What’s New in Colorectal Cancer Research?

Research is always going on in the area of colorectal cancer. Scientists are looking for causes and ways to prevent colorectal cancer, better ways to find it early (when it's small and easier to treat), and ways to improve treatments. Here are some examples of current research. Treatment in a clinical trial is often the only way to get these treatments.

Reducing colorectal cancer risk

Many studies are looking to identify the causes of colorectal cancer. The hope is that this might lead to new ways to help prevent it.

Other studies are looking to see if certain types of diets, dietary supplements, or medicines can lower a person’s risk of colorectal cancer. For example, many studies have shown that aspirin and pain relievers like it might help lower the risk of colorectal cancer, but these drugs can have serious side effects. Researchers are now trying to figure out if the benefits might outweigh the risks for certain groups of people thought to be at high colorectal cancer risk.

Early detection

Doctors are looking for better ways to find colorectal cancer early by studying new types of screening tests (like blood tests) and improving the ones already being used. Researchers are also trying to figure out if there's any test or screening plan that clearly works best.

They're also looking for ways to educate and encourage people to get the routine screening tests that are available today and known to help reduce the number of deaths from this cancer.

Diagnosis

Researchers are trying to define colorectal cancer sub-types. This means grouping colorectal cancers based on things like the genetic mutations in the cancer cells, how the cells look and behave, how fast the cells are dividing, and features of the tumor itself. As has been found with other cancer types, this might lead to better understanding of disease progression and outcomes, as well as more clearly defined treatment plans (precision medicine).

Lab tests to help plan treatment

Lab tests have been developed to help predict which patients have a higher risk of colorectal cancer recurrence (the cancer coming back after treatment). These tests look at different genes inside the person's colorectal cancer cells. These tests are being studied to see if they might help decide which treatment plan is best for each person. They might also be helpful in deciding if more treatment is needed after surgery.

As doctors continue to learn more about the genetic changes in colorectal cancer cells, they're also looking for better ways to predict outcomes and adjust treatment plans for each patient. Early studies have already shown that certain cancer cell changes can affect the response to certain chemo drugs, but more research is needed. Identifying changes that are only found in the cancer cells could also lead to better screening tests that look for these specific changes.

Treatment

Researchers are always looking for better ways to treat colorectal cancer.

Surgery

Surgeons continue to improve the operations used for colorectal cancers. Research looking at the benefits of laparoscopic and robotic surgeries compared to open surgeries (where bigger cuts are made in the skin) is common. Rectal cancer surgery done through the anus, without cutting the skin, is also being studied.

Organ preservation -- keeping your body working the way it normally does -- is another research goal. For instance:

  • Doctors are looking at the ideal timing of surgery after chemo is used to shrink a rectal tumor and how to know when they've got the best response in each patient.
  • Studies are also looking for better ways to reattach the ends of the colon after the length with the tumor has been removed.
  • Surgery that saves the anal sphincter muscle that controls the passing of stool is a rectal cancer research interest.

Sometimes when colorectal cancer recurs (comes back), it spreads to the peritoneum (the thin lining of the abdominal cavity and organs inside the abdomen). These cancers are often hard to treat. Surgeons have been studying a procedure called hyperthermic intraperitoneal chemotherapy (HIPEC). First, surgery is done to remove as much of the cancer in the belly as possible. Then, while still in the operating room, the abdominal cavity is bathed in heated chemotherapy drugs. This puts the chemo right into contact with the cancer cells, and the heat is thought to help the drugs work better. Some patients are living longer with this type of treatment, but more studies are needed to know which patients it can help. Doctors and nurses with special training and specialized equipment are needed, so it's not widely available. 

Chemotherapy

Chemotherapy is an important part of treatment for many people with colorectal cancer, and doctors are constantly trying to make it more effective and safer. Different approaches are being tested in clinical trials, including:

  • Testing new chemo drugs or drugs that are already used against other cancers.
  • Looking for new ways to combine drugs already known to work against colorectal cancer to see if they work better together.
  • Studying the best ways to combine chemotherapy with radiation therapy, targeted therapies, and/or immunotherapy.

Better ways to identify, prevent, and treat chemo side effects are other areas of research interest.

Targeted therapy

Targeted therapy drugs work differently from standard chemotherapy drugs. They affect specific parts of cancer cells that make them different from normal cells. Several targeted therapy drugs are already used to treat advanced colorectal cancer. Researchers are studying the best way to give these drugs and looking for new targeted therapy drugs. Studies are also looking at colorectal cancer cells to try to find specific gene changes (mutations) that might be targeted as part of treatment.

Studies are being done to see if using targeted therapy along with chemotherapy in earlier-stage cancers can help reduce the risk of recurrence.

Immunotherapy

An exciting area of research is the field of immunotherapy. This is treatment that uses the body’s own immune system to fight cancer.

Immune checkpoint inhibitors: An important part of the immune system is its ability to tell between normal cells in the body and those it sees as “foreign.” This lets the immune system attack the foreign cells while leaving the normal cells alone. To do this, it uses “checkpoint” proteins on certain immune cells. These proteins act like switches, needing to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to keep from being attacked by the immune system. 

Newer drugs that target checkpoint proteins hold a lot of promise as cancer treatments. Colorectal cancer cells that have specific gene changes, such as high levels of microsatellite instability (MSI-H), or changes in one of the mismatch repair (MMR) genes, tend to have a lot of other changes that make them different from normal colorectal cells. This might make them more visible to the immune system. Studies are looking at whether cancers with these changes are being helped by treatment with new drugs that focus on these cell changes.

Cancer vaccines: Researchers are studying several vaccines to try to treat colorectal cancer or keep it from coming back after treatment. Unlike vaccines that prevent infectious diseases, these vaccines are meant to boost the person’s immune system to better find and fight colorectal cancer cells.

Many types of vaccines are being studied. For example, some vaccines are created by removing some of the person’s own immune system cells (called dendritic cells) from the tumor, treating them with a substance that will help them find and attack cancer cells, and then putting them back into the person’s body.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: February 21, 2018 Last Revised: February 21, 2018

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