# Colorectal cancer

Source: https://onco.cc/cancers/colorectal/  
OnCo record `colorectal` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The cancer where screening works best and where immunotherapy can make some tumours disappear entirely; chemotherapy still carries most metastatic disease, now with antibodies and targeted combinations chosen by RAS, BRAF, mismatch repair and which side of the bowel the tumour started on.

## Summary

Colorectal cancer is the disease where screening works best: removing adenomas at colonoscopy prevents cancer, stool and blood tests catch it early, and localised disease is cured by surgery. It is the third most common cancer worldwide (about 1.9 million cases a year) and, because many are still found late, the second most common cause of cancer death (900,000 a year). Most cases arise through the adenoma-carcinoma sequence driven by APC loss, KRAS mutation, and TP53 loss (chromosomal instability); about 15% arise through mismatch-repair deficiency (dMMR/MSI-high), either sporadically via MLH1 methylation or through Lynch syndrome. Incidence is rising sharply in adults under 50 for reasons that remain unexplained.

How common it is, world and United States. The IARC fact sheets, served with the GLOBOCAN 2024 estimates, count the colon and the rectum separately: 1,206,011 new colon cancers a year (the 4th commonest cancer, age-standardised rate 10.8 per 100,000) with 556,774 deaths (the 5th commonest cause of cancer death, 4.7 per 100,000), and 778,594 rectal cancers (8th, 7.3 per 100,000) with 339,370 deaths (9th, 3.0 per 100,000). Added together that is 1,984,605 new cases and 896,144 deaths a year, which is where the familiar round figures of about 1.9 million cases and about 900,000 deaths come from. Asia has 49.3 percent of colon cases, Europe 27.2 percent, Northern America 10.6 percent, Latin America and the Caribbean 8.3 percent, Africa 3.4 percent and Oceania 1.3 percent. In the United States the SEER programme projects 158,850 new cases (7.5 percent of all cancers) and 55,230 deaths (8.8 percent of cancer deaths) for 2026, making colorectal cancer the 4th commonest cancer diagnosed and the 2nd commonest cause of cancer death; the rate of new cases is 37.6 per 100,000 a year (2019 to 2023) and the death rate 12.7 (2020 to 2024); the median age at diagnosis is 66 and at death 72; about 3.9 percent of Americans will be diagnosed in their lifetime; and 1,478,528 people were living with the disease in 2023. Rates differ by group: 59.5 per 100,000 in non-Hispanic American Indian and Alaska Native men and 50.1 in non-Hispanic Black men against 42.9 in non-Hispanic White men (SEER).

How common it is in the UK. Cancer Research UK counts 48,213 new bowel cancers a year (2019, 2021 to 2022), more than 130 a day, which makes it the 4th commonest cancer and 12 percent of all new cancers: about 26,800 in men and about 21,400 in women. It is the 2nd commonest cause of cancer death, with about 17,700 deaths a year (2022 to 2024), 48 a day. More than two-fifths (43 percent) of new cases are in people aged 75 and over, rates are highest at 85 to 89, and 59 percent of deaths are in the over-75s. The lifetime risk of a diagnosis is 1 in 20 for women and 1 in 17 for men born in 1961. The trends run in opposite directions: incidence rates are up about 6 percent since the early 1990s but down 3 percent in the last decade, and are projected to fall a further 7 percent by 2038 to 2040 (to about 47,700 cases a year), while mortality rates have almost halved (down 46 percent) since the early 1970s and fell 6 percent in the last decade. The rectum is the commonest single site (2016 to 2018). Deprivation shows through: mortality rates for lower gastrointestinal cancer are 22 percent higher in the most deprived fifth than the least for women and 27 percent higher for men, about 1,700 deaths a year in the UK.

The rise in early-onset disease. Colorectal cancer is becoming a young person's disease at the same time as it retreats in the old. The American Cancer Society's 2026 report finds overall incidence falling 0.9 percent a year over 2013 to 2022, driven by a 2.5 percent annual fall in people aged 65 and over, while incidence rose 3 percent a year in adults aged 20 to 49 and 0.4 percent a year at 50 to 64, dominated by tumours of the distal colon and rectum; rectal cancer incidence overall turned upwards by 1 percent a year from 2018 to 2022 after decades of decline and now accounts for 32 percent of colorectal cancers, up from 27 percent in the mid-2000s. Mortality under 50 has risen 1 percent a year since 2004 and at 50 to 64 by 1 percent a year since 2019, while it fell 2.3 percent a year in the over-65s from 2012. The earlier 2023 report put the same shift another way: the share of cases in people under 55 went from 11 percent in 1995 to 20 percent in 2019, and 60 percent of new cases were advanced in 2019 against 52 percent in the mid-2000s. The pattern is not American. A study of registry data from 36 countries found incidence in adults under 50 rising in 19 of them and, in nine spanning three continents (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, the UK and the USA), rising in the young while stable or falling in older adults; the uptick began in the mid-1990s in most high-income countries, and the steepest rises were in Korea and New Zealand (Siegel 2019). No cause has been established. Diet, obesity, type 2 diabetes, inactivity, alcohol, smoking and the microbiome are the candidates, and the generational pattern points at an exposure acting early in life.

What raises the risk, at population level. These are the factors that shape how many bowel cancers occur in a country, not an account of why any one person got theirs. Age comes first, and then a list that is unusually modifiable: Cancer Research UK judges 54 percent of UK bowel cancers preventable. Processed meat causes 13 percent of UK cases (risk 18 percent higher per 50 g a day; colon cancer risk 22 percent higher per 100 g a day of red meat, with no association for rectal cancer); too little fibre causes 28 percent (risk 10 percent lower per 10 g a day of total or cereal fibre, 20 percent lower per 90 g a day of whole grains); overweight and obesity cause 11 percent (colon cancer risk 30 percent higher in men and 12 percent higher in women per 5 units of body mass index, 25 percent higher per 10 cm of waist, and adenoma risk 47 percent higher in obesity); alcohol causes 6 percent (risk 7 percent higher per unit a day, 33 percent higher above 6 units a day); smoking causes 7 percent (17 to 21 percent higher risk in current smokers, adenomatous polyp risk about doubled, serrated polyp risk more than doubled); too little physical activity causes 5 percent (colon cancer risk 19 percent lower in the most active); and ionising radiation 2 percent. Medical conditions matter too: type 2 diabetes raises risk 22 to 30 percent, and inflammatory bowel disease (ulcerative or Crohn's colitis) raises it 70 percent, with a 5 percent risk of bowel cancer after 20 years of disease. Family history more than doubles risk with one affected first-degree relative. Inherited syndromes account for a minority but a decisive one: mismatch repair variants (Lynch syndrome) are carried by about 1 in 279 people and cause 1 to 4 percent of colon cancers, familial adenomatous polyposis fewer than 1 percent, and about 1 in 45 people carry a MUTYH variant (Win 2017; Cancer Research UK). Aspirin runs the other way: ever-use is associated with 17 percent lower risk, and longer use with lower risk still.

How it shows itself, and when to refer. The NHS lists the symptoms as changes in poo (looser, harder or going more or less often than usual), blood in the poo or bleeding from the bottom, a persistent feeling of needing to poo, tummy pain, a lump in the tummy, bloating, unexplained weight loss, and tiredness or breathlessness from anaemia; it advises seeing a GP for any of them, an urgent appointment or NHS 111 for black or dark red poo or bloody diarrhoea, and 999 or A&E for non-stop bleeding or large clots. None of these symptoms is specific, which is why England now puts a test between the symptom and the referral. NICE NG12 (1.3.1, adapted from the HealthTech guidance on quantitative faecal immunochemical testing in primary care) tells GPs to offer a quantitative faecal immunochemical test to adults with an abdominal mass, a change in bowel habit or iron-deficiency anaemia; aged 40 and over with unexplained weight loss and abdominal pain; under 50 with rectal bleeding plus abdominal pain or weight loss; 50 and over with unexplained rectal bleeding, abdominal pain or weight loss; and 60 and over with anaemia even without iron deficiency. A result of at least 10 micrograms of haemoglobin per gram of faeces triggers a suspected cancer pathway referral (1.3.2); below that, safety netting applies and strong clinical concern still overrides the test (1.3.3). A rectal mass goes straight to referral, and people with a rectal mass, an unexplained anal mass or anal ulceration do not need the test first. A previous negative screening result does not exempt a symptomatic person. In England in 2019, 38 percent of bowel cancers were diagnosed through an urgent suspected cancer referral, 22 percent after an emergency presentation and 12 percent through screening; 47 percent of staged cases in 2022 were stage I or II (Cancer Research UK).

Screening: what is offered and what it is worth. England invites everyone aged 50 to 74 every two years for a faecal immunochemical test done at home, with a colonoscopy for an abnormal result; the kit replaced the older guaiac test in June 2019, results come about two weeks after the laboratory receives the sample, and people aged 75 and over can request a kit every two years on the programme helpline (NHS; GOV.UK). The threshold that decides who is called for colonoscopy is a rationing decision as much as a clinical one: the English programme uses 120 micrograms of haemoglobin per gram of faeces, a figure no programme publication states but which the modelling of the English pilot calls the current threshold (Br J Cancer 2022; the same paper's estimates of what it buys are in the glossary). The symptomatic threshold in primary care is twelve times lower, at 10 micrograms per gram. The United States starts earlier: the US Preventive Services Task Force recommends screening from 50 to 75 (grade A) and from 45 to 49 (grade B), with selective screening from 76 to 85, by colonoscopy, faecal testing, stool DNA or computed tomography colonography. The evidence that screening saves lives is randomised. Annual faecal occult blood testing cut 13-year colorectal cancer mortality by 33 percent in 46,551 people in Minnesota (Mandel 1993). A single flexible sigmoidoscopy offered once to people aged 55 to 64 cut incidence by 26 percent and mortality by 30 percent over 17 years, and by 35 and 41 percent in those who actually attended (Atkin 2017). NordICC, the first randomised trial of screening colonoscopy, found a 10-year risk of colorectal cancer of 0.98 percent in the invited group against 1.20 percent in usual care, an 18 percent reduction, with 455 people needing to be invited to prevent one cancer; only 42 percent of those invited attended, and a later instrumental-variable analysis of the same trial estimated a 35 to 41 percent reduction in incidence among those screened (Bretthauer 2022).

How it is diagnosed and staged. Colonoscopy with biopsy is the test that makes the diagnosis and removes the precursor at the same visit; computed tomography colonography is the alternative when colonoscopy is not possible. Staging is by computed tomography of the chest, abdomen and pelvis, with magnetic resonance imaging of the pelvis for every rectal cancer. The eighth edition of the TNM system is the language: Tis is carcinoma in situ in the mucosa; T1 is into the inner layer, T2 into the muscle, T3 through the muscle into the surrounding tissue, T4a through the outer lining into the peritoneum and T4b into a nearby organ; N1a, N1b and N1c mean one node, two or three nodes, or tumour deposits without node involvement, and N2a and N2b mean four to six or seven or more nodes; M1a, M1b and M1c mean one distant site, two or more, or any spread to the peritoneum (Cancer Research UK). Rectal cancer adds two questions computed tomography cannot answer: how close the tumour comes to the plane the surgeon will cut along (the mesorectal fascia, which becomes the circumferential resection margin in the specimen), and whether tumour has spread into the veins outside the bowel wall. High-resolution magnetic resonance imaging answers the first with 92 percent specificity for predicting a clear margin, and in the 349 patients it predicted clear, 327 were clear at surgery (MERCURY, 408 patients, BMJ 2006). Every metastatic tumour is tested for RAS and BRAF V600E mutations before systemic therapy (NICE NG151 1.4.1), mismatch repair status is tested at diagnosis, and where the tumour started, the right colon or the left colon and rectum, predicts both biology and the benefit of EGFR antibodies. In the United States 34 percent of cases are found localised, 37 percent regional, 23 percent distant and 6 percent unstaged (SEER).

Pathology, the two pathways, and prevention. Almost all bowel cancers are adenocarcinomas of the gland cells that line the bowel; mucinous and signet ring cell tumours are rarer forms of adenocarcinoma, and squamous, neuroendocrine, sarcomatous, lymphoid and melanocytic tumours of the bowel are separate diseases with their own records (Cancer Research UK). Grade runs 1 to 4, from cells that look almost normal to cells that look nothing like them. The cancers arise along two routes. The conventional adenoma-carcinoma sequence, mapped in 172 specimens in 1988 and formalised as a model in 1990, runs from normal mucosa through adenoma to carcinoma as mutations accumulate: loss of the chromosome 5 region that carries the polyposis gene, RAS mutation (found in 58 percent of adenomas over 1 cm but only 9 percent of smaller ones), loss of chromosome 18 (73 percent of carcinomas) and loss of chromosome 17p (75 percent of carcinomas) (Vogelstein 1988; Fearon and Vogelstein 1990). The serrated pathway accounts for about 30 percent of colorectal carcinomas and runs instead through hyperplastic polyps, sessile serrated lesions and traditional serrated adenomas, with methylation of promoter islands and BRAF or KRAS mutation, and it produces most of the sporadic mismatch repair-deficient cancers (Bettington 2013). Prevention follows from the first route: in the National Polyp Study, removing adenomas at colonoscopy left 1,418 patients with 76 to 90 percent fewer cancers than expected, and at a median of 15.8 years mortality from colorectal cancer among 2,602 patients whose adenomas were removed was 53 percent lower than the general population would predict (Winawer 1993; Zauber 2012). Aspirin is the drug: in the CAPP2 trial, 600 mg of aspirin daily for at least two years cut colorectal cancer in Lynch syndrome carriers over ten years (hazard ratio 0.65 in the intention-to-treat analysis, 0.56 in those who completed two years), and NICE NG151 (1.1.1) now says to consider daily aspirin for more than two years in Lynch syndrome (Burn 2020).

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: COAD; COADREAD; TCGA-COAD; TCGA-COADREAD; colorectal adenocarcinoma (TCGA COAD and READ cohorts); Rectal Cancer; Bowel cancer; Colorectal adenocarcinoma; Cancer of the colon and rectum; Large bowel cancer; CRC
- Tags: gi; spike
- Group: gastrointestinal
- Burden: 1,206,011 new colon cancers and 556,774 deaths, plus 778,594 rectal cancers and 339,370 deaths, a year worldwide (GLOBOCAN 2024; about 1.98 million cases and 896,000 deaths added together). 48,213 UK cases and about 17,700 UK deaths a year, the 4th commonest cancer and the 2nd commonest cause of cancer death (Cancer Research UK); 158,850 US cases and 55,230 deaths projected for 2026 (SEER). Incidence is falling in the over-65s and rising 3 percent a year in adults aged 20 to 49 (American Cancer Society, 2026).
- Subtypes: Chromosomal instability / APC-KRAS-TP53 pathway (~80%); Mismatch-repair deficient / MSI-high (about 15% localised, about 5% metastatic); Lynch syndrome (hereditary dMMR, ~3%); BRAF V600E (8 to 10%, right-sided, aggressive; now has a first-line targeted triplet), plus non-V600 BRAF in 2 to 4%; KRAS-mutant (40 to 44%, with NRAS in a further 4 to 9%; G12D about 12%, G12V about 8%, G13D about 8%, G12C about 3%); HER2-amplified (2 to 3% of all tumours, 5 to 8% of RAS and BRAF wild-type ones, left-sided); Left-sided vs right-sided (embryologic origin drives biology); Consensus molecular subtypes CMS1-4; Early-onset (<50 years); Rectal vs colon (different local therapy); Micropapillary adenocarcinoma of the colon and rectum (small tumour nests with reversed polarity; heavy lymphatic and vascular invasion); Adenoma-like adenocarcinoma of the colon and rectum (invasive cancer that looks like an adenoma on biopsy; better outlook); Lynch syndrome-associated colorectal cancer (inherited mismatch repair variant; about 1 to 4 percent of colon cancers); Familial adenomatous polyposis-associated colorectal cancer (inherited APC variant; fewer than 1 percent of bowel cancers)
- Biomarkers: RAS (KRAS and NRAS exons 2-4) for anti-EGFR eligibility; BRAF V600E; MMR/MSI status (universal testing at diagnosis); HER2 amplification (IHC/ISH or NGS); Primary tumour sidedness; NTRK fusions (rare); POLE/POLD1 (ultramutated, IO-responsive); ctDNA MRD after surgery (Signatera, Guardant Reveal); CEA (monitoring); UGT1A1*28 (irinotecan dosing) and DPYD (fluoropyrimidine toxicity); Germline testing for Lynch when dMMR or young onset; APC inactivating mutation (wnt pathway gatekeeper): 58-77%; TP53 mutation (with 17p loss): 52-73%; KRAS activating mutation (any allele): 40-44%; KRAS G12D g12d allele (share of kras mutation records): 27-29%; KRAS G12V g12v allele (share of kras mutation records): 16-22%; KRAS G13D g13d allele (share of kras mutation records): 16-24%; KRAS G12C g12c allele (share of kras mutation records): 6-9%; KRAS outside exon 2 codon 59, 61, 117 or 146 mutation (share of kras missense records): 16-18%; NRAS activating mutation (codon 12, 13, 59, 61 or 117): 4-9%; BRAF V600E v600e mutation: 6-18%; BRAF non-V600 class ii and class iii mutations (d594, g466, g469, k601, n581) and fusions: 2-4%; PIK3CA hotspot mutation (e542k, e545k, h1047r): 20-28%; SMAD4 mutation or deep deletion (18q loss): 12-16%; FBXW7 inactivating mutation: 13-17%; ERBB2 (HER2) high-level amplification: 2-3%; ERBB2 mutation activating mutation (not amplification): 4-6%; MSI-high / dMMR microsatellite instability or mismatch repair deficiency: 5-15%; POLE exonuclease (proofreading) domain hotspot mutation, ultramutated tumours: 0.7-2%; POLD1 exonuclease domain hotspot mutation; germline p.ser478asn: 0.03%; Tumour mutational burden 10 or more mutations per megabase (panel): 15-19%; Chromosomal instability (CIN) aneuploidy with 18q, 17p and 8p loss and 8q, 13q and 20q gain: 84%; RNF43 inactivating mutation (g659fs hotspot): 5-12%; RSPO2 / RSPO3 gene fusion (ptprk-rspo3, eif3e-rspo2): 0.4-10%; CTNNB1 activating mutation or large in-frame deletion: 5-7%; AMER1 (FAM123B) inactivating mutation: 6-13%; SOX9 inactivating mutation: 10-12%; ARID1A inactivating mutation: 9-13%; TGFBR2 frameshift of the polyadenine coding microsatellite: 3-10%; B2M inactivating mutation or deletion (antigen presentation): 3-7%; TCF7L2 mutation or vti1a-tcf7l2 fusion: 7-15%; MYC high-level amplification (8q24): 4-5%; IGF2 high-level amplification with overexpression: 2%; EGFR high-level amplification (and acquired ectodomain mutation): 1-2%; NTRK1 / NTRK3 gene fusion (lmna-ntrk1, etv6-ntrk3): 0.2-0.3%; RET gene fusion (ncoa4-ret, ccdc6-ret): 0.1%; ALK gene fusion: 0.1%; PTEN inactivating mutation or deep deletion: 6-8%; BCL9L, RBM10, CTCF, KLF5 recurrently mutated genes found only in the large prospective exome cohort: 7%; Faecal haemoglobin by quantitative faecal immunochemical test: 10 micrograms per gram of faeces refers a symptomatic patient in England, 120 micrograms per gram calls a screened person for colonoscopy; Circumferential resection margin on rectal magnetic resonance imaging before surgery and on the specimen after it (1 mm rule); Extramural venous invasion on rectal magnetic resonance imaging

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/colorectal/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/colorectal/#overview [15 subtypes, 13 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/colorectal/#what-it-is [29 subtypes, 5 staging notes, 6 sites of spread]
- Symptoms and diagnosis (own page): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/colorectal/finding-it/ [7 symptoms, 52 biomarkers, 46 prevalence rows]
- Treatment (own page): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/colorectal/treating-it/ [39 settings, 7 regimens, 29 decisions with options]
- Trials and papers (own page): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/colorectal/evidence/ [301 trials, 668 trials in the subtypes, 135 key papers, 57 milestones]
- Biology and targets (own page): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/colorectal/science/ [301 targets, 27 pathways, 12 preclinical models]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/colorectal/where-you-are/ [108 centres, 34 centres in the subtypes, 29 UK centres]
- Decisions and support (own page): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/colorectal/living-with-it/ [81 questions, 6 red cards, 1 decision aid]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/colorectal/coming/ [109 medicines, 4 medicines in the subtypes, 301 trials, 89 ideas, 18 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/colorectal/data/ [1644 connected records, 24 notes]

