Research is always under way in the area of colorectal cancer. Scientists are looking for causes and ways to prevent colorectal cancer as well as ways to improve treatments.

Genetics

Scientists are learning more about some of the inherited and acquired changes in DNA that cause cells of the colon and rectum to become cancerous. Recent discoveries of inherited genes that increase a person's risk of developing colorectal cancer are already being used in genetic tests to inform people most at risk.

Advances in understanding how these genes work are expected to eventually lead to new drugs and gene therapies to correct these gene problems. Early phases of gene therapy trials are already in progress.

Chemoprevention

Chemoprevention is the use of natural or man-made chemicals to lower a person's risk of developing cancer. Researchers are testing whether certain supplements, minerals (such as calcium), and vitamins (such as folic acid or vitamin D) can lower colorectal cancer risk.

Some studies have found that people who take multi-vitamins containing folic acid (also known as folate), vitamin D supplements, or calcium (through either diet or supplements) may have a lower colorectal cancer risk than people who do not. Research to clarify the possible benefits of these and other substances, such as selenium and curcumin, is now under way.

Although taking aspirin or some other non-steroidal anti-inflammatory drugs (NSAIDs) is associated with a lower risk of colorectal cancer, these drugs can cause stomach ulcers and other side effects. For this reason, taking NSAIDs specifically for this purpose is not recommended for people at average colorectal cancer risk.

NSAIDs, such as sulindac and celecoxib (Celebrex), have been shown to reduce formation of adenomatous polyps in people with familial adenomatous polyposis (FAP). The FDA has approved celecoxib for reducing polyp formation in people with FAP. However, celecoxib may have side effects such as a potential increased heart risk. You should consult your doctor before beginning regular use of aspirin or another NSAID.

Most studies have found that a diet high in fruits and vegetables may lower colorectal cancer risk, as well as the risk of several other diseases. This hasn't been completely proven by all studies. But it is important that you eat enough servings -- at least 5 a day!

The benefits of dietary supplements are less clear. At this time, most experts recommend that people not take large doses of vitamins, minerals, or other agents unless they are part of a study or are under the advice and care of a doctor.

Earlier detection

Colorectal cancer is much easier to treat effectively if it is found at a very early stage. Studies continue to look at the effectiveness of current colorectal cancer screening methods and assess new ways to tell the public about the importance of being screened. Only about half of Americans age 50 or older have had any colorectal cancer screening at all. If everyone were tested as recommended, tens of thousands of lives could be saved each year. The American Cancer Society and other public health organizations are working to increase awareness of colorectal cancer screening among the general public and health care professionals.

Meanwhile, new imaging and lab tests are also being developed and tested. Newer, more accurate ways to look for changes in the stool that might indicate colorectal cancer have been developed. These include tests that are better able to detect blood in the stool (fecal immunochemical tests) and test that can detect changes in the DNA of cells in the stool. CT colonography (also known as virtual colonoscopy) is a special type of CT scan that can find colorectal polyps and cancers at least as accurately as a barium enema.

These tests are described in more detail in the section, "Can colorectal polyps and cancer be found early?"

Treatment

Newer surgery techniques

Surgeons are continuing to improve their techniques for operating on colorectal cancers. They now have a better understanding of what makes colorectal surgery more likely to be successful, such as making sure enough lymph nodes are removed during the operation.

Laparoscopic surgery, which is done through several small incisions in the abdomen as opposed to one large one, is becoming more widely used for some colon cancers. This approach usually allows patients to recover faster, with less pain after the operation.

Laparoscopic surgery is also being studied for treating some rectal cancers, although more research is needed to see if it as effective as standard surgery. Robotic surgery, in which the surgeon sits at a control panel and operates very precise robotic arms to perform the surgery, is also being studied.

Chemotherapy

Many clinical trials are testing new chemotherapy drugs or drugs that are now used against other cancers (such as cisplatin or gemcitabine). Other studies are looking at ways to combine drugs already known to be active against colorectal cancer, such as irinotecan and oxaliplatin, to improve their effectiveness. Still other studies are testing the best ways to combine chemotherapy with radiation therapy, targeted therapies, and/or immunotherapy.

Targeted therapies

Several targeted therapies are already used to treat colorectal cancer, including bevacizumab (Avastin), cetuximab (Erbitux), and panitumumab (Vectibix). Doctors continue to study the best way to give these drugs to make them more effective.

Although targeted therapies are currently used to treat advanced cancers, newer studies are looking at using them with chemotherapy in earlier stage cancers as part of adjuvant therapy to reduce the risk of recurrence.

Researchers are also studying dozens of new targeted therapies to increase the options for people with colorectal cancer. Some of these are monoclonal antibodies like those in current use, while others are more like conventional drugs that are given in pill form.

Immunotherapy

Researchers are studying several vaccines to try to treat colorectal cancer or prevent it from coming back after treatment. Unlike vaccines that prevent infectious diseases, these vaccines are meant to boost the patient's immune reaction to fight colorectal cancer more effectively.

Many types of vaccines are being studied. For example, some vaccines involve removing some of the patient's own immune system cells (called dendritic cells) from the blood, exposing them in the lab to a substance that will make them attack cancer cells, and then putting them back into the patient's body. At this time, these types of vaccines are only available in clinical trials.

Last Medical Review: 05/18/2009
Last Revised: 05/18/2009