2% respectively.
In current study there was a high statistical significant difference between the groups regarding their CEA levels (p value =0.001).CRC had the highest values (mean =11.52±9.61 ng/ml).While benign and healthy groups had lower values 2.97±1.79 ng/ml, 3.72±6.58ng/ml respectively.With Cutoff point 2.90ng/ml.
In current study there was a high statistical significant difference between the groups regarding their mSEPT9 levels (p value =0.001). CRC case group had significantly higher positive rates of mSEPT9 (mean =1347.9±928.6 ng/l).while benign and healthy groups had lower rates 270.3±148.5 ng/ l, 73.1±37.4 ng/ l respectively. With Cutoff point 231ng/l.
In current study, mSEPT9 achieved overall [sensitivity of 84% and specificity of 78%, with an AUC value of 0.911], superior to CEA [sensitivity: 78%; specificity: 76%; AUC: 0.808].
The combination of mSEPT9 with CEA further improved sensitivity 100%, though the specificity declined 56%.