## Standard of care

- The operation and what a stoma means: temporary or permanent: Removing the cancer with a rim of healthy bowel, and joining the two ends back together, is what cures most bowel cancer. The operation depends on where the tumour sits. Macmillan names the colon operations as a right or left hemi-colectomy, a sigmoid colectomy (also called a high anterior resection), a transverse colectomy or a total colectomy, and the rectal ones as a local excision for a very small stage 1 cancer, an anterior resection or low anterior resection for the upper or middle rectum, usually with a total mesorectal excision, and it says that if the cancer is very low in the rectum and close to the anus you are more likely to need a permanent stoma. NICE NG151 recommends laparoscopic (keyhole) resection as an alternative to open resection for both colon and rectal cancer when both are suitable, says to consider open surgery for locally advanced tumours or after previous abdominal or pelvic surgery, and to use robotic surgery only within established programmes with audited outcomes. It sets volume floors for rectal surgery: at least 10 major resections a year per hospital and at least 5 per surgeon. On the stoma, NICE asks teams to advise people of the likelihood of having one, why it might be necessary and for how long it might be needed, and to have a trained stoma professional provide information on care and on learning to live with it. Bowel Cancer UK puts it plainly: a reversible stoma is formed to let the join heal and a permanent one when the two ends cannot be joined, and the surgeon may not know for certain until the operation has started. A colostomy is formed from the large bowel and the output is more solid; an ileostomy is formed from the small bowel, the output is looser and more fluid and salt are lost. The NHS says recovery from a colostomy usually takes about 8 weeks, with no heavy lifting in that time, and that permanent colostomy supplies come free on prescription. Prehabilitation before the operation and an enhanced recovery programme after it are both worth asking about: NICE says to explain what recovery protocols involve and their value, and Bowel Cancer UK says prehabilitation reduces anxiety, improves fitness and can shorten the stay. ([Colectomy](https://onco.cc/terms/colectomy/), [Total mesorectal excision (TME)](https://onco.cc/terms/total-mesorectal-excision/), [Stoma (colostomy, ileostomy, urostomy)](https://onco.cc/terms/stoma/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/), [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/))
- Chemotherapy after surgery for stage 2 and stage 3, and how the benefit is worked out: Chemotherapy after the operation is given to kill cells that have already left the bowel but are too few to see, and the whole decision is about how large that risk is against what the treatment costs you. For stage 3 (cancer in the lymph nodes), NICE NG151 is explicit and the same for colon and for rectal cancer treated with short-course radiotherapy or no preoperative treatment: offer capecitabine with oxaliplatin (CAPOX) for 3 months, or if that is not suitable either oxaliplatin with fluorouracil and folinic acid (FOLFOX) for 3 to 6 months, or a single-agent fluoropyrimidine such as capecitabine for 6 months. It then says to base the choice on the person's histopathology (giving pT1 to T3 with pN1 against pT4 or pN2 as the example), performance status, personal preferences, comorbidities and age, which is the guideline's way of saying that three months of a doublet and six months of a single tablet are both defensible and the balance is yours to weigh. For stage 2 (no nodes involved) NICE NG151 makes no adjuvant recommendation at all, so the conversation runs on individual risk features, on the mismatch repair result, and increasingly on whether circulating tumour DNA is detectable after surgery; the ctDNA-guided studies on this record (DYNAMIC and the others) are where that question is being settled, and a trial is a reasonable answer. Two practical points NICE puts in writing: monitor prolonged sensory symptoms after platinum chemotherapy, because they are a sign the dose needs reducing to prevent permanent neuropathy, and a DPD blood test comes before fluorouracil or capecitabine because low DPD raises the risk of severe toxicity. The OnCo decision aid at /tools/colorectal-adjuvant-chemotherapy/ lays the NICE wording out by site, stage and fitness for oxaliplatin. ([CAPOX (capecitabine, oxaliplatin)](https://onco.cc/drugs/capox/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [DYNAMIC](https://onco.cc/trials/dynamic/))
- Rectal cancer: surgery or chemoradiotherapy first, and watch and wait if the tumour disappears: Rectal cancer is the part of bowel cancer where the order of treatment is a real choice. NICE NG151 says not to offer preoperative radiotherapy for early rectal cancer (cT1 to T2, cN0, M0) outside a clinical trial, and to offer preoperative radiotherapy or chemoradiotherapy where the cancer is cT1 to T2 with involved nodes, or cT3 to T4 with any node status. Two forms are used: a short course of radiotherapy on its own, and a longer course of radiotherapy given together with chemotherapy (Macmillan says the drug most commonly used is capecitabine tablets, started on the first morning of radiotherapy and taken throughout it, with a DPD test first), and in recent practice both are often followed by several months of chemotherapy before surgery (total neoadjuvant therapy, tested in RAPIDO, PRODIGE 23 and OPRA on this record; PROSPECT asked the opposite question, whether chemotherapy alone can replace radiotherapy in selected tumours). The reason this matters to a patient is that treatment before surgery shrinks the tumour, improves the chance of a clear margin, and in a minority makes the tumour disappear altogether on examination, MRI and endoscopy. NICE NG151 covers that case directly: inform people with a complete clinical and radiological response who wish to defer surgery that there is a risk of recurrence, and that there are no prognostic factors to guide selection for deferral; for those who choose to defer, encourage participation in a clinical trial and ensure data is collected via a national registry. Watch and wait is therefore not less treatment but a different commitment, to frequent examination and scans for years. For early rectal cancer NICE offers a shared decision between transanal excision, endoscopic submucosal dissection and total mesorectal excision, and gives a table comparing them on exactly the points a patient asks about: whether bowel is removed, whether a stoma is possible, hospital stay, scarring and the complications of each. ([Total neoadjuvant therapy (TNT, rectal cancer)](https://onco.cc/terms/total-neoadjuvant-therapy/), [Organ preservation (watch-and-wait, bladder-sparing, larynx preservation)](https://onco.cc/terms/organ-preservation/), [Total mesorectal excision (TME)](https://onco.cc/terms/total-mesorectal-excision/), [RAPIDO](https://onco.cc/trials/rapido/), [PRODIGE 23](https://onco.cc/trials/prodige-23/), [OPRA](https://onco.cc/trials/opra/), [PROSPECT (Alliance N1048)](https://onco.cc/trials/prospect/), [CAO/ARO/AIO-94 (German Rectal Cancer Study)](https://onco.cc/trials/cao-aro-aio-94/))
- Which first treatment when the cancer has spread, by RAS, BRAF, mismatch repair and which side of the bowel: When bowel cancer has spread, the first treatment is chosen by three test results and one piece of anatomy. NICE NG151 says to test for RAS and BRAF V600E mutations in all people with metastatic colorectal cancer suitable for systemic anticancer treatment, and separately recommends immunotherapy where the tumour is MSI-high or mismatch repair deficient. If RAS is wild-type, NICE recommends cetuximab or panitumumab with FOLFOX or FOLFIRI; if RAS is mutated, those antibodies do not work and bevacizumab with fluoropyrimidine-based chemotherapy is recommended where targeted treatment or immunotherapy is unsuitable. The anatomy is sidedness: cancers that start on the left (descending colon, sigmoid, rectum) respond better to the EGFR antibodies than cancers that start on the right, which is why the standard-of-care rows put anti-EGFR treatment with left-sided RAS wild-type disease and bevacizumab with right-sided or RAS-mutant disease (PARADIGM tested that question head to head; CRYSTAL and FIRE-3 are the older comparisons). BRAF V600E is its own group, with encorafenib and cetuximab added to chemotherapy (BREAKWATER). What this means at the appointment is that the first question is not which drug but which result, and that a treatment plan made before the molecular report is back may change. Two further decisions sit alongside: whether the primary tumour should be removed when it is causing no symptoms (NICE says consider it, and supplies a table of advantages and disadvantages to share), and when to take a break from oxaliplatin before the nerve damage becomes permanent. ([FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [FOLFIRI (5-FU, leucovorin, irinotecan)](https://onco.cc/drugs/folfiri/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [Panitumumab](https://onco.cc/drugs/panitumumab/), [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [Encorafenib](https://onco.cc/drugs/encorafenib/), [PARADIGM](https://onco.cc/trials/paradigm/), [CRYSTAL & FIRE-3](https://onco.cc/trials/crystal-fire3/), [BREAKWATER](https://onco.cc/trials/breakwater/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/), [Microsatellite-stable (MSS) / mismatch-repair proficient (pMMR)](https://onco.cc/terms/mss-pmmr/), [Sidedness (left vs right colon)](https://onco.cc/terms/sidedness/))
- Surgery or ablation when the cancer has spread to the liver: Bowel cancer that has spread to the liver is one of the few settings in which surgery for metastatic disease is done with the intention of cure, and a meaningful number of people live many years after it. NICE NG151 says to consider resection, either simultaneous with the bowel operation or sequential, after discussion by a multidisciplinary team with expertise in resection of disease in all involved sites, and to consider perioperative systemic anticancer therapy where liver resection is a suitable treatment. Where the liver disease is not resectable, it says to consider chemotherapy with local ablative techniques after discussion by a specialist multidisciplinary team, and not to offer selective internal radiation therapy as first-line treatment for liver metastases unsuitable for local treatment except under the arrangements its HealthTech guidance sets out. The same logic extends to the lungs: consider metastasectomy, ablation or stereotactic body radiation therapy for lung metastases suitable for local treatment, after discussion by a team including a thoracic surgeon and a specialist in non-surgical ablation, and consider a biopsy for a single lung lesion to exclude a primary lung cancer. For disease limited to the peritoneum, NICE says to offer systemic therapy and, within the multidisciplinary team, to discuss referral to a nationally commissioned specialist centre to consider cytoreductive surgery with heated intraperitoneal chemotherapy. The practical consequence for a patient is that the answer to whether an operation is possible depends on which team is looking, so asking whether a specialist liver or peritoneal unit has seen the scans is a fair question, and a second opinion is a recognised step (Bowel Cancer UK has a page on it). ([Hepatectomy (liver resection)](https://onco.cc/terms/hepatectomy/), [Thermal ablation (RFA, microwave, cryo)](https://onco.cc/technologies/thermal-ablation/), [Microwave and radiofrequency ablation systems](https://onco.cc/technologies/microwave-rf-ablation/), [Liver-directed therapy (TACE, TARE, HAI, ablation)](https://onco.cc/terms/liver-directed-therapy/), [HIPEC / PIPAC (intraperitoneal chemotherapy)](https://onco.cc/technologies/hipec/), [SABR-COMET: stereotactic ablative radiotherapy for oligometastatic cancer](https://onco.cc/trials/sabr-comet/))
- Immunotherapy when the tumour is mismatch repair deficient: A small minority of bowel cancers that have spread have lost the mismatch repair machinery that proof-reads DNA, which leaves the tumour carrying very many mutations and makes it visible to the immune system. For those people, immunotherapy has replaced chemotherapy as the first treatment. NICE NG151 recommends nivolumab with ipilimumab as an option for untreated unresectable or metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency, and pembrolizumab as an option for untreated metastatic disease with the same markers, stopped after 2 years or earlier if the disease progresses; after fluoropyrimidine-based combination chemotherapy it recommends nivolumab with ipilimumab, and pembrolizumab only if that combination cannot be used. KEYNOTE-177 and CheckMate 8HW are the trials behind those recommendations and are on this record. The same biology is being tested before surgery, where a few weeks of immunotherapy has cleared the tumour in a large fraction of mismatch repair deficient colon cancers (NICHE-2) and of rectal cancers (the dostarlimab work and the registrational AZUR-1), but outside those trials NICE does not recommend it, so the question at the clinic is whether a trial is open. Everything therefore turns on the test: ask whether mismatch repair immunohistochemistry or microsatellite instability testing has been done and what the result was, because a mismatch repair deficient result also starts the Lynch syndrome pathway for your family. ([Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [KEYNOTE-177](https://onco.cc/trials/keynote-177/), [CheckMate 8HW](https://onco.cc/trials/checkmate-8hw/), [NICHE-2](https://onco.cc/trials/niche-2/), [AZUR-1](https://onco.cc/trials/azur-1/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/), [MSI and mismatch-repair testing](https://onco.cc/technologies/msi-mmr-testing/))
- Later lines, when chemotherapy stops working: When the cancer grows through the first and second lines, there is still a recognised sequence, and knowing it in advance makes each step less sudden. NICE NG151 points to its appraisals for metastatic colorectal cancer previously treated with fluoropyrimidine-based chemotherapy, anti-VEGF or anti-EGFR therapy: trifluridine with tipiracil plus bevacizumab after 2 systemic treatments (the SUNLIGHT combination), fruquintinib after 2 systemic treatments if trifluridine with tipiracil plus bevacizumab is not suitable (FRESCO-2), regorafenib, and trifluridine with tipiracil alone. It also lists what is not recommended at this point, including aflibercept with irinotecan and fluorouracil after oxaliplatin, and cetuximab or panitumumab monotherapy after first-line chemotherapy. Where a rarer change is present the sequence changes: encorafenib with cetuximab for BRAF V600E after previous systemic treatment, larotrectinib through the Cancer Drugs Fund for NTRK fusion-positive tumours when there are no other satisfactory options, and the HER2 and KRAS G12C options on this record's other rows. These drugs are given to hold the cancer and protect quality of life rather than to cure, so the honest questions are what each is likely to buy, what it costs in side effects and hospital visits, how progression will be recognised, and what the stopping rule is. Bowel Cancer UK has pages on treating advanced bowel cancer and on taking a break from treatment; both are legitimate choices, and so is a trial. ([Trifluridine/tipiracil](https://onco.cc/drugs/trifluridine-tipiracil/), [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [Fruquintinib](https://onco.cc/drugs/fruquintinib/), [Regorafenib](https://onco.cc/drugs/regorafenib/), [SUNLIGHT](https://onco.cc/trials/sunlight/), [FRESCO-2](https://onco.cc/trials/fresco-2/))
- Lynch syndrome testing, and what it means for your family: Around 3 in 100 UK bowel cancers are caused by Lynch syndrome, an inherited fault in one of the mismatch repair genes, and Bowel Cancer UK says testing should be offered to everyone at diagnosis because the result changes treatment as well as family risk. The route runs in order: the tumour is stained for the mismatch repair proteins (or tested for microsatellite instability); where MLH1 is lost, the laboratory checks for MLH1 promoter methylation, which usually means the loss is sporadic rather than inherited; and where the pattern still suggests an inherited cause, a germline blood test is offered through the genomics service. A positive result has three consequences. For you, immunotherapy becomes an option in advanced disease, and lifelong colonoscopy surveillance begins. For your relatives, each child, brother and sister has a one in two chance of carrying the same change, and Bowel Cancer UK says they should be offered the same test, which it calls cascade testing; it estimates that most of the 175,000 to 200,000 people in the UK with Lynch syndrome do not know. For prevention, NICE NG151 says to consider aspirin, taken daily and for a period of more than 2 years, to reduce the risk of colorectal cancer in people with Lynch syndrome, noting that in January 2020 this was an off-label use and that NICE has produced a patient decision aid to support the discussion. Bowel Cancer UK says surveillance means colonoscopy every 18 months to two years and can reduce the chance of dying from bowel cancer by as much as 72 percent. ([Lynch syndrome](https://onco.cc/terms/lynch-syndrome/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [MSI and mismatch-repair testing](https://onco.cc/technologies/msi-mmr-testing/), [MLH1 promoter methylation (sporadic versus Lynch mismatch repair loss)](https://onco.cc/terms/mlh1-promoter-methylation/), [Colonoscopy](https://onco.cc/terms/colonoscopy/), [Aspirin](https://onco.cc/drugs/aspirin/))
- A clinical trial or standard treatment: At several points in bowel cancer a trial is a reasonable choice beside standard treatment rather than a last resort, and NICE NG151 says so itself in two places: preoperative radiotherapy for early rectal cancer should only happen within a clinical trial, and people who defer surgery after a complete response should be encouraged to take part in a trial with data collected via a national registry. The open questions this record follows are the ones a trial would answer for you: whether circulating tumour DNA after surgery should decide who has chemotherapy and for how long; whether immunotherapy before surgery can replace an operation in mismatch repair deficient colon and rectal cancer; whether the newer RAS inhibitors help the large majority whose tumours are RAS-mutant; and how to make immunotherapy work in microsatellite-stable disease, where it so far does not. Bowel Cancer UK says some trials test new treatments and others test new ways of using existing treatments, and that if you would like to take part you should ask your healthcare team whether you are suitable for any current trials in your area; the NHS says you can ask your doctor or a patient organisation about trials you may be eligible to join, and that you can choose to leave at any point without giving a reason and without it affecting the care you receive. Practical points worth settling before you agree: how many extra visits, scans or biopsies are involved, whether travel is reimbursed, whether the trial is open at another hospital if not here, and what the standard alternative would be if you decline. ([FOCUS4](https://onco.cc/trials/focus4/), [AZUR-1](https://onco.cc/trials/azur-1/), [DYNAMIC](https://onco.cc/trials/dynamic/), [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/))
- When to talk about palliative care: Palliative care is symptom control and support, and it is not a stage of the illness. Bowel Cancer UK says palliative care may start when you are diagnosed with advanced bowel cancer, or after treatment has stopped working, and that its aim is to improve quality of life; end of life care is a later part of the same service, usually in the last year of life. The NHS says that where bowel cancer cannot be cured you will be referred to a symptom control or palliative care team, who work with you to manage symptoms and help you and your loved ones get other support. A randomised trial in another cancer (Temel 2010) found that early palliative care alongside cancer treatment improved quality of life and mood, which is why the referral belongs alongside treatment rather than after it. In bowel cancer the concrete reasons are specific: pain from pelvic or liver disease, a bowel that is becoming obstructed, high stoma output and dehydration, poor appetite and weight loss, fatigue, low mood, sleep, and the practical questions about work, money and care at home. Bowel Cancer UK says you can choose where you would prefer to be cared for and where you wish to die, that care can be at home with the GP and community nurses, in a hospice (for a day or for a stay), in hospital or in a care home, and that your choices can be documented by your healthcare team and kept with your medical records so that the people close to you know them. Marie Curie sets out what palliative care covers and who provides it, and its support line and nurses are available to families as well as patients. ([Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Palliative radiotherapy](https://onco.cc/technologies/palliative-radiotherapy/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Curative intent vs palliative intent](https://onco.cc/terms/curative-intent/))
- Stage I and low-risk stage II colon cancer: Resection with complete mesocolic excision and at least twelve lymph nodes examined; observation afterwards. Adjuvant chemotherapy is not given for stage I. In stage II the absolute gain from fluorouracil and folinic acid is small: QUASAR (3,239 patients, 2,963 with stage II disease) found a relative risk of death of 0.82 and of recurrence 0.78, translating to about 3.6 percent absolute survival. DYNAMIC showed that a negative circulating tumour DNA result four to seven weeks after surgery identifies patients who can safely have no chemotherapy, cutting adjuvant use from 27.9 to 15.3 percent without worse recurrence-free survival. Mismatch-repair deficient stage II disease gains nothing from fluorouracil alone and is observed. ([QUASAR](https://onco.cc/trials/quasar/), [DYNAMIC](https://onco.cc/trials/dynamic/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/), [CEA surveillance after colorectal cancer surgery](https://onco.cc/technologies/cea-surveillance-colorectal/))
- High-risk stage II colon cancer: Resection then a discussion about three to six months of a fluoropyrimidine with or without oxaliplatin, weighing T4 disease, obstruction or perforation, fewer than twelve nodes examined, lymphovascular or perineural invasion and poor differentiation against the neuropathy risk. SCOT included high-risk stage II patients and found three months of oxaliplatin-containing chemotherapy non-inferior to six (three-year disease-free survival 76.7 against 77.1 percent) with grade 2 or worse neuropathy halved. Mismatch-repair deficiency remains a reason not to give fluorouracil alone. ([SCOT](https://onco.cc/trials/scot/), [QUASAR](https://onco.cc/trials/quasar/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [CAPOX (capecitabine, oxaliplatin)](https://onco.cc/drugs/capox/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/))
- Stage III colon cancer, mismatch-repair proficient: Resection then adjuvant oxaliplatin-fluoropyrimidine chemotherapy. MOSAIC established it (three-year disease-free survival 78.2 against 72.9 percent with fluorouracil alone, hazard ratio 0.77; six-year overall survival gain confined to stage III). Duration follows IDEA: three months of CAPOX for T1-3 N1 disease (three-year disease-free survival 83.1 against 83.3 percent for six months) and six months of FOLFOX or CAPOX for T4 or N2. Cetuximab must not be added: N0147 and PETACC-8 both found no benefit and more toxicity. ([MOSAIC](https://onco.cc/trials/mosaic/), [IDEA collaboration](https://onco.cc/trials/idea-collaboration/), [SCOT](https://onco.cc/trials/scot/), [TOSCA](https://onco.cc/trials/tosca/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [CAPOX (capecitabine, oxaliplatin)](https://onco.cc/drugs/capox/), [Alliance N0147](https://onco.cc/trials/n0147/), [PETACC-8](https://onco.cc/trials/petacc-8/))
- Stage III colon cancer, mismatch-repair deficient: Resection then FOLFOX with atezolizumab for twelve months (ATOMIC, three-year disease-free survival 86 against 77 percent), the first adjuvant immunotherapy success in colorectal cancer. Neoadjuvant nivolumab with ipilimumab is the alternative under test: NICHE-2 produced a 68 percent pathological complete response rate and AZUR-2 (NCT05855200, 892 patients, primary completion March 2029) is the phase 3 that would make perioperative dostarlimab standard. ([ATOMIC (Alliance A021502)](https://onco.cc/trials/atomic/), [NICHE-2](https://onco.cc/trials/niche-2/), [Study of Perioperative Dostarlimab in Participants With Untreated T4N0 or Stage III dMMR/MSI-H Resectable Colon Cancer](https://onco.cc/trials/nct05855200/), [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/))
- Locally advanced operable colon cancer: chemotherapy before surgery: Six weeks of preoperative oxaliplatin-fluoropyrimidine chemotherapy followed by surgery and eighteen weeks more is an option for radiologically staged T3 with deep invasion or T4 disease. FOxTROT (1,053 patients) found residual or recurrent disease within two years in 16.9 against 21.5 percent with surgery first (rate ratio 0.72), with fewer serious postoperative complications and 4.3 percent needing expedited surgery for obstruction. Panitumumab added nothing and mismatch-repair deficient tumours gained little, so they are better served by neoadjuvant immunotherapy in a trial. ([FOxTROT](https://onco.cc/trials/foxtrot/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [CAPOX (capecitabine, oxaliplatin)](https://onco.cc/drugs/capox/), [NICHE-2](https://onco.cc/trials/niche-2/))
