A paper on colorectal cancer published June 20 in The Lancet gives an overview on treatment advances, clinical trials, incidence trends, and ongoing challenges.
The overview provides an international perspective on colorectal cancer, which is the third most diagnosed cancer in the world. It notes that although incidence rates are rising in emerging-economy nations, many have yet to establish screening guidelines. While incidence and survival rates have improved in high-income economies for older patients, people younger than 50 are increasingly being diagnosed with colon cancer and rectal cancer for unknown reasons.
The paper also provides a multidisciplinary perspective on treatment advances and clinical trials. Ongoing developments are focused on sphincter preservation for rectal cancer, precision oncology for molecular alterations, use of circulating tumor DNA as well as analysis of the gut microbiome for diagnostic purposes, and new treatment strategies when colorectal cancer has spread to the liver. The research related to rectal cancer is particularly robust with seven clinical trials underway aimed at preserving the sphincter, four analyzing neoadjuvant approaches, and one testing a protocol omitting radiation treatment.
Cathy Eng, MD, co-leader of the Gastrointestinal Cancer Research Program and co-director of Gastrointestinal Oncology at Vanderbilt-Ingram Cancer Center, is the paper’s corresponding author.
“We hope this multidisciplinary, international overview of colorectal cancer will provide insight on the importance of education, screening and awareness to all health care providers given the reach of The Lancet. Currently, we may not know the causality of early-onset colorectal cancer but with continued education, we hope to have more patients diagnosed at an earlier stage. In addition, treatment for colorectal cancer continues to evolve, so we have done our best to provide a general overview with numerous up-to-date references for the reader to peruse. We want our readers to be able to walk away with a few take-home points and apply them to their clinical practices,” said Eng, the David H. Johnson Professor of Surgical and Medical Oncology, who also directs the Young Adult Cancers Program at Vanderbilt-Ingram.
Regions of the world without screening guidelines in place include the Middle East, North Africa, sub-Saharan Africa and Mexico, but some of these regions have low incidence rates. The nations with the highest incidence rates are the United States, China, Japan, Russia, India, Germany, Brazil, the United Kingdom, Italy and France.
“Colorectal cancer remains a common malignancy globally,” the paper stated in concluding remarks. “Prevention through screening techniques is crucial to reducing its incidence, especially in developing countries, where the highest incidence rates are expected to occur. Colorectal cancer screening reduces associated morbidity and would decrease mortality if a sufficient fraction of individuals were screened appropriately.”
Advanced lines of treatment utilizing precision oncology are now available for metastatic colorectal cancer, and more are in development. Other studies are underway to determine the value of circulating tumor DNA and the gut microbiome to monitor colorectal cancer development. Artificial intelligence (AI) is a tool that researchers are increasingly using to speed up the pace of discovery, but the paper noted that caution is warranted with AI because data consistency and interpretation continues to be refined.
