Path to a Cure

Process Indicator: Applying what we know from biology and hereditary risk to reduce late-stage colorectal cancer. 

Key Messages: 

• Technical developments in cell and molecular biology, biochemistry, genetics, imaging, statistics, and bioinformatics have propelled colorectal cancer research forward, with recent findings and developments opening up new opportunities to further reduce the toll of this disease. 

• It is now well-known that colorectal cancer emerges from mutations that accumulate within the genomes of normal cells that line the colon and rectum, eventually “hitting” critical genes that change their levels of expression and/or the structure of their encoded products. 

• A very large number of genes contributing to colorectal cancer development have been identified over the years and remain a major focus of current research efforts. In many cases, we understand the role of these genes and how they regulate colorectal cancer. Every tumor is genetically unique. 

• Genetic mutations (those that change the DNA sequence) and epigenetic mutations (those that do not change the DNA sequence) can lead to the development and progression of colorectal cancer. This can happen somatically, within the cells, or be inherited from family members. Lynch syndrome is the most common inherited condition. 

• In the U.S., the burden of early-age onset colorectal cancer falls disproportionately on minorities and individuals in specific geographic regions, mirroring colorectal cancer disparities observed in older adults. 

What We Are Doing 

Our Early Onset Disease Initiative encompasses multiple partnerships to collaboratively address why the colorectal cancer is increasing among those under 50 across the globe and to push for breakthrough treatment options. 

Process Indicator: Advancing colorectal cancer prevention and early detection. 

A number of factors have been shown to contribute to the risk of colorectal cancer. Factors that cannot be changed are older age, a personal or family history of colorectal cancer or colorectal polyps, a history of inflammatory bowel disease (IBD), inherited genes (e.g., Lynch syndrome), and racial/ethnic background. Factors that can be changed include lifestyle choices such as being overweight or obese, lack of physical activity, smoking, alcohol use, high dietary intake of red meats and sugars, and low intake of fruits and vegetables. 

Key Messages: 

• Symptoms of colorectal cancer include a change in bowel habits (diarrhea, constipation), chronic rectal bleeding, cramping/abdominal pain, weakness and fatigue, and unintended weight loss. 

• Screening is essential for early detection. Options for screening now include visual methods (colonoscopy, sigmoidoscopy, CT colonography) and stool-based (fecal occult blood test, fecal immunochemical tests, multi-targeted DNA test). 

• It is still widely acknowledged that our greatest opportunity to prevent late-stage colorectal cancer is through preventive screening. Colorectal cancer is one of the only truly preventable forms of cancer. 

• Colorectal cancer incidence and mortality rates also vary substantially by race and ethnicity. Among the five major racial/ethnic groups, rates are highest in non-Hispanic Blacks (hereinafter “Blacks”), followed closely by American Indians/ Alaskan Natives, and lowest in Asian Americans/Pacific Islanders. Fewer than one-half of individuals who receive care at federally qualified health centers are up-to-date for screening. 

Process Indicator: Expanding treatment strategies for colorectal cancer patients. 

Key Messages: 

• Approximately 85% of patients diagnosed with colorectal cancer have tumors that are microsatellite stable (MSS), which are predominantly treated with fluorouracil-based chemotherapy such as 5-FU, FOLFOX, FOLFIRI, or similar drugs. The most promising response rates vary a bit but range from approximately 38%-45%. 

• The remaining 15% of patients diagnosed with colorectal cancer have tumors that are Microsatellite Instable (MSI-H). One of the most notable treatments is Pembrolizumab (humanized monoclonal antibody against PD-1 receptor), which in 2017 was approved for all MSI-H cancers, based on results from five clinical trials for different cancers. It was the U.S. Food and Drug Administration’s (FDA’s) first tissue/site-agnostic approval. 

• Overall survival rates for late-stage colorectal cancer have not seen much improvement in the past decade, and stronger treatments and clinical trial improvement are imperative for progress. 

• A 2020 study noted a strong association between geographic residence and early-age onset colorectal cancer stage and survival, finding rural residences and those living long distances from the treating hospital were associated with later stage diagnoses and lower survival. 

Progress Indicator: Enhancing quality of life and preventing recurrence. 

Key Messages: 

• There are over 1.5 million colorectal cancer survivors in the United States. The five-year survival rate for people with colorectal cancer is 65%. 

• Considering caregivers is also part of survivorship. There is growing research and focus on the role and needs of caregivers. 

• There is an opportunity to provide guidance and consensus on colorectal cancer survivorship standards. Part of the equation is delivery of care for virtual, telehealth, or in-person visits. Let’s have focused discussions on how to support the unique issues faced by young patients, late-stage patients, and those with specific tumor types and/or receiving specific types of targeted therapies. 

• Our goal is for patients to live longer and enjoy their quality of life. To do this successfully, survivorship research efforts must elaborate and inform patients and their loved ones on the many issues relevant to long-term survival and risk of recurrence.   

• Late-stage survivors struggle with fear of cancer recurrence/ progression and feelings of powerlessness, sadness, or frustration from the life-changing effects of treatment and surgery. 

Currently, there are over 1.5 million colorectal cancer survivors in the United States. The five-year survival rate for people with colorectal  cancer is 65%. The term “survivorship” covers physical, psychological, social, and   financial issues affecting patients during and after treatment. Our community of colorectal cancer survivors includes people with no disease, people who continue to receive treatment to reduce their  risk, and those who manage a chronic but well-controlled disease  with quality of life. 

It is incredibly important to recognize thatn colorectal cancer impacts families and entire communities of people. 

While there are wellness and medical guidelines for colorectal cancer  patients after treatment is complete, gaps remain in who and how survivorship care is delivered. There is also variability from institution to institution about how survivorship care is delivered.