- Locally advanced rectal cancer: radiotherapy and total neoadjuvant therapy: Total mesorectal excision is the operation (Dutch TME trial) and preoperative rather than postoperative radiotherapy is the sequence (CAO/ARO/AIO-94: five-year local relapse 6 against 13 percent, no survival difference). High-risk disease (cT4, extramural vascular invasion, cN2, threatened mesorectal fascia, lateral nodes) is treated with total neoadjuvant therapy: short-course 5 x 5 Gy then CAPOX or FOLFOX before surgery (RAPIDO: three-year disease-related treatment failure 23.7 against 30.4 percent, hazard ratio 0.75; STELLAR: three-year disease-free survival 64.5 against 62.3 percent) or long-course chemoradiotherapy with FOLFIRINOX before it (PRODIGE 23: three-year disease-free survival 76 against 69 percent, hazard ratio 0.69). Delaying surgery four to eight weeks after short-course radiotherapy is safe (Stockholm III). For sphincter-sparing candidates who do not need radiotherapy, PROSPECT showed neoadjuvant FOLFOX with selective chemoradiotherapy is non-inferior (five-year disease-free survival 80.8 against 78.6 percent). ([Dutch TME trial](https://onco.cc/trials/dutch-tme-trial/), [CAO/ARO/AIO-94 (German Rectal Cancer Study)](https://onco.cc/trials/cao-aro-aio-94/), [RAPIDO](https://onco.cc/trials/rapido/), [PRODIGE 23](https://onco.cc/trials/prodige-23/), [STELLAR (rectal cancer)](https://onco.cc/trials/stellar-rectal/), [Stockholm III](https://onco.cc/trials/stockholm-iii/), [PROSPECT (Alliance N1048)](https://onco.cc/trials/prospect/), [Total neoadjuvant therapy (TNT, rectal cancer)](https://onco.cc/terms/total-neoadjuvant-therapy/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/))
- Rectal cancer: organ preservation and watch and wait: Consolidation chemotherapy after chemoradiotherapy, not induction before it, is the sequence that preserves the rectum: OPRA gave TME-free survival of 54 against 39 percent at five years (the long-term report, Journal of Clinical Oncology 2024; the first report gave 53 against 41 percent at three years), and CAO/ARO/AIO-12 found pathological complete response 25 against 17 percent with the same ordering. Patients with a clinical complete response on digital examination, endoscopy and MRI are offered watch and wait with endoscopy and MRI every three to four months. The International Watch & Wait Database (880 patients with a clinical complete response from 47 institutes) records two-year local regrowth of 25.2 percent, 88 percent of it within two years and 97 percent in the bowel wall where salvage surgery is possible, with five-year overall survival 85 percent and disease-specific survival 94 percent. In mismatch-repair deficient rectal cancer, dostarlimab for six months has produced complete clinical responses without surgery and AZUR-1 is the registrational trial. ([OPRA](https://onco.cc/trials/opra/), [CAO/ARO/AIO-12](https://onco.cc/trials/cao-aro-aio-12/), [International Watch & Wait Database](https://onco.cc/trials/iwwd/), [AZUR-1](https://onco.cc/trials/azur-1/), [Dostarlimab](https://onco.cc/drugs/dostarlimab/), [Clinical complete response (cCR)](https://onco.cc/terms/clinical-complete-response/), [Organ preservation (watch-and-wait, bladder-sparing, larynx preservation)](https://onco.cc/terms/organ-preservation/))
- Metastatic disease, mismatch-repair deficient or MSI-high, first line: Immunotherapy, not chemotherapy: pembrolizumab (KEYNOTE-177) or nivolumab with ipilimumab (CheckMate 8HW). In England NICE TA709 recommends pembrolizumab stopped at two years and TA1065 recommends nivolumab with ipilimumab; TA914 places pembrolizumab after fluoropyrimidine therapy only where nivolumab with ipilimumab is unsuitable. The FDA approved nivolumab with ipilimumab for this indication on 8 April 2025. Universal mismatch-repair or MSI testing at diagnosis is what makes this route possible. ([KEYNOTE-177](https://onco.cc/trials/keynote-177/), [CheckMate 8HW](https://onco.cc/trials/checkmate-8hw/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/), [Colorectal cancer drugs in England: what NICE has recommended](https://onco.cc/terms/colorectal-uk-drug-access/))
- Metastatic disease, RAS and BRAF wild-type, left-sided, first line: FOLFOX or FOLFIRI with panitumumab or cetuximab. PARADIGM showed panitumumab beats bevacizumab in left-sided RAS wild-type disease; FIRE-3 found overall survival 28.7 against 25.0 months for cetuximab against bevacizumab with FOLFIRI, while CALGB/SWOG 80405 found no overall difference (30.0 against 29.0 months) before sidedness was taken into account. Extended RAS testing of KRAS and NRAS exons 2, 3 and 4 is mandatory: PRIME showed patients with non-exon-2 RAS mutations do worse with panitumumab. In England TA439 funds cetuximab or panitumumab with FOLFOX or FOLFIRI first line only. ([PARADIGM](https://onco.cc/trials/paradigm/), [CRYSTAL & FIRE-3](https://onco.cc/trials/crystal-fire3/), [CALGB/SWOG 80405](https://onco.cc/trials/calgb-80405/), [PRIME](https://onco.cc/trials/prime/), [OPUS](https://onco.cc/trials/opus/), [Panitumumab](https://onco.cc/drugs/panitumumab/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [FOLFIRI (5-FU, leucovorin, irinotecan)](https://onco.cc/drugs/folfiri/), [Sidedness (left vs right colon)](https://onco.cc/terms/sidedness/), [Anti-EGFR antibody + chemotherapy in left-sided RAS/BRAF wild-type mCRC](https://onco.cc/pairings/anti-egfr-left-sided/))
- Metastatic disease, RAS-mutant or right-sided, first line: FOLFOX, FOLFIRI or FOLFOXIRI with bevacizumab; EGFR antibodies are contraindicated. FOLFOXIRI plus bevacizumab gives a higher response rate and longer progression-free survival than a doublet (TRIBE: 12.1 against 9.7 months; TRIBE2 progression-free survival 2 of 19.2 against 16.4 months) at the cost of grade 3-4 neutropenia in about half, and is preferred where deep response matters. After six cycles, maintenance with a fluoropyrimidine and bevacizumab beats observation (CAIRO3: progression-free survival 2 of 11.7 against 8.5 months). In England bevacizumab is funded under TA1136 only when targeted treatment or immunotherapy is unsuitable. ([TRIBE](https://onco.cc/trials/tribe/), [TRIBE2](https://onco.cc/trials/tribe2/), [CAIRO3](https://onco.cc/trials/cairo3/), [AVF2107g](https://onco.cc/trials/avf2107g/), [FOLFOXIRI (5-FU, leucovorin, oxaliplatin, irinotecan)](https://onco.cc/drugs/folfoxiri/), [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [Sidedness (left vs right colon)](https://onco.cc/terms/sidedness/))
- Metastatic disease, BRAF V600E: First line encorafenib with cetuximab and mFOLFOX6 (BREAKWATER), which the FDA approved on 20 December 2024 and converted to traditional approval on 24 February 2026. After previous treatment, encorafenib with cetuximab (BEACON CRC), which NICE recommends in England under TA668. The mechanism was established by SWOG S1406: BRAF blockade alone fails because it releases feedback activation of EGFR, so the EGFR antibody is not optional. There is no NICE recommendation for the first-line triplet. ([BREAKWATER](https://onco.cc/trials/breakwater/), [BEACON CRC](https://onco.cc/trials/beacon-crc/), [SWOG S1406](https://onco.cc/trials/swog-s1406/), [Encorafenib](https://onco.cc/drugs/encorafenib/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/))
- Metastatic disease, KRAS G12C: Sotorasib with panitumumab (CodeBreaK 300, FDA approval 16 January 2025) or adagrasib with cetuximab (KRYSTAL-1 colorectal cohort, accelerated approval 21 June 2024) after fluoropyrimidine, oxaliplatin and irinotecan. The confirmatory trials are KRYSTAL-10 (NCT04793958, 461 patients, active but closed) and, for first-line use, CodeBreaK 301 (NCT06252649, 450 patients, recruiting). Neither combination has a NICE recommendation, so they are not routinely funded in England. ([CodeBreaK 300](https://onco.cc/trials/codebreak-300/), [Phase 3 Study of MRTX849 With Cetuximab vs Chemotherapy in Patients With Advanced Colorectal Cancer With KRAS G12C Mutation (KRYSTAL-10)](https://onco.cc/trials/nct04793958/), [Study of Sotorasib, Panitumumab and FOLFIRI Versus FOLFIRI With or Without Bevacizumab-awwb in Treatment-naïve Participants With Metastatic Colorectal](https://onco.cc/trials/nct06252649/), [Sotorasib](https://onco.cc/drugs/sotorasib/), [Adagrasib](https://onco.cc/drugs/adagrasib/), [Panitumumab](https://onco.cc/drugs/panitumumab/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [KRAS & RAS inhibitors](https://onco.cc/technologies/kras-inhibitors/), [KRAS G12C inhibitor + anti-EGFR antibody (colorectal)](https://onco.cc/pairings/kras-plus-egfr-crc/))
- Metastatic disease, HER2-amplified and RAS wild-type: Tucatinib with trastuzumab (MOUNTAINEER, confirmed objective response 38.1 percent; FDA accelerated approval 19 January 2023) or trastuzumab deruxtecan at 5.4 mg/kg (DESTINY-CRC02, response 37.8 percent; DESTINY-CRC01 gave 45.3 percent at the higher 6.4 mg/kg dose with interstitial lung disease in 6 percent and two deaths). The tumour-agnostic HER2 IHC 3+ accelerated approval of trastuzumab deruxtecan came on 5 April 2024. MOUNTAINEER-03 (NCT05253651, 400 patients, primary completion December 2027) is testing first-line use. No NICE recommendation exists for either regimen in colorectal cancer. ([MOUNTAINEER](https://onco.cc/trials/mountaineer/), [MOUNTAINEER-03](https://onco.cc/trials/mountaineer-03/), [DESTINY-CRC01](https://onco.cc/trials/destiny-crc01/), [DESTINY-CRC02](https://onco.cc/trials/destiny-crc02/), [Tucatinib](https://onco.cc/drugs/tucatinib/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/))
- Metastatic disease, rarer biomarkers: NTRK, RET and POLE: NTRK fusions occur in well under 1 percent of colorectal cancers, almost always in right-sided, mismatch-repair deficient, RAS and BRAF wild-type tumours, and are treated with larotrectinib, which NICE recommends tumour-agnostically in England through the Cancer Drugs Fund only (TA630); entrectinib is no longer an option there, because TA644 has been withdrawn and its replacement TA1118 was terminated in January 2026. RET fusions are rarer still and are treated with selpercatinib under its tumour-agnostic approval. POLE or POLD1 exonuclease-domain mutations produce an ultramutated, immunotherapy-responsive tumour that is microsatellite-stable, so it is missed unless sequencing is done. All three are reasons to send comprehensive sequencing rather than a small hotspot panel in metastatic disease. ([Larotrectinib](https://onco.cc/drugs/larotrectinib/), [Entrectinib](https://onco.cc/drugs/entrectinib/), [Selpercatinib](https://onco.cc/drugs/selpercatinib/), [Tumour-agnostic (tissue-agnostic) approval](https://onco.cc/terms/tumour-agnostic/), [Companion diagnostics](https://onco.cc/technologies/companion-diagnostic/))
- Metastatic disease, later lines: Trifluridine-tipiracil with bevacizumab (SUNLIGHT: overall survival 10.8 against 7.5 months; FDA approval 2 August 2023; NICE TA1008), then fruquintinib (FRESCO-2: 7.4 against 4.8 months; FDA approval 8 November 2023; NICE TA1079 only where trifluridine-tipiracil with bevacizumab is unsuitable) or regorafenib (CORRECT: 6.4 against 5.0 months; NICE TA866). Second-line anti-angiogenic options after an oxaliplatin regimen are ziv-aflibercept (VELOUR: 13.50 against 12.06 months, not recommended by NICE in TA307) and ramucirumab (RAISE: 13.3 against 11.7 months, no NICE recommendation). Anti-EGFR rechallenge guided by circulating tumour DNA is promising and unproven in phase 3. ([SUNLIGHT](https://onco.cc/trials/sunlight/), [FRESCO-2](https://onco.cc/trials/fresco-2/), [CORRECT](https://onco.cc/trials/correct/), [CONCUR](https://onco.cc/trials/concur/), [RECOURSE](https://onco.cc/trials/recourse/), [FRESCO](https://onco.cc/trials/fresco/), [VELOUR](https://onco.cc/trials/velour/), [RAISE](https://onco.cc/trials/raise/), [Trifluridine/tipiracil](https://onco.cc/drugs/trifluridine-tipiracil/), [Fruquintinib](https://onco.cc/drugs/fruquintinib/), [Regorafenib](https://onco.cc/drugs/regorafenib/), [Ziv-aflibercept](https://onco.cc/drugs/ziv-aflibercept/), [Ramucirumab](https://onco.cc/drugs/ramucirumab/))
- Anti-EGFR resistance and rechallenge: Resistance to EGFR antibodies is universal and arises through RAS, BRAF and EGFR ectodomain mutant clones that expand under treatment and decay once it stops, which is why rechallenge is worth trying and why it must be selected by a blood test rather than by time alone. CHRONOS screened 52 patients with circulating tumour DNA, excluded the 31 percent with a resistance mutation and rechallenged the rest with panitumumab alone: 30 percent responded and 63 percent had disease control. CAVE rechallenged with cetuximab and avelumab and found median overall survival 17.3 months where baseline plasma RAS and BRAF were wild-type against 10.4 months where they were mutated (hazard ratio 0.49). Both trials are single-arm, so rechallenge is an option to consider in a trial or after discussion, not a standard. ([CHRONOS](https://onco.cc/trials/chronos/), [CAVE mCRC](https://onco.cc/trials/cave/), [Panitumumab](https://onco.cc/drugs/panitumumab/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/))
- Microsatellite-stable disease and immunotherapy: Ninety-five percent of metastatic colorectal cancers are microsatellite-stable and do not respond to PD-1 blockade; IMblaze370 confirmed that adding a MEK inhibitor does not change this (overall survival 8.87 against 8.51 months with regorafenib, hazard ratio 1.00). The most promising current approach is Fc-enhanced CTLA-4 blockade: botensilimab with balstilimab gave an objective response rate of 17 percent (17 of 101 response-evaluable patients among 148 treated) with disease control in 61 percent and median progression-free survival 3.5 months in the phase 1 (Bullock, Nature Medicine 2024), and 21 percent with median overall survival 21.2 months in the 123 patients of the later cohort selected for the absence of liver metastases (Clinical Cancer Research 2026). Both are single-arm. Liver metastases deplete tumour-specific CD8 T cells, which is the reason for the restriction and the reason results in unselected populations have been so poor. ([IMblaze370](https://onco.cc/trials/imblaze370/), [A Study of Botensilimab and Balstilimab for the Treatment of Colorectal Cancer](https://onco.cc/trials/nct05608044/), [Botensilimab](https://onco.cc/drugs/botensilimab/), [Balstilimab](https://onco.cc/drugs/balstilimab/), [Hot vs cold tumours](https://onco.cc/terms/cold-vs-hot/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/), [Making microsatellite-stable colorectal cancer immunotherapy-responsive](https://onco.cc/ideas/idea-immunotherapy-mss-crc/))
- Liver-limited and oligometastatic disease: Resection with curative intent where all disease can be removed with an adequate remnant; perioperative FOLFOX is the reference, although EORTC 40983 found the progression-free survival gain did not become a survival gain at 8.5 years (61.3 against 54.3 months, hazard ratio 0.88). Thermal ablation is the only local treatment with randomised survival evidence: CLOCC gave eight-year overall survival of 35.9 against 8.9 percent when radiofrequency ablation was added to systemic treatment. For initially unresectable liver metastases, CAIRO5 chose FOLFOXIRI with bevacizumab for right-sided or RAS/BRAF-mutant tumours and found panitumumab no better than bevacizumab for left-sided wild-type tumours, with resectability reviewed by a surgical panel every two months. Cetuximab must not be added around liver resection: New EPOC found median overall survival 55.4 against 81.0 months with it. ([EORTC 40983](https://onco.cc/trials/eortc-40983/), [CLOCC](https://onco.cc/trials/clocc/), [CAIRO5](https://onco.cc/trials/cairo5/), [New EPOC](https://onco.cc/trials/new-epoc/), [Hepatectomy (liver resection)](https://onco.cc/terms/hepatectomy/), [Thermal ablation (RFA, microwave, cryo)](https://onco.cc/technologies/thermal-ablation/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [Oligometastatic disease](https://onco.cc/terms/oligometastatic/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/))
- Peritoneal metastases: Complete cytoreductive surgery in selected patients with a Peritoneal Cancer Index of 25 or less gives a median overall survival above three years, but adding heated intraperitoneal oxaliplatin does not: PRODIGE 7 found 41.7 against 41.2 months with more late grade 3 or worse complications. HIPEC also failed as prophylaxis in T4 or perforated colon cancer (COLOPEC) and as systematic second-look surgery (PROPHYLOCHIP). Selection for surgery, and systemic chemotherapy, are what change the outcome; other agents and delivery methods, including pressurised intraperitoneal aerosol chemotherapy, remain investigational. ([PRODIGE 7](https://onco.cc/trials/prodige-7/), [COLOPEC](https://onco.cc/trials/colopec/), [PROPHYLOCHIP-PRODIGE 15](https://onco.cc/trials/prophylochip/), [HIPEC / PIPAC (intraperitoneal chemotherapy)](https://onco.cc/technologies/hipec/), [Debulking (cytoreductive surgery)](https://onco.cc/terms/debulking/), [Colorectal cancer: the failed and stopped programmes, and why](https://onco.cc/terms/colorectal-failed-programmes/))
- Circulating tumour DNA after surgery: A tumour-informed assay four to seven weeks after resection is the strongest single predictor of recurrence: GALAXY within CIRCULATE-Japan and DYNAMIC-III both show a large separation (DYNAMIC-III three-year recurrence-free survival 87 percent if negative against 49 percent if positive). De-escalation on a negative result is proven only in stage II (DYNAMIC, adjuvant chemotherapy use 15.3 against 27.9 percent with equal recurrence-free survival); in stage III, DYNAMIC-III could not show non-inferiority. Escalation on a positive result has failed twice: ALTAIR missed its disease-free survival endpoint (9.30 against 5.55 months, hazard ratio 0.79, p=0.107) and DYNAMIC-III's escalation arm gave no benefit. CIRCULATE-US (NRG-GI008) and TRACC are the trials still running. ([DYNAMIC](https://onco.cc/trials/dynamic/), [DYNAMIC-III](https://onco.cc/trials/dynamic-iii/), [ALTAIR](https://onco.cc/trials/altair/), [CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)](https://onco.cc/trials/circulate-japan/), [CIRCULATE-US](https://onco.cc/trials/circulate-us/), [BESPOKE CRC](https://onco.cc/trials/bespoke-crc/), [TRACC](https://onco.cc/trials/tracc/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/))
- The failed and stopped programmes: Adjuvant cetuximab (N0147, PETACC-8) gave no benefit and more toxicity; cetuximab around liver resection shortened life (New EPOC, 55.4 against 81.0 months). Oxaliplatin HIPEC failed three times (PRODIGE 7, COLOPEC, PROPHYLOCHIP). Checkpoint inhibition with a MEK inhibitor failed in microsatellite-stable disease (IMblaze370, hazard ratio 1.00 against regorafenib). Treating molecular recurrence with late-line chemotherapy failed (ALTAIR). In access, NICE did not recommend ziv-aflibercept (TA307) despite a positive phase 3 trial. ([Colorectal cancer: the failed and stopped programmes, and why](https://onco.cc/terms/colorectal-failed-programmes/), [Alliance N0147](https://onco.cc/trials/n0147/), [PETACC-8](https://onco.cc/trials/petacc-8/), [New EPOC](https://onco.cc/trials/new-epoc/), [PRODIGE 7](https://onco.cc/trials/prodige-7/), [COLOPEC](https://onco.cc/trials/colopec/), [PROPHYLOCHIP-PRODIGE 15](https://onco.cc/trials/prophylochip/), [IMblaze370](https://onco.cc/trials/imblaze370/), [ALTAIR](https://onco.cc/trials/altair/))
- UK access to treatments (NICE, September 2026): Funded in England: cetuximab and panitumumab first line in RAS wild-type disease (TA439); pembrolizumab first line for MSI-high or dMMR disease (TA709) and after chemotherapy where nivolumab with ipilimumab is unsuitable (TA914); nivolumab with ipilimumab first line (TA1065) and after previous treatment (TA716); encorafenib with cetuximab after previous treatment in BRAF V600E disease (TA668); trifluridine-tipiracil (TA405) and with bevacizumab after two lines (TA1008); regorafenib (TA866); fruquintinib at third line or later where trifluridine-tipiracil with bevacizumab is unsuitable (TA1079); bevacizumab with fluoropyrimidine chemotherapy first and second line where targeted treatment or immunotherapy is unsuitable (TA1136); larotrectinib for NTRK fusions, through the Cancer Drugs Fund rather than routine commissioning (TA630). Withdrawn: entrectinib (TA644, replaced by the terminated TA1118). Not funded: ziv-aflibercept (TA307, not recommended), and, for want of any appraisal, tucatinib with trastuzumab, trastuzumab deruxtecan in colorectal cancer, sotorasib with panitumumab, adagrasib with cetuximab and first-line encorafenib with chemotherapy. The clinical guideline is NG151. ([Colorectal cancer drugs in England: what NICE has recommended](https://onco.cc/terms/colorectal-uk-drug-access/), [Cancer Drugs Fund (England)](https://onco.cc/terms/cancer-drugs-fund/))
- Palliation: obstruction, stents and stomas: A self-expanding metal stent at colonoscopy relieves a left-sided obstruction within a day or two, either as a bridge to elective resection without a stoma or as definitive palliation; perforation, migration and re-obstruction are the risks and stenting is avoided during bevacizumab treatment. A defunctioning or end colostomy is preferred for right-sided or multi-level obstruction, peritoneal disease and a longer prognosis; right-sided obstruction is usually resected with primary anastomosis. Inoperable malignant bowel obstruction is managed medically with a syringe driver: an anti-emetic, hyoscine butylbromide or octreotide, dexamethasone and opioid analgesia, with a venting gastrostomy if vomiting persists. ([Palliation in colorectal cancer: obstruction, stents, stomas and liver capsule pain](https://onco.cc/terms/colorectal-palliation-obstruction-pain/), [Stoma (colostomy, ileostomy, urostomy)](https://onco.cc/terms/stoma/), [Endoscopic resection (EMR / ESD)](https://onco.cc/technologies/endoscopic-resection/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/))
- Palliation: liver capsule pain, pelvic symptoms and early palliative care: Liver capsule pain from bulky metastases is a position-dependent right upper quadrant pain that usually responds to dexamethasone and, when it does not, to a short course of palliative radiotherapy to the liver. Bleeding, discharge and pain from an unresectable rectal tumour respond to hypofractionated palliative radiotherapy; tenesmus is the hardest symptom and may need a nerve block or a stoma. Opioids are titrated with laxatives, and anaemia from chronic blood loss is treated with iron or transfusion. Early integrated palliative care alongside oncology from the diagnosis of incurable disease is recommended, and dietetic review matters where a stoma or short bowel follows surgery. ([Palliation in colorectal cancer: obstruction, stents, stomas and liver capsule pain](https://onco.cc/terms/colorectal-palliation-obstruction-pain/), [Palliative radiotherapy](https://onco.cc/technologies/palliative-radiotherapy/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Transfusion support and anaemia management](https://onco.cc/technologies/transfusion-support/))
- Diagnosis and staging (UK pathway): Quantitative faecal immunochemical testing in primary care to decide referral; colonoscopy with biopsy, or computed tomography colonography where colonoscopy is not possible; computed tomography of chest, abdomen and pelvis for everyone and high-resolution pelvic magnetic resonance imaging for every rectal cancer; RAS and BRAF V600E testing in metastatic disease before systemic therapy; mismatch repair testing at diagnosis, which also finds Lynch syndrome; baseline carcinoembryonic antigen. ([Faecal immunochemical test (FIT)](https://onco.cc/terms/fit-test/), [Colonoscopy](https://onco.cc/terms/colonoscopy/), [CT (computed tomography)](https://onco.cc/technologies/ct/), [MRI](https://onco.cc/technologies/mri/), [MSI and mismatch-repair testing](https://onco.cc/technologies/msi-mmr-testing/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [Circumferential resection margin (rectal cancer)](https://onco.cc/terms/circumferential-resection-margin/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [CEA surveillance after colorectal cancer surgery](https://onco.cc/technologies/cea-surveillance-colorectal/))
- Acute left-sided large bowel obstruction: Stenting for people being treated with palliative intent; either stenting or emergency surgery when potentially curative treatment is suitable. In CReST, stenting as a bridge to elective surgery relieved obstruction in 82.4 percent and cut stoma formation from 67.9 to 47.5 percent in patients treated with curative intent, with no difference in 30-day mortality, hospital stay, 3-year recurrence or survival. ([Obstruction and T4 disease in bowel cancer](https://onco.cc/terms/obstructing-colorectal-cancer/), [Endoscopy (EGD, EUS, ERCP)](https://onco.cc/terms/endoscopy/), [Colectomy](https://onco.cc/terms/colectomy/))
- Prevention and chemoprevention: Remove adenomas at colonoscopy and put the person on a surveillance interval set by what was found; consider daily aspirin for more than two years in Lynch syndrome. Population screening from 50 in England and 45 in the United States. Diet, weight, alcohol, smoking and physical activity account for the 54 percent of UK cases Cancer Research UK judges preventable. ([Surveillance intervals after polypectomy](https://onco.cc/terms/colonoscopy-surveillance-intervals/), [Polyp types in the bowel](https://onco.cc/terms/colorectal-polyp-types/), [Aspirin for cancer prevention and adjuvant therapy](https://onco.cc/technologies/aspirin-cancer-prevention/), [Lynch syndrome](https://onco.cc/terms/lynch-syndrome/), [Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)](https://onco.cc/technologies/colorectal-screening/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/))
- Follow-up after potentially curative surgery: Follow up for detection of local recurrence and distant metastases for the first three years, including serum carcinoembryonic antigen and computed tomography of the chest, abdomen and pelvis; a clearance colonoscopy at one year and a surveillance colonoscopy three years after that. ([CEA surveillance after colorectal cancer surgery](https://onco.cc/technologies/cea-surveillance-colorectal/), [CT (computed tomography)](https://onco.cc/technologies/ct/), [Colonoscopy](https://onco.cc/terms/colonoscopy/), [Surveillance intervals after polypectomy](https://onco.cc/terms/colonoscopy-surveillance-intervals/))
- Referral when symptoms suggest bowel cancer: Offer a quantitative faecal immunochemical test to the symptom groups NICE lists and refer on the suspected cancer pathway at 10 micrograms of haemoglobin per gram of faeces or above; refer a rectal mass without testing first; safety net people who do not return a sample or test below the threshold, and do not let a low result delay referral where clinical concern is strong. ([Faecal immunochemical test (FIT)](https://onco.cc/terms/fit-test/), [NHS bowel cancer screening programme](https://onco.cc/terms/bowel-cancer-screening-uk/), [Emergency presentation (route to diagnosis)](https://onco.cc/terms/emergency-presentation/))

