[Genetic diagnosis for cancer--tumorigenesis and genetic alterations]

During malignant transformation, cancer cells acquire multiple genetic alterations that override the normal mechanisms controlling cellular proliferation. In brief, cancer is a disease of genetic abnormalities caused by hereditary and/or environmental factors. Genetic diagnosis for cancer can be divided into four categories: 1) pre-symptomatic diagnosis, 2) existence diagnosis, 3) property diagnosis-prognosis diagnosis and 4) genetic test for gene therapy. 1) For hereditary cancer families, pre-symptomatic diagnosis is available. Individuals with multiple cancers can be diagnosed by microsatellite instability(MSI) test using resected cancer tissues and by genotyping of mismatch repair enzymes. If the genotype abnormality is detected, the propositus can obtain early diagnosis and prevention of cancer, and genetic services of their siblings. 2) Using PCR technology, occult tumor cells can be detected from blood and other biological body fluids, as targets of chimeric transcripts and tissue-specific expressions. 3) Molecular properties of cancer cells are investigated for grading malignancy and therapeutic sensitivities. Using the molecular properties, prognosis of the patient can be estimated. 4) Following the genetic test results, the specific and superior gene therapy can be applied individually. Post-therapeutic monitoring is also available only by genetic test. After the genome project, the significance of single nucleotide polymorphisms(SNPs) related with cancer will be established, then tailor-made therapy and/or prevention will be applicable to individuals. The ultimate goal of genetic diagnosis would be the final priority to the phenotypic diagnosis.