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Compelling evidence suggests that dietary intakes directly influence colorectal cancer (CRC) risk. Initial observations that CRC incidence is not ubiquitous worldwide, with incidence rates varying up to twenty-five fold between populations (Parkin et al., 2005), indicate the large degree to which this cancer type is influenced by diet and environment. Additionally, observations that migration of individuals confers rapid (within one generation) adoption of the CRC incidence of the host population (Boyle & Langman, 2000; McMichael & Giles, 1988), suggest that dietary and environmental factors determine the risk of colorectal neoplasia to a degree similar to, or in excess of, genetic predisposition. As diagnosis and treatment of CRC have improved, the study of the pathogenesis of colorectal neoplasia has increased. The most frequent precursor of CRC is the adenoma. As a proportion of adenomas, those of large size, with villous architecture and high grade dysplasia often progress to invasive adenocarcinoma, and this progression is associated with accumulation of mutations and other genetic and epigenetic changes. In the effort to understand the mechanisms and causes of colorectal cancer development, molecular genetic analyses have identified a variety of molecular changes and protein targets involved in colorectal tumourigenesis. The greater understanding of genetic, epigenetic and expression changes that occur during the development and progression of CRC has shown that these neoplasms do not comprise a single disease. Instead, colorectal cancers comprise a collection of distinct and independent neoplastic pathways, such as those pathways displaying chromosomal instability (CIN), microsatellite instability (MSI) or gene promoter activity changes due to the epigenetic phenomenon of methylation at CG dinucleotides (referred to as CIMP: CpG island methylation phenotype, whereby CpG describes dinoculeotides of cytosine and guanosine, separated by the characteristic phosphate group in the DNA structure). Each pathway subtype is characterised by individual genetic and molecular characteristics (Poulogiannis, 9

The Molecular Genetic Events in Colorectal Cancer and Diet