## State of the art

- dMMR disease: immunotherapy first line gives median OS over 6 years (KEYNOTE-177); neoadjuvant IO achieves 68% pCR and 100% 3-year DFS in colon (NICHE-2) and complete organ preservation in rectal cancer (dostarlimab, AZUR-1).
- BRAF V600E first-line targeted triplet doubled survival to 30 months (BREAKWATER); full approval in 2026.
- Adjuvant atezolizumab for dMMR stage III colon cancer halves recurrence (ATOMIC, 2025): the first adjuvant IO success in CRC.
- Sidedness plus RAS/BRAF status selects anti-EGFR therapy, yielding median OS near 38 months first line (PARADIGM).
- ctDNA-guided de-escalation is proven (DYNAMIC); blood-based screening is FDA-approved (Shield, 2024) and Medicare-covered.
- KRAS G12C and HER2 have approved targeted combinations; RAS(ON) inhibitors are entering phase 3 for the remaining KRAS alleles.
- Genomic landscape. WNT signalling is on in 93 to 96% of tumours (APC mutated in 58 to 77%, with RNF43, AXIN2, CTNNB1 and RSPO fusions covering most of the rest); TP53 52 to 73%, KRAS 40 to 44%, PIK3CA 20 to 28%, SMAD4 12 to 16%, FBXW7 13 to 17%, NRAS 4 to 9%, BRAF V600E 6 to 18%, HER2 amplification 2 to 3%. Every figure and its cohort is in the molecular table; the full account is in the notes on the Data page.
- Two instability classes. About 16% of tumours are hypermutated, three-quarters through mismatch repair failure and one-quarter through somatic mismatch repair or POLE mutation; the other 84% are chromosomally unstable, losing 18q, 17p and 8p and gaining 8q, 13q and 20q. The two are near-exclusive, which is why SMAD4 and TP53 loss are rare in MSI-high disease.
- Sidedness is biology. Right-sided tumours are 24.3% MSI-high and 19.2% BRAF V600E against 5.2% and 2.9% on the left, and carry more KRAS and PIK3CA and less APC and TP53. EGFR antibodies improve survival on the left (hazard ratio 0.75) and not on the right (1.12) in RAS wild-type disease, the only place in colorectal oncology where anatomy selects a drug.
- Two routes in. The adenoma-carcinoma sequence runs APC, KRAS, 18q, 17p and is mostly left-sided; the serrated pathway starts with BRAF or KRAS and proceeds by CpG island methylation, accounts for about 30% of carcinomas, and is where sporadic mismatch repair deficiency comes from, through MLH1 promoter silencing that accompanies BRAF mutation with an odds ratio of 203.
- Immunity. Mismatch repair deficient tumours carry a mean of 1,782 mutations against 73 and respond to checkpoint blockade from 31% (nivolumab, pre-treated) to 68% pathological complete response (four weeks of neoadjuvant nivolumab plus ipilimumab); microsatellite-stable tumours do not, and the phase 3 test against regorafenib failed. T-cell exclusion there is driven by TGF-beta in the stroma and by WNT activation in the cancer cell.
- Residual disease. Circulating tumour DNA after surgery carries recurrence hazard ratios of 7 to 18, and after adjuvant chemotherapy 17 to 51, with lead times over imaging of about 10 to 16 months. DYNAMIC is the only randomised trial in any solid tumour to change treatment on the result, cutting adjuvant chemotherapy from 28% to 15% in stage II colon cancer without losing recurrence-free survival.
- Testing, in practice. Mismatch repair immunohistochemistry on every tumour (with BRAF V600E or MLH1 methylation reflex where MLH1 is lost), extended RAS across KRAS and NRAS exons 2, 3 and 4 before any EGFR antibody, BRAF V600 separately from non-V600, HER2 by the colorectal-specific more-than-50% rule, and sequencing rather than staining where POLE ultramutation or a fusion is possible.

## Open problems

- Outcomes differ sharply by race, income and geography, and the gap survives adjustment for stage: five-year bowel cancer survival in England is 55 percent in the most deprived group against 62.9 percent in the least (Cancer Research UK), and emergency presentation, which carries the worst outlook, is concentrated in the same places.
- Microsatellite-stable disease, 95% of metastatic colorectal cancer, has no working immunotherapy: the phase 3 test of atezolizumab with or without a MEK inhibitor matched regorafenib, and the best signal so far, botensilimab plus balstilimab, comes from single-arm cohorts (17% of 101 response-evaluable patients in the phase 1, Bullock 2024; 21% of 123 patients selected for the absence of liver metastases in the 2026 report). No randomised trial has yet selected patients by immune biology rather than by line of therapy.
- The consensus molecular subtypes were predictive of which biological drug works in the one randomised analysis of them, yet the mesenchymal class is largely a measurement of stroma rather than of cancer cells, no assay is approved, and no prospective subtype-directed trial has been run.
- KRAS G12D, the commonest colorectal KRAS allele at about 29% of KRAS mutations, and G13D at about 18%, have no approved inhibitor; the only targeted allele, G12C, is about 3% of cases and needs an EGFR antibody alongside it.
- POLE-ultramutated tumours, 1% of cases and the most mutated in the disease, are invisible to the mismatch repair immunohistochemistry and MSI tests that every patient gets, so they are found only where sequencing is done.
- Extended RAS testing is required before an EGFR antibody, yet an assay that reads only KRAS codons 12 and 13 still misses about one in six KRAS mutations and nearly all NRAS mutations, and the FDA companion diagnostic list still carries the old codon 12 and 13 definition for cetuximab beside the extended one for panitumumab, so two tumours called wild-type by two laboratories are not making the same claim.
- Screening delivers the effect of its uptake, not of its test: 40.4 percent of the Nottingham screening group never returned a kit, and endoscopy capacity and the endoscopist's adenoma detection rate then decide what a positive test is worth.
- Incidence in adults under 50 is rising by 1.6 to 7.9 percent a year across Europe and the United States, the stage shift screening bought is reversing (60 percent of United States cases advanced in 2019 against 52 percent in the mid-2000s), and the only mechanistic lead is a bacterial toxin signature enriched 3.3-fold in cancers diagnosed before 40.
- Organ preservation for mismatch repair-proficient rectal cancer has never been randomised against surgery, and the bowel, urinary and sexual function that justifies it has never been a primary endpoint.
- Circulating tumour DNA identifies who will relapse but has still not been shown to tell anyone what to do about it outside stage II colon cancer: DYNAMIC-III could not prove de-escalation non-inferior in stage III, its escalation arm gave no benefit, and ALTAIR's post-adjuvant trifluridine/tipiracil missed its endpoint while causing grade 3 or higher haematological toxicity in 73 percent. The negative result is not a safe one either: about one in ten circulating tumour DNA-negative stage II patients still recurs.
- Peritoneal metastases have no systemic or regional treatment that adds to complete cytoreductive surgery: oxaliplatin HIPEC failed in PRODIGE 7 as treatment, in COLOPEC as prophylaxis and in PROPHYLOCHIP as second-look surgery, and no other intraperitoneal agent has randomised evidence.
- Why adding cetuximab around resection of colorectal liver metastases shortened median survival from 81.0 to 55.4 months in New EPOC has never been explained, and until it is, the safety of any targeted drug in a curative pathway rests on assumption rather than mechanism.
- The HER2 and KRAS G12C combinations approved in the United States on response rate alone have no confirmatory phase 3 result yet (MOUNTAINEER-03 completes December 2027, KRYSTAL-10 is closed but unreported, CodeBreaK 301 completes September 2028) and none is funded in England, so a patient's access to a biomarker-matched treatment now depends more on country than on biology.
- Palliative care in colorectal cancer, stents against stomas, medical management of inoperable obstruction, liver capsule pain, rests largely on small series and consensus rather than randomised evidence, even though obstruction is how a fifth of these cancers present.
- The screening threshold is a rationing decision. England calls a screened person for colonoscopy at 120 micrograms of haemoglobin per gram of faeces and refers a symptomatic person at 10; the gap is set by colonoscopy capacity, not by biology, and modelling of the English pilot shows how many cancers and adenomas a lower threshold would find (Br J Cancer 2022).
- Screening uptake carries the inequality. NordICC found only 42 percent of invited people attended, and the English programme's own standards set an acceptable uptake of 62 percent at ages 60 to 74 with no level yet agreed for the newly invited 50 to 59 group.
- Serrated lesions are the ones that get missed. They cause about 30 percent of colorectal cancers, bleed rarely so faecal tests find few of them, and are flat and pale enough to be missed at colonoscopy; interval cancers concentrate here.
- Quality of surgery and pathology still varies. The circumferential resection margin and the completeness of the mesorectal envelope are the strongest things a rectal cancer team controls, and both depend on reporting standards that are not applied everywhere.

## Notes

- Living with bowel cancer, care and decisions: This is orientation from public patient pages and guidelines, not advice for your case: your own team's instructions and 24-hour number come first. The ten decision rows above, the question sets for the surgeon, oncologist, stoma nurse, genomics and palliative care appointments, the first 60 days checklist and the red cards were written from NICE NG151 and the NHS, Bowel Cancer UK, Macmillan, Cancer Research UK, Colostomy UK, Maggie's and Marie Curie patient pages, all read on 24 September 2026.
- The science in detail, 1 of 7, in full; the one-sentence version is on the overview. Genomic landscape. WNT signalling is altered in 93% of tumours in the TCGA analysis and 96% once intronic APC splice events and large in-frame CTNNB1 deletions are counted: APC mutated in 58 to 77% by cohort, with RNF43 5 to 12%, CTNNB1 5 to 7%, AMER1 6 to 13%, TCF7L2 7 to 15% and RSPO2 or RSPO3 fusions covering most of the APC-wild-type remainder. TP53 52 to 73%, KRAS 40 to 44%, PIK3CA 20 to 28%, FBXW7 13 to 17%, SMAD4 12 to 16%, ARID1A 9 to 13%, SOX9 10 to 12%, NRAS 4 to 9%, BRAF V600E 6 to 18%, B2M 3 to 7%, ERBB2 amplification 2 to 3% and mutation 4 to 6%, MYC amplification 4 to 5%, IGF2 amplification about 2%, and fusions of NTRK, RET and ALK each at or below 0.3%. Every figure and its cohort is in the molecular table; the cBioPortal rows were computed on the TCGA PanCancer Atlas and 2012 deposits, the DFCI prospective exome cohort, the Genentech discovery set, two MSK-IMPACT cohorts (1,134 and 7,237 samples), the MSK early-onset comparison and the Chinese ChangKang project.
- The science in detail, 2 of 7, in full; the one-sentence version is on the overview. Two instability classes. About 16% of colorectal cancers are hypermutated: three-quarters through mismatch repair failure, usually sporadic MLH1 promoter silencing, and one-quarter through somatic mismatch repair gene or POLE mutation. The other 84% are chromosomally unstable, with a persistent segregation defect running above 10^-2 chromosome gains or losses per division and the characteristic 18q, 17p and 8p losses and 8q, 13q and 20q gains. The two classes are near-exclusive, which is why SMAD4 and TP53 loss are rare in MSI-high tumours and why coding-microsatellite frameshift targets (TGFBR2 38.6% against 1.8%, RNF43 63.8% against 3.7%, ARID1A 65.2% against 6.3%, B2M 31.0% against 1.5%) are almost confined to them. Median tumour mutational burden separates three regimes: 5.7 per megabase microsatellite stable, 56.9 MSI-high and 172.1 in POLE exonuclease hotspot tumours.
- The science in detail, 3 of 7, in full; the one-sentence version is on the overview. Sidedness as biology. In the 3,483 MSK-IMPACT samples with a named subsite, microsatellite instability was 24.3% on the right against 5.2% on the left, BRAF V600E 19.2% against 2.9%, KRAS 51.9% against 39.7%, PIK3CA 32.4% against 15.5%, APC 65.0% against 77.6% and TP53 56.7% against 79.2%. Right-sided microsatellite-stable tumours carry mitogenic pathway mutations; left-sided ones often carry none and depend on ligand instead, which is the mechanism behind the treatment rule. Across six randomised trials in 2,159 RAS wild-type patients, adding an EGFR antibody improved overall survival on the left (hazard ratio 0.75) and not on the right (1.12), interaction p less than 0.001, while right-sided disease was worse in every arm (overall survival hazard ratio 2.03 in the control arms). The caution is that the bowel is a gradient: RAS mutation falls from 70% at the caecum to 43% at the hepatic flexure, BRAF V600 rises from 10% to 22% across the same stretch, the sigmoid-rectal region is distinct from the rest of the left colon, and the transverse colon clusters with the left.
- The science in detail, 4 of 7, in full; the one-sentence version is on the overview. Two routes in, plus two short cuts. The adenoma-carcinoma sequence runs APC, then KRAS, then 18q and SMAD4, then 17p and TP53, and is mostly left-sided; it starts before any visible lesion, since about 1% of normal crypts in middle age already carry a driver. The serrated pathway starts with BRAF V600E or KRAS in a hyperplastic polyp or sessile serrated lesion, proceeds by CpG island methylation rather than chromosome loss, accounts for about 30% of carcinomas, and is where sporadic mismatch repair deficiency comes from through MLH1 promoter silencing; serrated-class polyps are found in 20 to 40% of average-risk people and are the ones most often missed. Lynch syndrome is the inherited short cut, 3.1% of colorectal cancer probands, caused by a germline MLH1, MSH2, MSH6 or PMS2 variant or a 3' EPCAM deletion. Polymerase proofreading failure is the fourth route: 1.0% of cancers, ultramutated but microsatellite stable, with an excellent prognosis.
- The science in detail, 5 of 7, in full; the one-sentence version is on the overview. Immunity. Mismatch repair deficient tumours carry a mean of 1,782 somatic mutations against 73 in proficient ones, and that is why they respond: 4 of 10 against 0 of 18 in the first pembrolizumab study, 31.1% with single-agent nivolumab in 74 previously treated patients, 16.5 against 8.2 months of progression-free survival with first-line pembrolizumab, and 68% pathological complete response after four weeks of neoadjuvant nivolumab plus ipilimumab. Microsatellite-stable disease has failed every unselected attempt, most clearly IMblaze370, where atezolizumab with or without a MEK inhibitor matched regorafenib in 363 patients. The mechanism is not only low mutation load: TGF-beta-activated stroma excludes T cells and its blockade makes mouse liver metastases checkpoint-sensitive, and tumour-cell WNT activation independently tracks the absence of T cells. Inside the responsive group, biallelic B2M and HLA loss is the documented escape route. Immunoscore, a digital CD3 and CD8 count, is prognostic across the whole disease independently of stage and microsatellite status (hazard ratio 0.20 high against low in 2,681 patients).
- The science in detail, 6 of 7, in full; the one-sentence version is on the overview. Residual disease in blood. Tumour-informed circulating tumour DNA after resection gives recurrence hazard ratios of 7 to 18, after adjuvant chemotherapy 17 to 51, and during surveillance up to 43, with lead times over imaging of about 10 to 16 months; week-4 positivity in 1,039 prospectively followed patients carried a hazard ratio of 10 and 18-month disease-free survival of 38.4% against 90.5%. DYNAMIC randomised 455 patients and cut adjuvant chemotherapy use from 28% to 15% with two-year recurrence-free survival of 93.5% against 92.4%, the only randomised evidence in any solid tumour that a residual disease result can safely change treatment. What is missing is escalation evidence, and the false negatives are real: 16 of 164 ctDNA-negative stage II patients recurred. Plasma sequencing does two other jobs here, watching RAS-mutant clones emerge under EGFR blockade months before imaging, and selecting HER2-amplified patients as accurately as tissue.
- The science in detail, 7 of 7, in full; the one-sentence version is on the overview. Testing, in practice. Mismatch repair immunohistochemistry (MLH1, MSH2, MSH6, PMS2) on every colorectal cancer, with MSI PCR where the stain is equivocal, and BRAF V600E or MLH1 promoter methylation as a reflex where MLH1 is lost; extended RAS across KRAS and NRAS exons 2, 3 and 4 before any EGFR antibody, because a codon 12 and 13 assay misses about one in six KRAS mutations and nearly all NRAS ones; BRAF reported as V600E or non-V600, since the two carry median survivals of 11.4 and 60.7 months and only V600E has a regimen; HER2 scored by the colorectal-specific rule of intense membranous staining in more than 50% of cells, which selects about 5% of RAS wild-type patients; and sequencing rather than staining where POLE ultramutation or an NTRK, RET, ALK or RSPO fusion is possible, since none of those is visible to immunohistochemistry. Primary tumour side belongs on the report alongside the genotype.
- Frequencies marked cBioPortal were computed from the public API on 24 September 2026 on the sequenced sample lists of coadread_tcga_pan_can_atlas_2018 (534 sequenced of 594), coadread_tcga_pub (224 of 276), coadread_dfci_2016 (619), coadread_genentech (72), crc_msk_2017 (1,134), crc_msk_2026 (7,237), crc_eo_2020 (1,516) and crc_sysucc_2022 (1,015), as sample-level counts of non-synonymous mutation, high-level amplification, deep deletion or structural variant. They are not the papers' own percentages, which are quoted alongside.
- Panel content decides what is seen. ACVR2A, BCL9L, RSPO2 and CDX2 read zero in the MSK-IMPACT cohorts because they are not on the panel, not because they are absent from the disease; RSPO3 fusions read 0.44% on a DNA panel against 10% for RSPO2 and RSPO3 together on transcriptome sequencing. Copy-number calls on 20q genes such as PTPRT and GNAS largely reflect the broad chromosome 20q gain of the chromosomally unstable class rather than focal amplification, and the ChangKang copy-number profile calls amplification much more liberally than the others, so its copy-number rows are not used here.
- KRAS and BRAF allele shares are counts of mutation records over all mutation records for that gene in a study, so a tumour with two mutations in one gene counts twice. Study-level mutation rates also differ with cohort design: the prospective population cohort reads BRAF V600E at 17.9% and the metastatic referral cohorts at 7.5 to 7.9%, because sporadic right-sided BRAF-mutant disease is over-represented in resected series and under-represented in metastatic ones.
- Is bowel cancer the same as colorectal cancer? Yes. Bowel cancer is the everyday British name for cancer of the large bowel, which doctors split into colon cancer and rectal cancer and together call colorectal cancer. Cancer of the small bowel and cancer of the anus are different diseases with their own pages. The colon and rectum are counted separately by the world registries and together by most UK and US statistics, which is why the same disease can be the 4th and the 8th commonest cancer in one paragraph and the 3rd in another.
- How common is it? Worldwide, 1,206,011 colon cancers and 778,594 rectal cancers a year with 556,774 and 339,370 deaths (GLOBOCAN 2024), which is about 1.98 million cases and about 896,000 deaths added together. In the UK, 48,213 cases and about 17,700 deaths a year, the 4th commonest cancer and the 2nd commonest cause of cancer death (Cancer Research UK). In the United States, 158,850 cases and 55,230 deaths projected for 2026 (SEER). The lifetime risk in the UK is 1 in 20 for women and 1 in 17 for men.
- Why do I keep reading that it is rising in young people when the overall numbers are falling? Both are true, in different age groups. In the United States, incidence fell 0.9 percent a year over 2013 to 2022 overall, but rose 3 percent a year in adults aged 20 to 49 while falling 2.5 percent a year in the over-65s (American Cancer Society, 2026). In the UK, incidence rates are down 3 percent in the last decade. The same divergence appears in 19 of 36 countries with registry data, and in nine of them rates rose in the young while stable or falling in older adults (Siegel 2019). No cause is established.
- What raises the risk, and how much of it can I change? Cancer Research UK judges 54 percent of UK cases preventable. Eating too little fibre accounts for 28 percent, processed meat 13 percent, overweight and obesity 11 percent, smoking 7 percent, alcohol 6 percent, too little physical activity 5 percent and ionising radiation 2 percent. Type 2 diabetes raises risk 22 to 30 percent and inflammatory bowel disease 70 percent, with a 5 percent risk of cancer after 20 years of colitis. A first-degree relative with the disease more than doubles risk. Age is the largest factor and cannot be changed: 43 percent of UK cases are in people aged 75 and over.
- Who is offered NHS bowel screening, and what does the test do? In England everyone aged 50 to 74 who is registered with a GP is sent a faecal immunochemical test kit through the post every two years; depending on when you turned 50 the first kit arrives at 50, 52 or 54. People aged 75 and over can ask for a kit every two years on the free helpline. The kit looks for blood in a single stool sample you collect at home and post back; results come in about two weeks. Most people are told no further tests are needed. If blood is found you are invited to see a specialist nurse and usually offered a colonoscopy; blood in the poo often turns out to be a fissure or a polyp rather than cancer (NHS; GOV.UK).
- Does screening actually save lives? Yes, and it has been shown in randomised trials rather than inferred. Annual faecal occult blood testing cut 13-year colorectal cancer mortality by 33 percent in Minnesota (Mandel 1993). One flexible sigmoidoscopy offered at 55 to 64 cut incidence by 26 percent and mortality by 30 percent over 17 years, and by 35 and 41 percent among those who attended (Atkin 2017). NordICC, the first randomised trial of screening colonoscopy, cut the 10-year risk of colorectal cancer from 1.20 to 0.98 percent on an invitation basis in a trial where only 42 percent of invitees attended (Bretthauer 2022). Removing the polyps is what does most of the work.
- My GP gave me a poo test rather than referring me. Is that right? It is what NICE asks for. NG12 (1.3.1) tells GPs to offer a quantitative faecal immunochemical test to people with a change in bowel habit, an abdominal mass, iron-deficiency anaemia and several combinations of bleeding, pain and weight loss by age, and to refer on the suspected cancer pathway at 10 micrograms of haemoglobin per gram of faeces or above (1.3.2). Below the threshold the GP should safety net you, and if clinical concern is strong the referral should not wait for the test (1.3.3). A rectal mass is referred without the test. If you were screened recently and have symptoms now, you should still be tested.
- Why does rectal cancer get a magnetic resonance scan when colon cancer does not? Because the rectum sits in a narrow pelvis and the surgeon's plane of dissection runs within millimetres of the tumour. The scan measures how close the tumour comes to that plane, the mesorectal fascia, which becomes the circumferential resection margin in the specimen, and whether tumour has grown into the veins outside the bowel wall. Those two readings decide whether radiotherapy or chemoradiotherapy comes before surgery. In the MERCURY study of 408 patients, magnetic resonance imaging predicted a clear margin with 92 percent specificity, and 327 of the 349 it predicted clear were clear at operation.
- What is watch and wait? In some people the rectal tumour disappears completely after chemoradiotherapy, leaving a flat white scar and a normal scan. Instead of removing the rectum, the team watches with regular examination, endoscopy and magnetic resonance imaging and operates only if the tumour comes back. In 880 such patients in the International Watch and Wait Database, 25.2 percent had a regrowth by two years, almost all of it in the bowel wall and 88 percent of it within two years, and five-year overall survival was 85 percent. In the OPRA trial about half of patients kept their rectum at five years. NICE (NG151 1.3.7) says to tell people who defer surgery that there is a risk of recurrence, that no marker predicts who is safe, and to record the outcome in a national registry.
- My report says the circumferential resection margin is involved. What does that mean? It means tumour was found within 1 mm of the cut surface at the side of the removed rectum. It matters because that is where rectal cancer recurs: in the 52 specimens Quirke examined in 1986, 14 had tumour at the lateral margin and 12 of those recurred in the pelvis. In more than 17,500 patients reviewed in 2008, an involved margin predicted local recurrence, distant metastases and shorter survival, and its predictive power for local recurrence was higher after preoperative radiotherapy than without it. It usually leads to a discussion about more treatment, not to a conclusion about you.
- What happens if the bowel blocks? Where a primary tumour is left in place in metastatic disease, around 20 in 100 people develop obstruction, perforation, bleeding or pain needing surgery (NICE NG151). For acute obstruction on the left side, NICE offers either a stent through the blockage followed by planned surgery a few weeks later, or emergency surgery, when cure is still the aim; for palliative treatment a stent is the option to consider. In the CReST trial, stenting relieved the obstruction in 82.4 percent and reduced the proportion of people left with a stoma from 67.9 to 47.5 percent, with no difference in 30-day mortality, length of stay, recurrence at three years or survival.
- The cancer has spread to my liver. Is that the end? Not necessarily. Colorectal cancer that has spread only to the liver, and sometimes only to the lung, is treated with the aim of cure: resection or ablation of the metastases, sometimes at the same operation as the primary, with chemotherapy before and after (NICE NG151 1.5.15 to 1.5.19). In the EORTC 40983 trial, perioperative chemotherapy added about 9 percentage points to three-year progression-free survival in patients who had their liver metastases resected. Where the metastases are not removable at first, chemotherapy with an EGFR antibody raised the proportion that became operable from 32 to 60 percent in the CELIM trial. In England, around 45 percent of people whose liver metastases were operated on survived five years or more (Morris 2010).
- What is the outlook? Averages hide a wide range and predate the newest drugs. In the United States 65.4 percent of people are alive at five years, which rises to 91.3 percent for the 34 percent found while the cancer is still confined to the bowel and falls to 16.9 percent for distant disease (SEER). In England, around 90 percent survive five years with stage 1, around 85 percent with stage 2, 65 percent with stage 3 and around 10 percent with stage 4, and almost 55 percent of everyone survives ten years (Cancer Research UK). Survival in the UK has more than doubled since the 1970s. These are population figures, not a personal prognosis.

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- National Bowel Cancer Audit: State of the Nation 2025: https://www.natcan.org.uk/reports/nboca-state-of-the-nation-report-2025/
- Bowel Cancer UK: https://www.bowelcanceruk.org.uk/
- GLOBOCAN colon fact sheet (IARC Global Cancer Observatory, 2024 estimates): https://gco.iarc.who.int/media/globocan/factsheets/cancers/8-colon-fact-sheet.pdf
- GLOBOCAN rectum fact sheet (IARC Global Cancer Observatory, 2024 estimates): https://gco.iarc.who.int/media/globocan/factsheets/cancers/9-rectum-fact-sheet.pdf
- SEER Cancer Stat Facts: colorectal cancer (rates, stage distribution, survival by stage, age and race): https://seer.cancer.gov/statfacts/html/colorect.html
- CRUK: bowel cancer statistics (incidence, mortality, survival, early diagnosis, treatment): https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer
- CRUK: bowel cancer incidence statistics: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/incidence
- CRUK: bowel cancer mortality statistics: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/mortality
- CRUK: bowel cancer survival statistics (professional): https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/survival
- CRUK: bowel cancer risk factors (professional): https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/risk-factors
- CRUK: TNM staging for bowel cancer: https://www.cancerresearchuk.org/about-cancer/bowel-cancer/stages-types-and-grades/TNM-staging
- CRUK: grades and types of bowel cancer: https://www.cancerresearchuk.org/about-cancer/bowel-cancer/stages-types-and-grades/grades-and-types
- CRUK: survival for bowel cancer (by stage, England 2016 to 2020): https://www.cancerresearchuk.org/about-cancer/bowel-cancer/survival
- CRUK: symptoms of bowel cancer: https://www.cancerresearchuk.org/about-cancer/bowel-cancer/symptoms
- NHS: bowel cancer screening (the home test kit, ages 50 to 74): https://www.nhs.uk/tests-and-treatments/bowel-cancer-screening/
- GOV.UK: NHS bowel cancer screening programme overview (target population and the screening test): https://www.gov.uk/guidance/bowel-cancer-screening-programme-overview
- GOV.UK: bowel cancer screening programme standards, reporting from 1 April 2025 (uptake thresholds): https://www.gov.uk/government/publications/bowel-cancer-screening-programme-standards/bowel-cancer-screening-programme-standards-reporting-from-1-april-2025
- NICE NG12: suspected cancer, recommendations by site (lower gastrointestinal tract 1.3.1 to 1.3.5): https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer
- NICE HealthTech guidance: quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care: https://www.nice.org.uk/guidance/dg56
- US Preventive Services Task Force, JAMA 2021: screening for colorectal cancer (start at 45, grade B; 50 to 75, grade A): https://doi.org/10.1001/jama.2021.6238
- Monahan, Gut 2020: BSG, ACPGBI and UKCGG guidelines for the management of hereditary colorectal cancer: https://doi.org/10.1136/gutjnl-2019-319915
- Colorectal cancer statistics, 2026 (American Cancer Society, CA: a Cancer Journal for Clinicians): https://doi.org/10.3322/caac.70067
- Colorectal cancer statistics, 2023 (American Cancer Society, CA: a Cancer Journal for Clinicians): https://doi.org/10.3322/caac.21772
- Siegel, Gut 2019: global patterns and trends in colorectal cancer incidence in young adults (36 countries): https://doi.org/10.1136/gutjnl-2019-319511
- Mandel, N Engl J Med 1993: reducing mortality from colorectal cancer by screening for faecal occult blood (Minnesota, 46,551 people): https://doi.org/10.1056/nejm199305133281901
- Atkin, Lancet 2017: UK Flexible Sigmoidoscopy Screening Trial, 17 years of follow-up (170,034 people): https://doi.org/10.1016/s0140-6736(17)30396-3
- Bretthauer, N Engl J Med 2022: NordICC, effect of colonoscopy screening on risks of colorectal cancer and related death (84,585 people): https://doi.org/10.1056/nejmoa2208375
- Br J Cancer 2022: interscreening interval and faecal immunochemical test threshold in the English bowel cancer screening programme (FIT pilot): https://doi.org/10.1038/s41416-022-01919-y
- Vogelstein, N Engl J Med 1988: genetic alterations during colorectal tumour development (172 specimens): https://doi.org/10.1056/nejm198809013190901
- Fearon and Vogelstein, Cell 1990: a genetic model for colorectal tumorigenesis: https://doi.org/10.1016/0092-8674(90)90186-i
- Bettington, Histopathology 2013: the serrated pathway to colorectal carcinoma, current concepts and challenges: https://doi.org/10.1111/his.12055
- Expert Rev Gastroenterol Hepatol 2025: the serrated pathway and colorectal cancer, what the gastroenterologist should know: https://doi.org/10.1080/17474124.2025.2509797
- Winawer, N Engl J Med 1993: prevention of colorectal cancer by colonoscopic polypectomy (National Polyp Study, 1,418 patients): https://doi.org/10.1056/nejm199312303292701
- Zauber, N Engl J Med 2012: colonoscopic polypectomy and long-term prevention of colorectal cancer deaths (National Polyp Study, 2,602 patients): https://doi.org/10.1056/nejmoa1100370
- Rutter, Gut 2020: BSG, ACPGBI and Public Health England post-polypectomy and post-resection surveillance guidelines: https://doi.org/10.1136/gutjnl-2019-319858
- ESGE Guideline update 2020: post-polypectomy colonoscopy surveillance: https://doi.org/10.1055/a-1185-3109
- Burn, Lancet 2020: CAPP2, cancer prevention with aspirin in Lynch syndrome, 10-year follow-up (861 patients randomised): https://doi.org/10.1016/s0140-6736(20)30366-4
- Nagtegaal, Histopathology 2020: the 2019 WHO classification of tumours of the digestive system: https://doi.org/10.1111/his.13975
- Heald, Br J Surg 1982: the mesorectum in rectal cancer surgery, the clue to pelvic recurrence?: https://doi.org/10.1002/bjs.1800691019
- Quirke, Lancet 1986: local recurrence of rectal adenocarcinoma due to inadequate surgical resection (52 specimens sliced transversely): https://doi.org/10.1016/s0140-6736(86)92612-7
- Nagtegaal and Quirke, J Clin Oncol 2008: what is the role for the circumferential margin in the modern treatment of rectal cancer? (more than 17,500 patients): https://doi.org/10.1200/jco.2007.12.7027
- MERCURY Study Group, BMJ 2006: diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer (408 patients): https://doi.org/10.1136/bmj.38937.646400.55
- Battersby, Ann Surg 2016: MERCURY II, prospective validation of a low rectal cancer magnetic resonance imaging staging system (279 patients): https://doi.org/10.1097/sla.0000000000001193
- van der Valk, Lancet 2018: long-term outcomes of clinical complete responders in the International Watch and Wait Database (880 patients): https://doi.org/10.1016/s0140-6736(18)31078-x
- Garcia-Aguilar, J Clin Oncol 2022: OPRA, organ preservation in rectal adenocarcinoma treated with total neoadjuvant therapy (324 patients): https://doi.org/10.1200/jco.22.00032
- Verheij, J Clin Oncol 2024: long-term results of the OPRA trial (median follow-up 5.1 years): https://doi.org/10.1200/jco.23.01208
- Nordlinger, Lancet 2008: EORTC 40983, perioperative FOLFOX4 and surgery versus surgery alone for resectable colorectal liver metastases (364 patients): https://doi.org/10.1016/s0140-6736(08)60455-9
- Folprecht, Lancet Oncol 2010: CELIM, tumour response and secondary resectability of colorectal liver metastases with cetuximab (111 patients): https://doi.org/10.1016/s1470-2045(09)70330-4
- Quenet, Lancet Oncol 2021: PRODIGE 7, cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases (265 patients): https://doi.org/10.1016/s1470-2045(20)30599-4
- Morris, Br J Surg 2010: surgical management and outcomes of colorectal cancer liver metastases (England): https://doi.org/10.1002/bjs.7032
- Hill, Br J Surg 2022: CReST, colorectal endoscopic stenting trial for obstructing left-sided colorectal cancer (245 patients): https://doi.org/10.1093/bjs/znac141
- FOxTROT Collaborative Group, J Clin Oncol 2023: preoperative chemotherapy for operable colon cancer, mature results (699 patients allocated to preoperative chemotherapy, randomised 2:1): https://doi.org/10.1200/jco.22.00046
- Win, Cancer Epidemiol Biomarkers Prev 2017: prevalence and penetrance of major genes and polygenes for colorectal cancer (5,744 families): https://doi.org/10.1158/1055-9965.epi-16-0693
- Moller, Gut 2017: cancer incidence and survival in Lynch syndrome under surveillance, the Prospective Lynch Syndrome Database (1,942 carriers): https://doi.org/10.1136/gutjnl-2015-309675
- Gastrointest Endosc Clin N Am 2022: endoscopic management and surgical considerations for familial adenomatous polyposis: https://doi.org/10.1016/j.giec.2021.08.007

## Connected records

- collections: [Australia's national cancer screening programs](https://onco.cc/collections/australia-cancer-screening-programs/), [Colorectal Cancer Alliance](https://onco.cc/collections/colorectal-cancer-alliance/), [Ireland's National Screening Service](https://onco.cc/collections/ireland-national-screening-service/), [NHS cancer screening programmes](https://onco.cc/collections/nhs-cancer-screening-programmes/), [Time to Screen (New Zealand national screening)](https://onco.cc/collections/nz-time-to-screen/)
- biomarkers: [BRAF class II and class III mutations (non-V600)](https://onco.cc/biomarkers/braf-class-ii-iii/), [BRAF V600E (and V600K)](https://onco.cc/biomarkers/braf-v600e/), [CEACAM5 expression](https://onco.cc/biomarkers/ceacam5-expression/), [ctDNA MRD positivity (molecular residual disease after curative treatment)](https://onco.cc/biomarkers/ctdna-mrd-positive/), [dMMR (mismatch repair deficiency by IHC)](https://onco.cc/biomarkers/dmmr-ihc/), [HER2 IHC 3+ (HER2-positive by immunohistochemistry)](https://onco.cc/biomarkers/her2-ihc-3-plus/), [HER2 ISH amplified (ERBB2 gene amplification)](https://onco.cc/biomarkers/her2-ish-amplified/), [KRAS G12C](https://onco.cc/biomarkers/kras-g12c/), [KRAS G12D (and other non-G12C KRAS mutations)](https://onco.cc/biomarkers/kras-g12d/), [MSI-high (microsatellite instability by PCR or sequencing)](https://onco.cc/biomarkers/msi-high/), [NTRK1/2/3 gene fusion](https://onco.cc/biomarkers/ntrk-fusion/), [PIK3CA mutation](https://onco.cc/biomarkers/pik3ca-hotspot-mutation/), [RAS wild-type (extended KRAS and NRAS testing)](https://onco.cc/biomarkers/ras-wild-type/), [RET fusion and RET mutation](https://onco.cc/biomarkers/ret-fusion/), [TMB-high (tumour mutational burden >= 10 mutations per megabase)](https://onco.cc/biomarkers/tmb-high/)
- roadmaps: [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/), [ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment](https://onco.cc/roadmaps/ctdna-tests/), [Early detection roadmap: organ screening → blood tests for many cancers](https://onco.cc/roadmaps/early-detection-roadmap/), [KRAS roadmap: undruggable → G12C → pan-RAS](https://onco.cc/roadmaps/kras-roadmap/)
- ideas: [A biomarker-directed trial of vitamin D after surgery for digestive tract cancers](https://onco.cc/ideas/idea-reg-vitamin-d-digestive-cancer-biomarker-trial/), [A blood test for the pre-metastatic niche](https://onco.cc/ideas/idea-bio2-premetastatic-niche-assay/), [A cheap old tablet to restore appetite](https://onco.cc/ideas/idea-bio2-low-dose-olanzapine-appetite/), [A dietitian in every gastrointestinal and head and neck tumour board](https://onco.cc/ideas/idea-nl-dietitian-in-every-mdt/), [A dose-finding trial for exercise after cancer](https://onco.cc/ideas/idea-nl-exercise-dose-finding/), [A frameshift neoantigen vaccine for Lynch syndrome carriers as the first preventive cancer vaccine approval](https://onco.cc/ideas/idea-moon-lynch-vaccine-phase3/), [A funded programme of organ-preservation trials to avoid radical surgery](https://onco.cc/ideas/idea-fund-organ-preservation-programme/), [A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled](https://onco.cc/ideas/idea-moon-mrd-weather-service/), [A prevention programme for chemotherapy nerve damage: SARM1 inhibitors, cooling and compression](https://onco.cc/ideas/idea-moon-neuropathy-prevention-programme/), [A public fund and label pathway to trial generic drugs against cancer](https://onco.cc/ideas/idea-moon-generics-for-cancer-fund/), [A randomised trial of a shared-antigen vaccine to prevent Lynch syndrome cancers](https://onco.cc/ideas/idea-prev-lynch-frameshift-vaccine-rct/), [A ring-fenced metastasis programme with metastasis-specific endpoints](https://onco.cc/ideas/idea-fund-metastasis-moonshot/), [A test to tell true oligometastatic disease from hidden widespread spread](https://onco.cc/ideas/idea-bio2-oligometastatic-signature/), [A trial of GLP-1 weight-loss drugs with cancer as the primary outcome](https://onco.cc/ideas/idea-prev-glp1-cancer-prevention-rct/), [A video-based surgical quality registry linking assessed skill to cancer outcomes](https://onco.cc/ideas/idea-fund-surgical-video-registry/), [Automated combination discovery: patient-sample screens feeding Bayesian platform trials](https://onco.cc/ideas/idea-moon-automated-combination-discovery/), [Automatic germline testing for every cancer type where it changes care](https://onco.cc/ideas/idea-prev-reflex-germline-testing/), [Bank three spatially separate tumour blocks from every resection](https://onco.cc/ideas/idea-bio1-multiregion-blocks-default/), [Borrow from past control arms to shrink the control group in phase 3](https://onco.cc/ideas/idea-tr1-bayesian-borrowing-smaller-controls/), [Break the neutrophil DNA nets that catch tumour cells after surgery](https://onco.cc/ideas/idea-bio2-net-blockade-perioperative/), [Cancer interception vaccines for high-risk carriers](https://onco.cc/ideas/idea-interception-vaccines/), [Cancer warnings on alcohol labels, evaluated as a natural experiment](https://onco.cc/ideas/idea-prev-alcohol-cancer-warning-labels/), [Cheap perioperative beta-blocker plus anti-inflammatory to blunt surgical stress](https://onco.cc/ideas/idea-bio2-perioperative-betablocker-nsaid/), [Combine the new anti-wasting antibody with exercise and protein](https://onco.cc/ideas/idea-bio2-gdf15-plus-exercise/), [Confirm or refute the harm of antioxidant supplements during chemotherapy](https://onco.cc/ideas/idea-nl-antioxidant-supplement-harm-confirmation/), [Controlled feeding trials to separate ultra-processing from calories](https://onco.cc/ideas/idea-nl-upf-controlled-feeding-trial/), [Covalent chemistry for the RAS mutations that still have no drug](https://onco.cc/ideas/idea-bio1-pan-ras-covalent-g12d/), [ctDNA-guided adjuvant therapy as the default in stage II-III colon cancer](https://onco.cc/ideas/idea-ctdna-guided-adjuvant-crc/), [Dose chemotherapy by muscle mass, not body surface area](https://onco.cc/ideas/idea-bio2-lean-mass-dosing/), [Engineered bacteria that live in tumours and manufacture drugs there](https://onco.cc/ideas/idea-bio2-engineered-bacteria-payloads/), [Evaluate alcohol minimum unit pricing against cancer incidence](https://onco.cc/ideas/idea-nl-alcohol-minimum-pricing-cancer-endpoints/), [Factorial trials that test several cheap generics at once in the adjuvant setting](https://onco.cc/ideas/idea-tr2-factorial-adjuvant-generics/), [Find out what is driving early-onset bowel cancer, starting with colibactin, before extending screening any further](https://onco.cc/ideas/idea-crc-early-onset-cause-hunt/), [Find peritoneal spread while it is still small, and run complete cytoreduction through networks rather than adding heated chemotherapy](https://onco.cc/ideas/idea-crc-peritoneal-disease-found-early-and-treated-in-networks/), [Four weeks of training and nutrition before major cancer surgery, as standard](https://onco.cc/ideas/idea-bio2-prehabilitation-standard/), [Fund structured exercise after colon cancer surgery as a treatment, because a randomised trial says it works as well as a drug](https://onco.cc/ideas/idea-crc-exercise-as-a-funded-treatment/), [Get biomarker-directed aspirin after colorectal surgery into labels and guidelines](https://onco.cc/ideas/idea-reg-aspirin-pik3ca-implementation/), [Get every Lynch syndrome carrier onto the right dose of aspirin](https://onco.cc/ideas/idea-prev-lynch-aspirin-implementation/), [Grow each trial patient's tumour as organoids to decide which platform arm opens next](https://onco.cc/ideas/idea-tr2-organoid-coclinical-arms/), [Keep a freshly removed tumour alive on a pump and test drugs in it](https://onco.cc/ideas/idea-bio1-ex-vivo-perfused-tumour/), [Link bariatric and GLP-1 registries to cancer registries in every country that has both](https://onco.cc/ideas/idea-nl-bariatric-cancer-registry-linkage/), [Look for the resistant sub-population before the first dose](https://onco.cc/ideas/idea-bio1-baseline-ultradeep-resistant-clones/), [Make every cold tumour hot: a coordinated programme to reprogramme immune-excluded tumours](https://onco.cc/ideas/idea-moon-cold-to-hot-programme/), [Making microsatellite-stable colorectal cancer immunotherapy-responsive](https://onco.cc/ideas/idea-immunotherapy-mss-crc/), [Mandatory staged registries for new surgical techniques before wide adoption](https://onco.cc/ideas/idea-fund-device-technique-registry/), [Match therapy to the type of scar-forming cell in the tumour](https://onco.cc/ideas/idea-bio2-caf-subtype-assignment/), [Mechanically pulverise one tumour with ultrasound to wake the immune system](https://onco.cc/ideas/idea-bio2-histotripsy-immune-priming/), [Metastasis prevention as a formal indication with its own trials and regulatory pathway](https://onco.cc/ideas/idea-moon-metastasis-prevention-indication/), [Multimodal prehabilitation for older patients before major cancer surgery](https://onco.cc/ideas/idea-acc-prehabilitation-older-surgery/), [Off-the-shelf KRAS vaccines after pancreatic cancer surgery](https://onco.cc/ideas/idea-shared-kras-vaccine-adjuvant/), [Off-the-shelf natural killer cells to sweep up residual disease](https://onco.cc/ideas/idea-bio2-nk-cells-for-mrd/), [Offer the blood test for bowel cancer only to people who refuse stool tests or colonoscopy](https://onco.cc/ideas/idea-prev-blood-crc-test-for-non-responders/), [Oncology teams order germline tests; tele-genetic counsellors handle the results](https://onco.cc/ideas/idea-acc-mainstream-tele-genetic-counselling/), [Patent-free open-source development of repurposed and off-patent cancer drugs](https://onco.cc/ideas/idea-fund-open-source-repurposing-leads/), [Pathologists order genomic profiling automatically at diagnosis of advanced cancer](https://onco.cc/ideas/idea-acc-reflex-genomic-profiling-at-diagnosis/), [Pay for supervised exercise the way we pay for drugs](https://onco.cc/ideas/idea-bio2-exercise-reimbursement/), [Perioperative beta-blocker plus COX-2 inhibitor to reduce metastasis after surgery](https://onco.cc/ideas/idea-reg-perioperative-propranolol-etodolac/), [Personalised stool-test cut-offs by age, sex and prior results](https://onco.cc/ideas/idea-prev-fit-risk-adapted-thresholds/), [Personalised vaccines given only when the blood test turns positive](https://onco.cc/ideas/idea-bio2-mrd-triggered-neoantigen-vaccine/), [Population germline screening for hereditary cancer genes with cascade testing](https://onco.cc/ideas/idea-moon-population-germline-screening/), [Pre-consented cohorts that can be randomised to future trials (TwiCs)](https://onco.cc/ideas/idea-tr1-pre-consented-cohort-randomisation/), [Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint](https://onco.cc/ideas/idea-crc-organ-preservation-randomised-in-pmmr-rectal/), [Reprogramme suppressive macrophages instead of trying to delete them](https://onco.cc/ideas/idea-bio2-trem2-myeloid-reprogramming/), [Reprogramme the liver's own immune cells to refuse metastases](https://onco.cc/ideas/idea-bio2-liver-niche-kupffer-reprogramming/), [Risk-stratified follow-up: low-risk survivors to primary care with fast re-entry](https://onco.cc/ideas/idea-acc-risk-stratified-follow-up/), [Select microsatellite stable patients for immunotherapy by a measured immune biomarker, not by how many treatments they have already failed](https://onco.cc/ideas/idea-crc-mss-immunotherapy-by-biomarker-not-by-line/), [Sexual health assessed and treated as a standard toxicity domain](https://onco.cc/ideas/idea-moon-sexual-health-as-toxicity-domain/), [SMART designs to test treatment strategies, not just single drugs](https://onco.cc/ideas/idea-tr1-smart-designs-for-adaptive-strategies/), [Social impact bonds for cancer prevention, repaid from avoided treatment costs](https://onco.cc/ideas/idea-fund-social-impact-bonds-prevention/), [Standing reflex biomarker panels per tumour type, run without an oncologist's order](https://onco.cc/ideas/idea-acc-reflex-biomarker-panels-by-tumour/), [Strip the platelet coat off travelling tumour cells in ctDNA-positive patients](https://onco.cc/ideas/idea-bio2-platelet-cloak-aspirin-mrd/), [Structured exercise prescribed like a drug in all curative-intent cancer care](https://onco.cc/ideas/idea-exercise-as-adjuvant/), [Structured mentorship so district general surgeons perform common cancer operations safely](https://onco.cc/ideas/idea-acc-district-surgeon-oncology-mentorship/), [Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps](https://onco.cc/ideas/idea-crc-ctdna-de-escalation-beyond-stage-ii/), [Test DPYD, UGT1A1 and TPMT/NUDT15 before the first dose, everywhere](https://onco.cc/ideas/idea-tr1-pre-emptive-pharmacogenomic-testing/), [Train the bone marrow to make better anti-tumour immune cells](https://onco.cc/ideas/idea-bio2-trained-immunity-priming/), [Treat insomnia in survivors and measure whether the cancer notices](https://onco.cc/ideas/idea-nl-sleep-circadian-survivorship-rct/), [Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model](https://onco.cc/ideas/idea-crc-screening-uptake-and-age-extension/), [Two-week pre-operative windows to compare combination biology head to head](https://onco.cc/ideas/idea-tr2-window-of-opportunity-triplets/), [UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set](https://onco.cc/ideas/idea-crc-uk-colonoscopy-capacity-and-fit-threshold/), [UK gap: shorten the route to diagnosis for patients below the screening age, where the rise in incidence is](https://onco.cc/ideas/idea-crc-uk-young-patient-referral-and-diagnostic-interval/), [Unmask hidden antigens with a short epigenetic course before immunotherapy](https://onco.cc/ideas/idea-bio2-epigenetic-priming-cold-tumours/), [Upfront reduced-dose regimens tested head-to-head in frail older patients](https://onco.cc/ideas/idea-acc-upfront-reduced-dose-trials-frail/), [Use a polygenic risk score to set when screening starts](https://onco.cc/ideas/idea-prev-prs-screening-start-age/), [Use pre-surgery immunotherapy windows as the field's biomarker engine](https://onco.cc/ideas/idea-bio2-neoadjuvant-biomarker-engine/), [Use tumour DNA in blood to decide when to pause treatment in metastatic cancer](https://onco.cc/ideas/idea-tr1-ctdna-guided-stop-in-metastatic-disease/), [When the blood test is positive, hunt for the lesion with sensitive imaging](https://onco.cc/ideas/idea-bio2-localise-the-mrd/), [WRN inhibitors: a second synthetic-lethal win for mismatch-repair cancers](https://onco.cc/ideas/idea-bio1-wrn-msi-programme/), [Zebrafish avatars for a drug answer within a week](https://onco.cc/ideas/idea-bio1-zebrafish-avatars/)
- cancers: [Adenoma-like adenocarcinoma of the colon and rectum](https://onco.cc/cancers/colorectal-adenoma-like-adenocarcinoma/), [Advanced and metastatic small bowel adenocarcinoma](https://onco.cc/cancers/advanced-small-bowel-adenocarcinoma/), [Ampullary cancer (ampulla of Vater)](https://onco.cc/cancers/ampullary/), [Anal cancer (squamous cell carcinoma)](https://onco.cc/cancers/anal/), [Appendiceal adenocarcinoma (mucinous and non-mucinous, including signet ring cell)](https://onco.cc/cancers/appendiceal-adenocarcinoma/), [Appendiceal cancer and pseudomyxoma peritonei](https://onco.cc/cancers/appendiceal/), [BRAF V600E-mutant colorectal cancer](https://onco.cc/cancers/braf-v600e-colorectal/), [Colon cancer (adenocarcinoma of the colon)](https://onco.cc/cancers/colon-cancer/), [Early-onset colorectal cancer (under 50)](https://onco.cc/cancers/early-onset-colorectal/), [Familial adenomatous polyposis-associated colorectal cancer](https://onco.cc/cancers/fap-associated-colorectal-cancer/), [HER2-amplified colorectal cancer](https://onco.cc/cancers/her2-amplified-colorectal/), [KRAS G12C-mutant colorectal cancer](https://onco.cc/cancers/kras-g12c-colorectal/), [Lynch syndrome-associated colorectal cancer](https://onco.cc/cancers/lynch-associated-colorectal-cancer/), [Medullary carcinoma of the colon](https://onco.cc/cancers/colorectal-medullary-carcinoma/), [Micropapillary adenocarcinoma of the colon and rectum](https://onco.cc/cancers/colorectal-micropapillary-carcinoma/), [Mismatch-repair deficient (MSI-high) colorectal cancer](https://onco.cc/cancers/msi-high-colorectal/), [Mucinous adenocarcinoma of the colon and rectum](https://onco.cc/cancers/colorectal-mucinous-adenocarcinoma/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/), [Serrated adenocarcinoma of the colon and rectum](https://onco.cc/cancers/colorectal-serrated-adenocarcinoma/), [Signet ring cell carcinoma of the colon and rectum](https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/), [Small intestine cancer (small bowel adenocarcinoma)](https://onco.cc/cancers/small-bowel/)
- technologies: [After treatment in Australia: a stated model of survivorship care](https://onco.cc/technologies/rejuv-access-survivorship-care-australia/), [After treatment in Germany: a rehabilitation entitlement, not a leaflet](https://onco.cc/technologies/rejuv-access-survivorship-care-germany/), [After treatment in the Nordic countries: rehabilitation written into the pathway](https://onco.cc/technologies/rejuv-access-survivorship-care-nordic/), [After treatment in the UK: personalised care, and follow-up you lead yourself](https://onco.cc/technologies/rejuv-access-survivorship-care-uk/), [After treatment in the United States: the survivorship care plan, and what the trial found](https://onco.cc/technologies/rejuv-access-survivorship-care-us/), [AI polyp detection in colonoscopy](https://onco.cc/technologies/ai-endoscopy-detection/), [Alcohol reduction, pricing and cancer warning labels](https://onco.cc/technologies/alcohol-reduction-labelling/), [Alternative medicine used instead of standard treatment](https://onco.cc/technologies/alternative-medicine-instead-of-treatment/), [Anti-angiogenic therapy](https://onco.cc/technologies/antiangiogenic/), [Antibody-drug conjugate (ADC)](https://onco.cc/technologies/adc/), [Anxiety after cancer, in survivors and in their partners](https://onco.cc/technologies/rejuv-mind-anxiety-after-cancer/), [Anxiety around scans, and what the evidence says about how often to scan](https://onco.cc/technologies/rejuv-mind-scan-anxiety/), [Asking people how they are, every week, as a treatment in its own right](https://onco.cc/technologies/rejuv-measure-epro-as-treatment/), [Aspirin for cancer prevention and adjuvant therapy](https://onco.cc/technologies/aspirin-cancer-prevention/), [Balance, dizziness and falls after cancer treatment](https://onco.cc/technologies/rejuv-rehab-balance-vestibular/), [Bariatric surgery and cancer incidence](https://onco.cc/technologies/bariatric-surgery-cancer-incidence/), [Biosimilar manufacturing and comparability](https://onco.cc/technologies/biosimilar-manufacturing/), [Body image after cancer treatment: how it is measured, what drives it, and what helps](https://onco.cc/technologies/rejuv-mind-body-image-after-cancer/), [Bowel function after pelvic radiotherapy](https://onco.cc/technologies/bowel-after-pelvic-radiotherapy/), [Breath and volatile-organic-compound detection](https://onco.cc/technologies/breath-vocs/), [C-arm medical linear accelerators (TrueBeam, Versa HD and others)](https://onco.cc/technologies/c-arm-linac/), [Cachexia pharmacotherapy: GDF-15 blockade, anamorelin, olanzapine](https://onco.cc/technologies/cachexia-appetite-pharmacotherapy/), [Cancer interception vaccines](https://onco.cc/technologies/interception-vaccination/), [Cancer rehabilitation: the discipline that puts function back](https://onco.cc/technologies/rejuv-rehab-cancer-rehabilitation/), [Capsule endoscopy (PillCam, EndoCapsule, CapsoCam)](https://onco.cc/technologies/capsule-endoscopy-systems/), [Cardiopulmonary exercise testing: the hardest number in recovery](https://onco.cc/technologies/rejuv-measure-cardiopulmonary-exercise-testing/), [CEA surveillance after colorectal cancer surgery](https://onco.cc/technologies/cea-surveillance-colorectal/), [Cell-free DNA methylation tests](https://onco.cc/technologies/cfdna-methylation-testing/), [CellSearch circulating tumour cell count](https://onco.cc/technologies/cellsearch-ctc-count/), [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/), [Children of a parent treated for cancer](https://onco.cc/technologies/rejuv-life-children-of-a-parent-with-cancer/), [Circulating tumour cell capture](https://onco.cc/technologies/ctc-capture/), [Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield)](https://onco.cc/technologies/closed-system-transfer-devices/), [Coffee and tea intake](https://onco.cc/technologies/coffee-intake-cancer/), [Cognitive behavioural therapy for fatigue and distress](https://onco.cc/technologies/cbt-fatigue-distress/), [Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)](https://onco.cc/technologies/colorectal-screening/), [Companion diagnostics](https://onco.cc/technologies/companion-diagnostic/), [Comprehensive genomic profiling](https://onco.cc/technologies/cgp/), [Continuous and near-continuous ctDNA monitoring](https://onco.cc/technologies/continuous-ctdna-monitoring/), [CT (computed tomography)](https://onco.cc/technologies/ct/), [CT body composition and sarcopenia measurement](https://onco.cc/technologies/ct-body-composition-sarcopenia/), [Cytogenetics and FISH](https://onco.cc/technologies/cytogenetics-fish/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Depression during and after cancer: the interview-based prevalence, and the care model that works](https://onco.cc/technologies/rejuv-mind-depression-after-cancer/), [Dietary supplements during cancer treatment: interactions and harms](https://onco.cc/technologies/dietary-supplements-treatment-interactions/), [DNA methylation profiling](https://onco.cc/technologies/methylation-profiling/), [DPYD genotyping and DPD phenotyping before fluoropyrimidines](https://onco.cc/technologies/dpyd-genotyping/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Employment rights with cancer in the United Kingdom](https://onco.cc/technologies/rejuv-life-employment-rights-uk/), [Employment rights with cancer in the United States](https://onco.cc/technologies/rejuv-life-employment-rights-us/), [Endoscopic resection (EMR / ESD)](https://onco.cc/technologies/endoscopic-resection/), [Endoscopic ultrasound and EBUS systems](https://onco.cc/technologies/endoscopic-ultrasound-systems/), [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/), [EORTC QLQ-C30: the questionnaire most cancer trials use](https://onco.cc/technologies/rejuv-measure-eortc-qlq-c30/), [EQ-5D: health reduced to one number, and what that number is for](https://onco.cc/technologies/rejuv-measure-eq-5d/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Exercise during chemotherapy and radiotherapy](https://onco.cc/technologies/exercise-during-chemotherapy/), [Exercise is the best-evidenced thing on this front, and most survivors are not doing it](https://onco.cc/technologies/rejuv-access-exercise-programmes/), [FACT-G and the FACIT family: the other main questionnaire](https://onco.cc/technologies/rejuv-measure-fact-and-facit/), [Fasting and fasting-mimicking diets around chemotherapy](https://onco.cc/technologies/fasting-mimicking-diet/), [Fatigue after cancer treatment: what actually works](https://onco.cc/technologies/cancer-related-fatigue-management/), [Fear that the cancer will come back: how common it is, and when it stops being ordinary worry](https://onco.cc/technologies/rejuv-mind-fear-of-recurrence/), [Financial toxicity and financial navigation](https://onco.cc/technologies/financial-navigation/), [G8 geriatric screening tool](https://onco.cc/technologies/g8-geriatric-screening/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Getting psychological help after cancer: the stepped-care model, and what is actually commissioned](https://onco.cc/technologies/rejuv-mind-access-to-psychological-care/), [GLP-1 receptor agonists and obesity-related cancer risk](https://onco.cc/technologies/glp1-agonists-cancer-risk/), [Going back to driving, lifting and exercise](https://onco.cc/technologies/rejuv-rehab-driving-and-exercise-return/), [Going back to work after cancer: the rates, and the programmes that change them](https://onco.cc/technologies/rejuv-life-return-to-work/), [HER2 tyrosine kinase inhibitors](https://onco.cc/technologies/her2-tyrosine-kinase-inhibitors/), [HIPEC / PIPAC (intraperitoneal chemotherapy)](https://onco.cc/technologies/hipec/), [HIPEC perfusion pumps and PIPAC nebulisers](https://onco.cc/technologies/hipec-pipac-devices/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [How recovery is measured: the questionnaires behind the numbers](https://onco.cc/technologies/rejuv-measure-patient-reported-outcomes/), [Hydrazine sulfate](https://onco.cc/technologies/hydrazine-sulfate/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Immunonutrition before cancer surgery](https://onco.cc/technologies/immunonutrition-perioperative/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Intraoperative fluorescence and Cerenkov imaging systems (SPY, Firefly, LumiSystem, LightPath)](https://onco.cc/technologies/intraoperative-fluorescence-imaging-systems/), [Intraoperative radiotherapy (IORT)](https://onco.cc/technologies/intraoperative-radiotherapy/), [KRAS & RAS inhibitors](https://onco.cc/technologies/kras-inhibitors/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Liver transplantation for cancer (Milan criteria and beyond)](https://onco.cc/technologies/liver-transplant-oncology/), [Living with a stoma, and living after an amputation](https://onco.cc/technologies/rejuv-mind-body-after-stoma-and-limb-loss/), [Measuring fear of recurrence: the FCRI and its cut-off](https://onco.cc/technologies/rejuv-measure-fear-of-recurrence-inventory/), [Measuring muscle and fat on scans the patient already had](https://onco.cc/technologies/rejuv-measure-body-composition/), [Mediterranean and plant-forward dietary patterns](https://onco.cc/technologies/mediterranean-plant-forward-diet/), [Metastatic seeding and dormancy models](https://onco.cc/technologies/metastasis-seeding-models/), [Microwave and radiofrequency ablation systems](https://onco.cc/technologies/microwave-rf-ablation/), [Money after treatment: what the cost of cancer does once the treatment has finished](https://onco.cc/technologies/rejuv-life-money-after-treatment/), [Monoclonal antibodies](https://onco.cc/technologies/monoclonal-antibody/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/), [MRI](https://onco.cc/technologies/mri/), [MRI field strengths: 1.5 T, 3 T and 7 T](https://onco.cc/technologies/mri-field-strengths/), [MSI and mismatch-repair testing](https://onco.cc/technologies/msi-mmr-testing/), [Multi-cancer early detection (MCED)](https://onco.cc/technologies/mced/), [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/), [Multitarget stool RNA test (ColoSense)](https://onco.cc/technologies/multitarget-stool-rna-test/), [Muscle and strength after treatment: sarcopenia, cachexia and what rebuilds](https://onco.cc/technologies/muscle-recovery-after-cancer-treatment/), [Nerve damage from chemotherapy: what recovers, and what helps](https://onco.cc/technologies/cipn-recovery-and-treatment/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Off-the-shelf cancer vaccines](https://onco.cc/technologies/shared-antigen-vaccine/), [Oncofertility and fertility preservation](https://onco.cc/technologies/fertility-preservation/), [Palliative radiotherapy](https://onco.cc/technologies/palliative-radiotherapy/), [Partners and relationships after cancer: what the divorce data actually show](https://onco.cc/technologies/rejuv-life-partners-and-intimacy/), [Patient-derived organoids](https://onco.cc/technologies/organoids/), [Peer support and support groups](https://onco.cc/technologies/peer-support-groups/), [Pelvic floor rehabilitation after prostate and rectal surgery and after pelvic radiotherapy](https://onco.cc/technologies/rejuv-rehab-pelvic-floor/), [Pharmacogenomic testing before chemotherapy](https://onco.cc/technologies/oncology-pharmacogenomics/), [Polygenic risk scores for cancer](https://onco.cc/technologies/polygenic-risk-scores/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/), [PRO-CTCAE: side effects graded by the person having them](https://onco.cc/technologies/rejuv-measure-pro-ctcae/), [Probiotics for chemotherapy and radiotherapy diarrhoea](https://onco.cc/technologies/probiotics-treatment-diarrhoea/), [PROMIS: the item banks that let a short questionnaire be precise](https://onco.cc/technologies/rejuv-measure-promis/), [Prospective surveillance: looking for the problem before it becomes a disability](https://onco.cc/technologies/rejuv-rehab-prospective-surveillance/), [PSK (Krestin) mushroom polysaccharide as adjuvant therapy](https://onco.cc/technologies/psk-krestin-adjuvant/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Radioembolisation (TARE / SIRT, yttrium-90)](https://onco.cc/technologies/radioembolisation-tare/), [Radiosensitisers](https://onco.cc/technologies/radiosensitisers/), [Recovery after pelvic exenteration](https://onco.cc/technologies/rejuv-recon-pelvic-exenteration/), [Red and processed meat reduction](https://onco.cc/technologies/red-processed-meat-reduction/), [Referral to rehabilitation: the service most people who need it never see](https://onco.cc/technologies/rejuv-access-rehabilitation-referral/), [Residual disease kinetics (BCR-ABL halving and ctDNA slopes)](https://onco.cc/technologies/mrd-kinetics-models/), [Ring-gantry linacs (Halcyon, Ethos)](https://onco.cc/technologies/ring-gantry-linac/), [RNA sequencing & expression profiling](https://onco.cc/technologies/rna-seq/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [Scrambler therapy (Calmare) for chemotherapy nerve pain](https://onco.cc/technologies/scrambler-therapy/), [Screening for distress: what the thermometer can and cannot do](https://onco.cc/technologies/rejuv-mind-distress-screening/), [Serum tumour markers: proper use and misuse](https://onco.cc/technologies/serum-tumour-markers/), [Sexual function and intimacy after cancer, for both sexes](https://onco.cc/technologies/sexual-function-after-cancer/), [Shark cartilage (AE-941, Neovastat)](https://onco.cc/technologies/shark-cartilage/), [Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works](https://onco.cc/technologies/rejuv-mind-sleep-after-cancer/), [Sleep and circadian interventions in cancer](https://onco.cc/technologies/sleep-circadian-interventions/), [Stoma reversal after rectal cancer surgery: who gets the bowel joined up again](https://onco.cc/technologies/rejuv-recon-stoma-reversal/), [Structured exercise programmes after curative treatment](https://onco.cc/technologies/structured-exercise-survivorship/), [Surgical robots: da Vinci, Hugo, Versius and single-port systems](https://onco.cc/technologies/surgical-robot-platforms/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [Systematic drug repurposing](https://onco.cc/technologies/drug-repurposing/), [Targeting the tumour's own microbes](https://onco.cc/technologies/tumour-microbiome-targeting/), [The carer's own recovery: what is known about the person who is not the patient](https://onco.cc/technologies/rejuv-life-carers/), [The exercise prescription after cancer: the dose the guidelines state](https://onco.cc/technologies/exercise-prescription-after-cancer/), [The gap between the rehabilitation people need and the rehabilitation they are offered](https://onco.cc/technologies/rejuv-rehab-provision-gap/), [The questionnaires that were never returned, and the people never asked](https://onco.cc/technologies/rejuv-measure-missing-data-and-who-is-not-asked/), [The word survivor, and why the vocabulary is not a detail](https://onco.cc/technologies/rejuv-mind-the-word-survivor/), [Thermal ablation (RFA, microwave, cryo)](https://onco.cc/technologies/thermal-ablation/), [Thinking and memory after cancer treatment: what is measurable, and what helps](https://onco.cc/technologies/cognitive-impairment-after-cancer-treatment/), [Time-restricted eating in cancer prevention and survivorship](https://onco.cc/technologies/time-restricted-eating/), [Transfusion support and anaemia management](https://onco.cc/technologies/transfusion-support/), [Treating fear of recurrence: the randomised trials, their effect sizes, and where the treatment is available](https://onco.cc/technologies/rejuv-mind-fear-of-recurrence-treatment/), [Tumour mutational burden testing](https://onco.cc/technologies/tmb-testing/), [UGT1A1 genotyping before irinotecan](https://onco.cc/technologies/ugt1a1-genotyping/), [Ultra-processed food and sugar-sweetened drinks](https://onco.cc/technologies/ultra-processed-food-ssb/), [Vitamin D and omega-3 supplementation](https://onco.cc/technologies/vitamin-d-omega3-supplementation/), [Walking, gripping and standing up: the tests that take five minutes](https://onco.cc/technologies/rejuv-measure-functional-tests/), [Wearables and step counts: measuring what someone actually does](https://onco.cc/technologies/rejuv-measure-wearables-and-step-counts/), [What a prehabilitation programme actually contains, and how long it needs](https://onco.cc/technologies/rejuv-rehab-prehabilitation-programme/), [What comes back after treatment, treatment by treatment](https://onco.cc/technologies/rejuv-recovery-matrix/), [What has actually been implemented since those trials, and what has not](https://onco.cc/technologies/rejuv-measure-epro-implementation/), [What recovery costs in the rest of the world](https://onco.cc/technologies/rejuv-access-what-it-costs-elsewhere/), [What recovery costs in the UK, and what it does not](https://onco.cc/technologies/rejuv-access-what-it-costs-uk/), [What recovery costs in the United States](https://onco.cc/technologies/rejuv-access-what-it-costs-us/), [What the randomised trials of prehabilitation found, operation by operation](https://onco.cc/technologies/rejuv-rehab-prehabilitation-evidence/), [Where rehabilitation is commissioned, and who misses out](https://onco.cc/technologies/rejuv-rehab-commissioning-inequity/), [Who misses out on recovery care, measured](https://onco.cc/technologies/rejuv-access-who-misses-out/), [Whole-exome & whole-genome sequencing](https://onco.cc/technologies/wes-wgs/)
- terms: [Abdominoperineal resection](https://onco.cc/terms/abdominoperineal-resection/), [Adenocarcinoma](https://onco.cc/terms/adenocarcinoma/), [Adenoma detection rate](https://onco.cc/terms/adenoma-detection-rate/), [Adenoma-carcinoma sequence](https://onco.cc/terms/adenoma-carcinoma-sequence/), [Adolescent and young adult (AYA) oncology](https://onco.cc/terms/aya-oncology/), [Alcohol-attributable cancer](https://onco.cc/terms/alcohol-attributable-cancer/), [Anti-EGFR rechallenge](https://onco.cc/terms/anti-egfr-rechallenge/), [Bowel cancer after abdominal and pelvic radiotherapy](https://onco.cc/terms/second-primary-bowel-after-abdominal-radiotherapy/), [BRAF V600E mutation](https://onco.cc/terms/braf-v600-mutation/), [Cancer Drugs Fund (England)](https://onco.cc/terms/cancer-drugs-fund/), [Cancer-related fatigue (tiredness)](https://onco.cc/terms/cancer-related-fatigue/), [Carers: what you can do and UK carer support (bowel cancer)](https://onco.cc/terms/carers-bowel-cancer-uk/), [Cell-free DNA (cfDNA)](https://onco.cc/terms/cfdna/), [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Circumferential resection margin (rectal cancer)](https://onco.cc/terms/circumferential-resection-margin/), [Clinical complete response (cCR)](https://onco.cc/terms/clinical-complete-response/), [Clonal evolution and the ecological view of cancer](https://onco.cc/terms/clonal-evolution-theory/), [Colectomy](https://onco.cc/terms/colectomy/), [Colibactin](https://onco.cc/terms/colibactin/), [Colonoscopy](https://onco.cc/terms/colonoscopy/), [Colorectal cancer drugs in England: what NICE has recommended](https://onco.cc/terms/colorectal-uk-drug-access/), [Colorectal cancer trials open today (registry snapshot)](https://onco.cc/terms/colorectal-trials-open-today/), [Colorectal cancer: the failed and stopped programmes, and why](https://onco.cc/terms/colorectal-failed-programmes/), [Complete response](https://onco.cc/terms/complete-response/), [Consensus molecular subtypes (CMS1-4)](https://onco.cc/terms/cms-subtypes/), [Conversion therapy in bowel cancer](https://onco.cc/terms/conversion-therapy-colorectal/), [Copy number alteration (CNA)](https://onco.cc/terms/copy-number-variation-term/), [CpG island methylator phenotype (CIMP)](https://onco.cc/terms/cimp/), [Curative intent vs palliative intent](https://onco.cc/terms/curative-intent/), [Cytoreductive surgery](https://onco.cc/terms/cytoreductive-surgery/), [Debulking (cytoreductive surgery)](https://onco.cc/terms/debulking/), [Downstaging and conversion therapy](https://onco.cc/terms/downstaging/), [Driver mutation](https://onco.cc/terms/driver-mutation/), [Dysplasia (pre-cancerous change)](https://onco.cc/terms/dysplasia/), [Emergency presentation (route to diagnosis)](https://onco.cc/terms/emergency-presentation/), [EMR and ESD (endoscopic mucosal resection, endoscopic submucosal dissection)](https://onco.cc/terms/endoscopic-resection-term/), [Endoscopy (EGD, EUS, ERCP)](https://onco.cc/terms/endoscopy/), [Extended RAS testing](https://onco.cc/terms/extended-ras-testing/), [Faecal immunochemical test (FIT)](https://onco.cc/terms/fit-test/), [Faecal occult blood test (guaiac)](https://onco.cc/terms/faecal-occult-blood-test/), [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Financial toxicity](https://onco.cc/terms/financial-toxicity/), [FISH / ISH (in situ hybridisation)](https://onco.cc/terms/fish/), [FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX](https://onco.cc/terms/folfox-family/), [Gene amplification and copy-number change](https://onco.cc/terms/gene-amplification/), [Gene fusion](https://onco.cc/terms/gene-fusion/), [Germline vs somatic mutations](https://onco.cc/terms/germline-vs-somatic/), [Glycaemic index and glycaemic load](https://onco.cc/terms/glycaemic-index/), [Grade](https://onco.cc/terms/tumour-grade/), [Hand-foot syndrome and hand-foot skin reaction](https://onco.cc/terms/hand-foot-syndrome/), [Hepatectomy (liver resection)](https://onco.cc/terms/hepatectomy/), [HERACLES criteria (HER2 in bowel cancer)](https://onco.cc/terms/heracles-criteria/), [Hereditary cancer syndromes](https://onco.cc/terms/hereditary-cancer-syndromes/), [HIPEC (hyperthermic intraperitoneal chemotherapy)](https://onco.cc/terms/hipec-procedure/), [Hot vs cold tumours](https://onco.cc/terms/cold-vs-hot/), [Hypofractionation (fewer, larger radiotherapy doses)](https://onco.cc/terms/hypofractionation/), [Immune exclusion](https://onco.cc/terms/immune-exclusion/), [Immunohistochemistry (IHC)](https://onco.cc/terms/ihc/), [Immunoscore](https://onco.cc/terms/immunoscore/), [Interval cancer](https://onco.cc/terms/interval-cancer/), [KRAS mutation subtypes (G12C, G12D, G12V)](https://onco.cc/terms/kras-mutation-subtypes/), [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [LGR5](https://onco.cc/terms/lgr5/), [Liver-directed therapy (TACE, TARE, HAI, ablation)](https://onco.cc/terms/liver-directed-therapy/), [Liver-limited metastatic bowel cancer](https://onco.cc/terms/liver-limited-metastatic-colorectal/), [Living with a stoma after bowel cancer surgery](https://onco.cc/terms/living-with-a-stoma-bowel-cancer/), [Living with FOLFOX, CAPOX, FOLFIRI and the EGFR antibodies](https://onco.cc/terms/chemotherapy-side-effects-colorectal/), [Low anterior resection syndrome (LARS)](https://onco.cc/terms/low-anterior-resection-syndrome/), [Lynch syndrome](https://onco.cc/terms/lynch-syndrome/), [Lynch syndrome testing after bowel cancer, and what it means for the family](https://onco.cc/terms/lynch-syndrome-testing-uk/), [Malnutrition screening tools (MUST, NRS-2002, MST, PG-SGA)](https://onco.cc/terms/malnutrition-screening/), [Metabolic syndrome and insulin resistance](https://onco.cc/terms/metabolic-syndrome/), [Microenvironment and inflammation: tumours as wounds that do not heal](https://onco.cc/terms/microenvironment-inflammation-theory/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/), [Microsatellite-stable (MSS) / mismatch-repair proficient (pMMR)](https://onco.cc/terms/mss-pmmr/), [Microwave ablation (MWA)](https://onco.cc/terms/microwave-ablation/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [MLH1 promoter methylation (sporadic versus Lynch mismatch repair loss)](https://onco.cc/terms/mlh1-promoter-methylation/), [Mucositis and stomatitis](https://onco.cc/terms/mucositis/), [Mutational signature](https://onco.cc/terms/mutational-signature/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Neoantigen](https://onco.cc/terms/neoantigen/), [Neutropenia](https://onco.cc/terms/neutropenia/), [Next-generation sequencing (NGS)](https://onco.cc/terms/ngs/), [NHS bowel cancer screening programme](https://onco.cc/terms/bowel-cancer-screening-uk/), [Nutrition impact symptoms](https://onco.cc/terms/nutrition-impact-symptoms/), [Obesity-related cancers (IARC list of 13)](https://onco.cc/terms/obesity-related-cancers/), [Obstruction and T4 disease in bowel cancer](https://onco.cc/terms/obstructing-colorectal-cancer/), [Oligometastatic disease](https://onco.cc/terms/oligometastatic/), [Organ preservation (watch-and-wait, bladder-sparing, larynx preservation)](https://onco.cc/terms/organ-preservation/), [Palliation in colorectal cancer: obstruction, stents, stomas and liver capsule pain](https://onco.cc/terms/colorectal-palliation-obstruction-pain/), [Performance status (ECOG, Karnofsky)](https://onco.cc/terms/performance-status/), [Peripheral neuropathy (chemotherapy-induced)](https://onco.cc/terms/peripheral-neuropathy/), [Peritoneal cancer index](https://onco.cc/terms/peritoneal-carcinomatosis-index/), [Peritoneal metastases from bowel cancer](https://onco.cc/terms/colorectal-peritoneal-metastases/), [Peritoneal metastasis](https://onco.cc/terms/peritoneal-metastasis/), [Peritoneum and peritoneal metastases](https://onco.cc/terms/peritoneum/), [Platinum drugs and PARP inhibitors: the newer leukaemia risk](https://onco.cc/terms/rejuv-second-platinum-and-parp-inhibitors/), [POLE ultramutation (POLEmut)](https://onco.cc/terms/pole-ultramutation/), [Polyp types in the bowel](https://onco.cc/terms/colorectal-polyp-types/), [R-spondin fusion](https://onco.cc/terms/rspo-fusion/), [Radiofrequency ablation (RFA)](https://onco.cc/terms/radiofrequency-ablation/), [Radiotherapy](https://onco.cc/terms/radiotherapy/), [Radiotherapy and second cancers: field, dose and age at exposure](https://onco.cc/terms/rejuv-second-radiotherapy-dose-field-and-age/), [Rash and skin toxicity (acneiform rash, paronychia)](https://onco.cc/terms/rash-skin-toxicity/), [Re-irradiation](https://onco.cc/terms/re-irradiation/), [Resectable, borderline resectable and unresectable](https://onco.cc/terms/resectability/), [Screening survivors: where the UK, American and European answers differ](https://onco.cc/terms/rejuv-second-screening-after-treatment-compared/), [Screening uptake](https://onco.cc/terms/screening-uptake/), [Seed and soil hypothesis of metastasis (Paget)](https://onco.cc/terms/seed-and-soil-hypothesis/), [Serrated pathway](https://onco.cc/terms/serrated-pathway/), [Sexual function, fertility and body image after bowel cancer](https://onco.cc/terms/sex-fertility-after-bowel-cancer/), [Sidedness (left vs right colon)](https://onco.cc/terms/sidedness/), [Somatic mutation theory of cancer](https://onco.cc/terms/somatic-mutation-theory/), [Somatic mutations from exome and genome sequencing (WXS, WGS)](https://onco.cc/terms/somatic-mutations-wxs-wgs/), [Stage shift](https://onco.cc/terms/stage-shift/), [Stoma (colostomy, ileostomy, urostomy)](https://onco.cc/terms/stoma/), [Surveillance intervals after polypectomy](https://onco.cc/terms/colonoscopy-surveillance-intervals/), [TARE / SIRT (radioembolisation with yttrium-90)](https://onco.cc/terms/tare/), [TNM staging](https://onco.cc/terms/tnm-staging/), [Total mesorectal excision (TME)](https://onco.cc/terms/total-mesorectal-excision/), [Total neoadjuvant therapy (TNT, rectal cancer)](https://onco.cc/terms/total-neoadjuvant-therapy/), [Tumour marker](https://onco.cc/terms/tumour-marker/), [Tumour markers (CEA, LDH, chromogranin, thyroglobulin)](https://onco.cc/terms/tumour-markers/), [Tumour mutational burden (TMB)](https://onco.cc/terms/tmb/), [Tumour-agnostic (tissue-agnostic) approval](https://onco.cc/terms/tumour-agnostic/), [Tumour-informed versus tumour-naive ctDNA assays](https://onco.cc/terms/tumour-informed-assay/), [Variant of uncertain significance (VUS)](https://onco.cc/terms/vus/), [Watch and wait after chemoradiotherapy for rectal cancer](https://onco.cc/terms/watch-and-wait-rectal-cancer/), [When to seek urgent help with bowel cancer (NHS 111 and 999)](https://onco.cc/terms/urgent-help-bowel-cancer/), [Wild-type (WT)](https://onco.cc/terms/wild-type/), [Work and money with bowel cancer (UK)](https://onco.cc/terms/work-and-money-bowel-cancer-uk/)
- drugs: [ABT-301](https://onco.cc/drugs/abt-301/), [Adagrasib](https://onco.cc/drugs/adagrasib/), [AK117](https://onco.cc/drugs/ak117/), [AK119](https://onco.cc/drugs/ak119/), [Aspirin](https://onco.cc/drugs/aspirin/), [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Autogene cevumeran](https://onco.cc/drugs/autogene-cevumeran/), [Avelumab](https://onco.cc/drugs/avelumab/), [Balstilimab](https://onco.cc/drugs/balstilimab/), [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [Botensilimab](https://onco.cc/drugs/botensilimab/), [Calderasib](https://onco.cc/drugs/calderasib/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [CAPOX (capecitabine, oxaliplatin)](https://onco.cc/drugs/capox/), [Catumaxomab](https://onco.cc/drugs/catumaxomab/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [Cobimetinib](https://onco.cc/drugs/cobimetinib/), [Cologuard](https://onco.cc/drugs/cologuard/), [Cologuard Plus](https://onco.cc/drugs/cologuard-plus/), [CT3001](https://onco.cc/drugs/ct3001/), [Daraxonrasib](https://onco.cc/drugs/daraxonrasib/), [Divarasib](https://onco.cc/drugs/divarasib/), [Dostarlimab](https://onco.cc/drugs/dostarlimab/), [Doxifluridine](https://onco.cc/drugs/doxifluridine/), [EIK1005](https://onco.cc/drugs/eik1005/), [ELI-002 7P](https://onco.cc/drugs/eli-002-7p/), [Elironrasib](https://onco.cc/drugs/elironrasib/), [Encorafenib](https://onco.cc/drugs/encorafenib/), [Entrectinib](https://onco.cc/drugs/entrectinib/), [Envafolimab](https://onco.cc/drugs/envafolimab/), [Favezelimab](https://onco.cc/drugs/favezelimab/), [Floxuridine](https://onco.cc/drugs/floxuridine/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [FOLFIRI (5-FU, leucovorin, irinotecan)](https://onco.cc/drugs/folfiri/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [FOLFOXIRI (5-FU, leucovorin, oxaliplatin, irinotecan)](https://onco.cc/drugs/folfoxiri/), [FoundationOne CDx / Liquid CDx](https://onco.cc/drugs/foundationone-cdx/), [Fruquintinib](https://onco.cc/drugs/fruquintinib/), [Gotistobart](https://onco.cc/drugs/gotistobart/), [GRT-C901](https://onco.cc/drugs/grt-c901/), [GRT-R902](https://onco.cc/drugs/grt-r902/), [Guardant Reveal](https://onco.cc/drugs/guardant-reveal/), [Guardant360 CDx](https://onco.cc/drugs/guardant360-cdx/), [HDM2017](https://onco.cc/drugs/hdm2017/), [HR070803](https://onco.cc/drugs/hr070803/), [IBI363](https://onco.cc/drugs/ibi363/), [INCA33890](https://onco.cc/drugs/inca33890/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Irinotecan (and liposomal irinotecan)](https://onco.cc/drugs/irinotecan/), [Ivonescimab](https://onco.cc/drugs/ivonescimab/), [JDQ443](https://onco.cc/drugs/jdq443/), [JK08](https://onco.cc/drugs/jk08/), [JMT203](https://onco.cc/drugs/jmt203/), [JYP0015](https://onco.cc/drugs/jyp0015/), [Lapatinib](https://onco.cc/drugs/lapatinib/), [Larotrectinib](https://onco.cc/drugs/larotrectinib/), [Leucovorin (folinic acid)](https://onco.cc/drugs/leucovorin/), [MCLA-129](https://onco.cc/drugs/mcla-129/), [MI Cancer Seek](https://onco.cc/drugs/caris-mi-cancer-seek/), [Mitomycin C](https://onco.cc/drugs/mitomycin/), [MRTX1133](https://onco.cc/drugs/mrtx1133/), [Napabucasin](https://onco.cc/drugs/napabucasin/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Oleclumab](https://onco.cc/drugs/oleclumab/), [Olomorasib](https://onco.cc/drugs/olomorasib/), [Oncodetect](https://onco.cc/drugs/oncodetect/), [Onvansertib](https://onco.cc/drugs/onvansertib/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Panitumumab](https://onco.cc/drugs/panitumumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Pertuzumab](https://onco.cc/drugs/pertuzumab/), [Petosemtamab](https://onco.cc/drugs/petosemtamab/), [PF-08634404](https://onco.cc/drugs/pf-08634404/), [PM8002](https://onco.cc/drugs/pm8002/), [Precemtabart tocentecan](https://onco.cc/drugs/precemtabart-tocentecan/), [Pucotenlimab](https://onco.cc/drugs/pucotenlimab/), [QL1706](https://onco.cc/drugs/ql1706/), [Raltitrexed](https://onco.cc/drugs/raltitrexed/), [Ramucirumab](https://onco.cc/drugs/ramucirumab/), [Regorafenib](https://onco.cc/drugs/regorafenib/), [Selpercatinib](https://onco.cc/drugs/selpercatinib/), [SGM-101](https://onco.cc/drugs/sgm-101/), [Shield](https://onco.cc/drugs/shield/), [SHR-8068](https://onco.cc/drugs/shr-8068/), [Signatera](https://onco.cc/drugs/signatera/), [SimpleScreen CRC](https://onco.cc/drugs/simplescreen-crc/), [Sitneprotafib](https://onco.cc/drugs/sitneprotafib/), [Sotevtamab](https://onco.cc/drugs/sotevtamab/), [Sotorasib](https://onco.cc/drugs/sotorasib/), [Tegafur, gimeracil and oteracil (S-1)](https://onco.cc/drugs/tegafur-gimeracil-oteracil/), [Telisotuzumab adizutecan](https://onco.cc/drugs/telisotuzumab-adizutecan/), [Tempus xT CDx](https://onco.cc/drugs/tempus-xt-cdx/), [therascreen companion diagnostic kits (KRAS, EGFR, PIK3CA, FGFR, BRAF)](https://onco.cc/drugs/therascreen-cdx/), [TQB2922](https://onco.cc/drugs/tqb2922/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [Trifluridine/tipiracil](https://onco.cc/drugs/trifluridine-tipiracil/), [TruSight Oncology Comprehensive](https://onco.cc/drugs/trusight-oncology-comprehensive/), [TST003](https://onco.cc/drugs/tst003/), [Tucatinib](https://onco.cc/drugs/tucatinib/), [Tunlametinib](https://onco.cc/drugs/tunlametinib/), [VB15010](https://onco.cc/drugs/vb15010/), [Vemurafenib](https://onco.cc/drugs/vemurafenib/), [VENTANA MMR RxDx Panel](https://onco.cc/drugs/ventana-mmr-rxdx/), [VS-7375](https://onco.cc/drugs/vs-7375/), [XNW27011](https://onco.cc/drugs/xnw27011/), [YL202](https://onco.cc/drugs/yl202/), [Ziv-aflibercept](https://onco.cc/drugs/ziv-aflibercept/), [Zoldonrasib](https://onco.cc/drugs/zoldonrasib/)
- targets: [ACKR3](https://onco.cc/targets/ackr3/), [ACVR1B](https://onco.cc/targets/acvr1b/), [ACVR2A](https://onco.cc/targets/acvr2a/), [AFDN](https://onco.cc/targets/afdn/), [AFF4](https://onco.cc/targets/aff4/), [ALCAM](https://onco.cc/targets/alcam/), [ALK](https://onco.cc/targets/alk/), [AMER1](https://onco.cc/targets/amer1/), [ANK1](https://onco.cc/targets/ank1/), [APC](https://onco.cc/targets/apc/), [ARAF](https://onco.cc/targets/araf/), [AREG](https://onco.cc/targets/areg/), [ARHGEF12](https://onco.cc/targets/arhgef12/), [ARID1A](https://onco.cc/targets/arid1a/), [ARID1B](https://onco.cc/targets/arid1b/), [ASXL1](https://onco.cc/targets/asxl1/), [ATF1](https://onco.cc/targets/atf1/), [ATM](https://onco.cc/targets/atm/), [ATP1A1](https://onco.cc/targets/atp1a1/), [ATP2B3](https://onco.cc/targets/atp2b3/), [ATRX](https://onco.cc/targets/atrx/), [AXIN2](https://onco.cc/targets/axin2/), [B2M](https://onco.cc/targets/b2m/), [BARD1](https://onco.cc/targets/bard1/), [BCL11B](https://onco.cc/targets/bcl11b/), [BCL3](https://onco.cc/targets/bcl3/), [BCL6](https://onco.cc/targets/bcl6/), [BCL9](https://onco.cc/targets/bcl9/), [BCL9L](https://onco.cc/targets/bcl9l/), [BCOR](https://onco.cc/targets/bcor/), [BCORL1](https://onco.cc/targets/bcorl1/), [BIRC6](https://onco.cc/targets/birc6/), [BIRC7](https://onco.cc/targets/birc7/), [BLM](https://onco.cc/targets/blm/), [BMP2](https://onco.cc/targets/bmp2/), [BMP4](https://onco.cc/targets/bmp4/), [BMP5](https://onco.cc/targets/bmp5/), [BMPR1A](https://onco.cc/targets/bmpr1a/), [BRAF](https://onco.cc/targets/braf/), [BRIP1](https://onco.cc/targets/brip1/), [BUB1B](https://onco.cc/targets/bub1b/), [C11orf65](https://onco.cc/targets/c11orf65/), [CACNA1D](https://onco.cc/targets/cacna1d/), [CARD11](https://onco.cc/targets/card11/), [CCND1](https://onco.cc/targets/ccnd1/), [CCND2](https://onco.cc/targets/ccnd2/), [CCNE1](https://onco.cc/targets/ccne1/), [CD44](https://onco.cc/targets/cd44/), [CD79A](https://onco.cc/targets/cd79a/), [CDC73](https://onco.cc/targets/cdc73/), [CDH11](https://onco.cc/targets/cdh11/), [CDKN1A](https://onco.cc/targets/cdkn1a/), [CDX2](https://onco.cc/targets/cdx2/), [CEACAM1](https://onco.cc/targets/ceacam1/), [CEACAM5](https://onco.cc/targets/ceacam5/), [CEP89](https://onco.cc/targets/cep89/), [CHD4](https://onco.cc/targets/chd4/), [CHEK2](https://onco.cc/targets/chek2/), [CIC](https://onco.cc/targets/cic/), [CIITA](https://onco.cc/targets/ciita/), [COX-2 (PTGS2)](https://onco.cc/targets/cox2/), [CRAF (RAF1)](https://onco.cc/targets/raf1/), [CRTC1](https://onco.cc/targets/crtc1/), [CSMD3](https://onco.cc/targets/csmd3/), [CTCF](https://onco.cc/targets/ctcf/), [CTLA-4](https://onco.cc/targets/ctla4/), [CTNNA1](https://onco.cc/targets/ctnna1/), [CTNNB1](https://onco.cc/targets/ctnnb1/), [CYLD](https://onco.cc/targets/cyld/), [DCAF12L2](https://onco.cc/targets/dcaf12l2/), [DCC](https://onco.cc/targets/dcc/), [DCLK1](https://onco.cc/targets/dclk1/), [DDX5](https://onco.cc/targets/ddx5/), [DICER1](https://onco.cc/targets/dicer1/), [DKK1](https://onco.cc/targets/dkk1/), [DNM2](https://onco.cc/targets/dnm2/), [DUSP16](https://onco.cc/targets/dusp16/), [EGFR](https://onco.cc/targets/egfr/), [EIF4EBP1](https://onco.cc/targets/eif4ebp1/), [ELF3](https://onco.cc/targets/elf3/), [EP300](https://onco.cc/targets/ep300/), [EpCAM](https://onco.cc/targets/epcam/), [EPHA7](https://onco.cc/targets/epha7/), [EPHB4](https://onco.cc/targets/ephb4/), [ERCC2](https://onco.cc/targets/ercc2/), [ERCC3](https://onco.cc/targets/ercc3/), [ERCC4](https://onco.cc/targets/ercc4/), [ERCC5](https://onco.cc/targets/ercc5/), [ERCC6](https://onco.cc/targets/ercc6/), [EREG](https://onco.cc/targets/ereg/), [ETV1](https://onco.cc/targets/etv1/), [ETV5](https://onco.cc/targets/etv5/), [FANCA](https://onco.cc/targets/fanca/), [FANCC](https://onco.cc/targets/fancc/), [FANCE](https://onco.cc/targets/fance/), [FANCG](https://onco.cc/targets/fancg/), [FAT3](https://onco.cc/targets/fat3/), [FAT4](https://onco.cc/targets/fat4/), [FBXO11](https://onco.cc/targets/fbxo11/), [FBXW7](https://onco.cc/targets/fbxw7/), [FES](https://onco.cc/targets/fes/), [FGFR4](https://onco.cc/targets/fgfr4/), [FLCN](https://onco.cc/targets/flcn/), [FOS](https://onco.cc/targets/fos/), [FOXC2](https://onco.cc/targets/foxc2/), [FOXF1](https://onco.cc/targets/foxf1/), [FUBP1](https://onco.cc/targets/fubp1/), [GNAS](https://onco.cc/targets/gnas/), [GREM1](https://onco.cc/targets/grem1/), [GRIN2A](https://onco.cc/targets/grin2a/), [GSTP1](https://onco.cc/targets/gstp1/), [HCK kinase](https://onco.cc/targets/hck/), [HER2](https://onco.cc/targets/her2/), [HHIP](https://onco.cc/targets/hhip/), [HLA-C](https://onco.cc/targets/hla-c/), [HNF1A](https://onco.cc/targets/hnf1a/), [HOXC11](https://onco.cc/targets/hoxc11/), [HOXD11](https://onco.cc/targets/hoxd11/), [HRAS](https://onco.cc/targets/hras/), [HSPA5](https://onco.cc/targets/hspa5/), [HSPH1](https://onco.cc/targets/hsph1/), [IL-11 receptor alpha](https://onco.cc/targets/il11ra/), [IL6ST](https://onco.cc/targets/il6st/), [ING1](https://onco.cc/targets/ing1/), [IRS2](https://onco.cc/targets/irs2/), [IRS4](https://onco.cc/targets/irs4/), [JAK3](https://onco.cc/targets/jak3/), [JUN](https://onco.cc/targets/jun/), [KAT6A](https://onco.cc/targets/kat6a/), [KAT6B](https://onco.cc/targets/kat6b/), [KDM5A](https://onco.cc/targets/kdm5a/), [KDM5C](https://onco.cc/targets/kdm5c/), [KLF5](https://onco.cc/targets/klf5/), [KMT2C](https://onco.cc/targets/kmt2c/), [KMT2D](https://onco.cc/targets/kmt2d/), [KNL1](https://onco.cc/targets/knl1/), [KRAS](https://onco.cc/targets/kras/), [LATS1](https://onco.cc/targets/lats1/), [LATS2](https://onco.cc/targets/lats2/), [LGR5](https://onco.cc/targets/lgr5-gene/), [LMO1](https://onco.cc/targets/lmo1/), [LRP1B](https://onco.cc/targets/lrp1b/), [MAF](https://onco.cc/targets/maf/), [MAFB](https://onco.cc/targets/mafb/), [MAP2K4](https://onco.cc/targets/map2k4/), [MAP3K1](https://onco.cc/targets/map3k1/), [MAPK11](https://onco.cc/targets/mapk11/), [MAX](https://onco.cc/targets/max/), [MBD4](https://onco.cc/targets/mbd4/), [MEK1/2](https://onco.cc/targets/mek/), [MIR218-1](https://onco.cc/targets/mir218-1/), [Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2)](https://onco.cc/targets/mmr/), [MLH1](https://onco.cc/targets/mlh1/), [MLH3](https://onco.cc/targets/mlh3/), [MN1](https://onco.cc/targets/mn1/), [MPRIP](https://onco.cc/targets/mprip/), [MSH2](https://onco.cc/targets/msh2/), [MSH3](https://onco.cc/targets/msh3/), [MSH6](https://onco.cc/targets/msh6/), [MT-CO1](https://onco.cc/targets/mt-co1/), [MUTYH](https://onco.cc/targets/mutyh/), [MYB](https://onco.cc/targets/myb/), [MYC](https://onco.cc/targets/myc-gene/), [MYH9](https://onco.cc/targets/myh9/), [MYOD1](https://onco.cc/targets/myod1/), [NBEA](https://onco.cc/targets/nbea/), [NCOA3](https://onco.cc/targets/ncoa3/), [NCOR1](https://onco.cc/targets/ncor1/), [NCOR2](https://onco.cc/targets/ncor2/), [NDRG1](https://onco.cc/targets/ndrg1/), [NFATC2](https://onco.cc/targets/nfatc2/), [NFKB2](https://onco.cc/targets/nfkb2/), [NIN](https://onco.cc/targets/nin/), [NOTCH1](https://onco.cc/targets/notch1/), [NR2F2](https://onco.cc/targets/nr2f2/), [NR4A3](https://onco.cc/targets/nr4a3/), [NRAS](https://onco.cc/targets/nras/), [NRG1](https://onco.cc/targets/nrg1/), [NSD2](https://onco.cc/targets/nsd2/), [NSD3](https://onco.cc/targets/nsd3/), [NTHL1](https://onco.cc/targets/nthl1/), [NTRK](https://onco.cc/targets/ntrk/), [OLIG2](https://onco.cc/targets/olig2/), [PALB2](https://onco.cc/targets/palb2/), [PALD1 (paladin)](https://onco.cc/targets/pald1/), [PARP4](https://onco.cc/targets/parp4/), [PATZ1](https://onco.cc/targets/patz1/), [PBRM1](https://onco.cc/targets/pbrm1/), [PCBP1](https://onco.cc/targets/pcbp1/), [PD-1](https://onco.cc/targets/pd1/), [PDGFRL](https://onco.cc/targets/pdgfrl/), [PER1](https://onco.cc/targets/per1/), [PHLPP2](https://onco.cc/targets/phlpp2/), [PHOX2B](https://onco.cc/targets/phox2b/), [PIK3CA / PI3K-alpha](https://onco.cc/targets/pik3ca/), [PIK3R1](https://onco.cc/targets/pik3r1/), [PMS1](https://onco.cc/targets/pms1/), [PMS2](https://onco.cc/targets/pms2/), [POLD1](https://onco.cc/targets/pold1/), [POLE](https://onco.cc/targets/pole/), [POLQ](https://onco.cc/targets/polq/), [POU5F1](https://onco.cc/targets/pou5f1/), [POU5F1B](https://onco.cc/targets/pou5f1b/), [PPARG](https://onco.cc/targets/pparg/), [PPM1D](https://onco.cc/targets/ppm1d/), [PPP1R15A](https://onco.cc/targets/ppp1r15a/), [PPP2R1A](https://onco.cc/targets/ppp2r1a/), [PRDM1](https://onco.cc/targets/prdm1/), [PREX2](https://onco.cc/targets/prex2/), [PRKD1](https://onco.cc/targets/prkd1/), [PRNCR1](https://onco.cc/targets/prncr1/), [PSIP1](https://onco.cc/targets/psip1/), [PSMD4](https://onco.cc/targets/psmd4/), [PTEN](https://onco.cc/targets/pten/), [PTK6 (BRK)](https://onco.cc/targets/ptk6/), [PTP4A3](https://onco.cc/targets/ptp4a3/), [PTPRC](https://onco.cc/targets/ptprc/), [PTPRK](https://onco.cc/targets/ptprk/), [QKI](https://onco.cc/targets/qki/), [RAD50](https://onco.cc/targets/rad50/), [RAD51D](https://onco.cc/targets/rad51d/), [RASA1](https://onco.cc/targets/rasa1/), [RBM10](https://onco.cc/targets/rbm10/), [RECQL4](https://onco.cc/targets/recql4/), [RET](https://onco.cc/targets/ret/), [RICTOR](https://onco.cc/targets/rictor/), [RNF43](https://onco.cc/targets/rnf43/), [RNF6](https://onco.cc/targets/rnf6/), [ROBO2](https://onco.cc/targets/robo2/), [RON receptor (MST1R)](https://onco.cc/targets/ron/), [RPL22](https://onco.cc/targets/rpl22/), [RRN3](https://onco.cc/targets/rrn3/), [RSPO2](https://onco.cc/targets/rspo2/), [RSPO3](https://onco.cc/targets/rspo3/), [SALL4](https://onco.cc/targets/sall4/), [SDHA](https://onco.cc/targets/sdha/), [SDHC](https://onco.cc/targets/sdhc/), [SETDB1](https://onco.cc/targets/setdb1/), [SFRP4](https://onco.cc/targets/sfrp4/), [SH2B3](https://onco.cc/targets/sh2b3/), [SHP2 (PTPN11)](https://onco.cc/targets/shp2/), [SIRPA](https://onco.cc/targets/sirpa/), [SIX1](https://onco.cc/targets/six1/), [SLC34A2](https://onco.cc/targets/slc34a2/), [SLFN11](https://onco.cc/targets/slfn11/), [SMAD2](https://onco.cc/targets/smad2/), [SMAD3](https://onco.cc/targets/smad3/), [SMAD4](https://onco.cc/targets/smad4/), [SMAD7](https://onco.cc/targets/smad7/), [SND1](https://onco.cc/targets/snd1/), [SOX2](https://onco.cc/targets/sox2/), [SOX9](https://onco.cc/targets/sox9/), [SYK](https://onco.cc/targets/syk/), [TAF1L](https://onco.cc/targets/taf1l/), [TBX3](https://onco.cc/targets/tbx3/), [TCF7L2](https://onco.cc/targets/tcf7l2/), [TENT5C](https://onco.cc/targets/tent5c/), [TET1](https://onco.cc/targets/tet1/), [TFE3](https://onco.cc/targets/tfe3/), [TGFB1](https://onco.cc/targets/tgfb1/), [TGFBR2](https://onco.cc/targets/tgfbr2/), [TGIF1](https://onco.cc/targets/tgif1/), [THBS2](https://onco.cc/targets/thbs2/), [Thymidylate synthase (TYMS)](https://onco.cc/targets/tyms/), [TIE2 receptor (TEK)](https://onco.cc/targets/tie2/), [TMEM238L](https://onco.cc/targets/tmem238l/), [Topoisomerase I (TOP1)](https://onco.cc/targets/top1/), [TP53](https://onco.cc/targets/tp53/), [TPM3](https://onco.cc/targets/tpm3/), [TRIM33](https://onco.cc/targets/trim33/), [TRRAP](https://onco.cc/targets/trrap/), [TSC1](https://onco.cc/targets/tsc1/), [TYMP](https://onco.cc/targets/tymp/), [UBR5](https://onco.cc/targets/ubr5/), [UGT1A](https://onco.cc/targets/ugt1a/), [USP6](https://onco.cc/targets/usp6/), [VEGF / VEGFR](https://onco.cc/targets/vegf/), [WNT11](https://onco.cc/targets/wnt11/), [WNT6](https://onco.cc/targets/wnt6/), [WRN helicase (MSI-high cancers)](https://onco.cc/targets/wrn/), [XPA](https://onco.cc/targets/xpa/), [ZEB1](https://onco.cc/targets/zeb1/), [ZMIZ1](https://onco.cc/targets/zmiz1/)
- companies: [A2 Biotherapeutics](https://onco.cc/companies/a2-biotherapeutics/), [Abbott Laboratories](https://onco.cc/companies/abbott/), [Adventris Pharmaceuticals](https://onco.cc/companies/adventris-pharmaceuticals/), [Aeterna Zentaris](https://onco.cc/companies/aeterna-zentaris/), [Agenus](https://onco.cc/companies/agenus/), [AIO (Arbeitsgemeinschaft Internistische Onkologie)](https://onco.cc/companies/aio/), [Alliance for Clinical Trials in Oncology](https://onco.cc/companies/alliance-oncology/), [Ambagon Therapeutics](https://onco.cc/companies/ambagon-therapeutics/), [Amgen](https://onco.cc/companies/amgen/), [Anbogen Therapeutics](https://onco.cc/companies/anbogen-therapeutics/), [Artios Pharma](https://onco.cc/companies/artios-pharma/), [Australasian Gastro-Intestinal Trials Group](https://onco.cc/companies/agitg/), [Austrian Breast & Colorectal Cancer Study Group](https://onco.cc/companies/abcsg/), [Bayer](https://onco.cc/companies/bayer/), [Belmont Medical Technologies](https://onco.cc/companies/belmont-medical-technologies/), [BigHat Biosciences](https://onco.cc/companies/bighat-biosciences/), [Boston Scientific](https://onco.cc/companies/boston-scientific/), [BridgeBio Oncology Therapeutics](https://onco.cc/companies/bridgebio-oncology-therapeutics/), [Bristol Myers Squibb](https://onco.cc/companies/bms/), [Canadian Cancer Trials Group (CCTG)](https://onco.cc/companies/cctg/), [Cancer Prevention Pharmaceuticals](https://onco.cc/companies/cancer-prevention-pharmaceuticals/), [Capnomed (Reger Medizintechnik)](https://onco.cc/companies/capnomed/), [CMR Surgical](https://onco.cc/companies/cmr-surgical/), [Criterium](https://onco.cc/companies/criterium/), [CytomX Therapeutics](https://onco.cc/companies/cytomx-therapeutics/), [D3 Bio (Wuxi)](https://onco.cc/companies/d3-bio-wuxi/), [Eikon Therapeutics](https://onco.cc/companies/eikon-therapeutics/), [Eli Lilly (incl. Loxo)](https://onco.cc/companies/eli-lilly/), [Erasca](https://onco.cc/companies/erasca/), [Exact Sciences (Abbott)](https://onco.cc/companies/exact-sciences/), [Freenome](https://onco.cc/companies/freenome/), [Frontier Medicines](https://onco.cc/companies/frontier-medicines/), [Geneoscopy](https://onco.cc/companies/geneoscopy/), [GI Innovation](https://onco.cc/companies/gi-innovation/), [Gritstone bio](https://onco.cc/companies/gritstone/), [GSK](https://onco.cc/companies/gsk/), [Guardant Health](https://onco.cc/companies/guardant-health/), [Haystack Oncology](https://onco.cc/companies/haystack-oncology/), [Helio Genomics](https://onco.cc/companies/helio-genomics/), [Korean Cancer Study Group](https://onco.cc/companies/kcsg/), [Kumquat Biosciences](https://onco.cc/companies/kumquat-biosciences/), [Lucence](https://onco.cc/companies/lucence/), [Lyell Immunopharma](https://onco.cc/companies/lyell-immunopharma/), [Mabwell (Shanghai) Bioscience](https://onco.cc/companies/mabwell-shanghai-bioscience/), [Mast Therapeutics](https://onco.cc/companies/mast-therapeutics/), [MBrace Therapeutics](https://onco.cc/companies/mbrace-therapeutics/), [Menarini Silicon Biosystems](https://onco.cc/companies/menarini-silicon-biosystems/), [Merck & Co. (MSD)](https://onco.cc/companies/merck/), [Merck KGaA (EMD Serono)](https://onco.cc/companies/merck-kgaa/), [ModeX Therapeutics](https://onco.cc/companies/modex-therapeutics/), [MRC Clinical Trials Unit at UCL](https://onco.cc/companies/mrc-ctu/), [Multitude Therapeutics](https://onco.cc/companies/multitude-therapeutics/), [Natera](https://onco.cc/companies/natera/), [NatureCeuticals](https://onco.cc/companies/natureceuticals/), [Neonc Technologies](https://onco.cc/companies/neonc-technologies/), [Norgine](https://onco.cc/companies/norgine/), [Nouscom](https://onco.cc/companies/nouscom/), [NSABP Foundation](https://onco.cc/companies/nsabp-foundation/), [OncoC4](https://onco.cc/companies/oncoc4/), [Oncolytics Biotech](https://onco.cc/companies/oncolytics-biotech/), [Outcomes4Me](https://onco.cc/companies/outcomes4me/), [Persephone Biosciences](https://onco.cc/companies/persephone-biosciences/), [Pfizer (incl. Seagen)](https://onco.cc/companies/pfizer/), [Qilu Pharmaceutical](https://onco.cc/companies/qilu-pharmaceutical/), [Quanta Therapeutics](https://onco.cc/companies/quanta-therapeutics/), [Quantum Surgical](https://onco.cc/companies/quantum-surgical/), [Radiopharm Theranostics](https://onco.cc/companies/radiopharm-theranostics/), [Recursion Pharmaceuticals](https://onco.cc/companies/recursion/), [Roche / Genentech](https://onco.cc/companies/roche-genentech/), [Salubris Biotherapeutics](https://onco.cc/companies/salubris-biotherapeutics/), [Samsung Bioepis](https://onco.cc/companies/samsung-bioepis/), [Servier](https://onco.cc/companies/servier/), [Shanghai Kechow Pharma](https://onco.cc/companies/shanghai-kechow-pharma/), [Shenzhen Ionova Life Sciences](https://onco.cc/companies/shenzhen-ionova-life-sciences/), [Sirtex Medical](https://onco.cc/companies/sirtex/), [STCube](https://onco.cc/companies/stcube/), [Strata Oncology](https://onco.cc/companies/strata-oncology/), [Taiho Pharmaceutical (Otsuka)](https://onco.cc/companies/taiho/), [Takeda](https://onco.cc/companies/takeda/), [Teclison](https://onco.cc/companies/teclison/), [TiumBio](https://onco.cc/companies/tiumbio/), [UNICANCER](https://onco.cc/companies/unicancer/), [Universal DX](https://onco.cc/companies/universal-dx/), [Vyriad](https://onco.cc/companies/vyriad/), [West Japan Oncology Group](https://onco.cc/companies/wjog/), [Xilis](https://onco.cc/companies/xilis/), [Zeria Pharmaceutical](https://onco.cc/companies/zeria/)
- institutions: [A.C. Camargo Cancer Center](https://onco.cc/institutions/ac-camargo/), [Aichi Cancer Center](https://onco.cc/institutions/aichi-cancer-center/), [Amsterdam UMC / Cancer Center Amsterdam](https://onco.cc/institutions/amsterdam-umc/), [Atrium Health Wake Forest Baptist Comprehensive Cancer Center](https://onco.cc/institutions/wake-forest-cancer/), [Auckland City Hospital / Te Pūriri o Te Ora Cancer and Blood Service](https://onco.cc/institutions/auckland-city-hospital/), [Beatson West of Scotland Cancer Centre / CRUK Scotland Institute](https://onco.cc/institutions/beatson-glasgow/), [Bowel Cancer UK](https://onco.cc/institutions/bowel-cancer-uk/), [Bowel Research UK](https://onco.cc/institutions/bowel-research-uk/), [Bowelbabe Fund for Cancer Research UK](https://onco.cc/institutions/bowelbabe-fund/), [Cancer Care Alberta (Alberta Health Services)](https://onco.cc/institutions/cancer-care-alberta/), [Cancer Council Australia](https://onco.cc/institutions/cancer-council-australia/), [Cancer Grand Challenges](https://onco.cc/institutions/cancer-grand-challenges/), [Cancer Institute of Iran, Imam Khomeini Hospital Complex](https://onco.cc/institutions/tehran-cancer-institute/), [Case Comprehensive Cancer Center](https://onco.cc/institutions/case-ccc/), [Champalimaud Foundation, Champalimaud Clinical Centre](https://onco.cc/institutions/champalimaud/), [Chao Family Comprehensive Cancer Center, UC Irvine](https://onco.cc/institutions/uci-chao/), [Cleveland Clinic Abu Dhabi](https://onco.cc/institutions/cleveland-clinic-abu-dhabi/), [Comprehensive Cancer Center Freiburg (CCCF)](https://onco.cc/institutions/ccc-freiburg/), [Comprehensive Cancer Center Vienna, Medical University of Vienna / AKH](https://onco.cc/institutions/ccc-vienna/), [Edinburgh Cancer Centre / CRUK Scotland Centre](https://onco.cc/institutions/edinburgh-cancer-centre/), [First Affiliated Hospital of Sun Yat-sen University](https://onco.cc/institutions/sysu-first-affiliated-hospital/), [Hamad Medical Corporation / National Center for Cancer Care and Research](https://onco.cc/institutions/hamad-medical-corporation/), [Ho Chi Minh City Oncology Hospital](https://onco.cc/institutions/hcmc-oncology-hospital/), [Hospital de Clínicas de Porto Alegre](https://onco.cc/institutions/hcpa-porto-alegre/), [Hospital del Mar / Hospital del Mar Research Institute](https://onco.cc/institutions/hospital-del-mar/), [Hospital Universitari i Politècnic La Fe](https://onco.cc/institutions/la-fe-valencia/), [Hunan Cancer Hospital](https://onco.cc/institutions/hunan-cancer-hospital/), [Huntsman Cancer Institute, University of Utah](https://onco.cc/institutions/huntsman/), [HUS Comprehensive Cancer Center, Helsinki University Hospital](https://onco.cc/institutions/helsinki-hus/), [Imperial College Healthcare NHS Trust / Imperial College London Cancer Research](https://onco.cc/institutions/imperial-cancer-centre/), [INCLIVA Biomedical Research Institute / Hospital Clínico Universitario de Valencia](https://onco.cc/institutions/incliva-valencia/), [Institut National d'Oncologie, Rabat](https://onco.cc/institutions/institut-national-oncologie-rabat/), [Institut Salah Azaïez](https://onco.cc/institutions/institut-salah-azaiez/), [Institute of Oncology Ljubljana](https://onco.cc/institutions/onkoloski-institut-ljubljana/), [Instituto Alexander Fleming](https://onco.cc/institutions/instituto-alexander-fleming/), [Instituto Português de Oncologia de Lisboa Francisco Gentil](https://onco.cc/institutions/ipo-lisboa/), [Instituto Português de Oncologia do Porto Francisco Gentil](https://onco.cc/institutions/ipo-porto/), [Israel Cancer Association](https://onco.cc/institutions/israel-cancer-association/), [Istituto di Candiolo IRCCS (FPO)](https://onco.cc/institutions/candiolo/), [Istituto Nazionale Tumori IRCCS Fondazione G. Pascale](https://onco.cc/institutions/pascale-naples/), [Istituto Oncologico Veneto IRCCS](https://onco.cc/institutions/iov-veneto/), [Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center](https://onco.cc/institutions/johns-hopkins/), [Kaiser Permanente Division of Research](https://onco.cc/institutions/kaiser-permanente-research/), [Keio University Hospital](https://onco.cc/institutions/keio-university-hospital/), [King Faisal Specialist Hospital and Research Centre](https://onco.cc/institutions/kfshrc/), [King Hussein Cancer Center](https://onco.cc/institutions/khcc/), [Leeds Cancer Centre, St James's University Hospital](https://onco.cc/institutions/leeds-cancer-centre/), [Leiden University Medical Center](https://onco.cc/institutions/lumc-leiden/), [Maria Skłodowska-Curie National Research Institute of Oncology](https://onco.cc/institutions/nio-warsaw/), [Markey Cancer Center, University of Kentucky](https://onco.cc/institutions/kentucky-markey/), [Masaryk Memorial Cancer Institute](https://onco.cc/institutions/mou-brno/), [Max Delbrück Center for Molecular Medicine](https://onco.cc/institutions/mdc-berlin/), [Mayo Clinic Comprehensive Cancer Center in Arizona](https://onco.cc/institutions/mayo-clinic-arizona/), [Memorial Sloan Kettering Cancer Center](https://onco.cc/institutions/mskcc/), [Mount Vernon Cancer Centre](https://onco.cc/institutions/mount-vernon-cancer-centre/), [MUSC Hollings Cancer Center](https://onco.cc/institutions/musc-hollings/), [National Cancer Center Hospital](https://onco.cc/institutions/ncc-japan/), [National Cancer Center Hospital East](https://onco.cc/institutions/ncc-hospital-east/), [National Cancer Center Korea](https://onco.cc/institutions/ncc-korea/), [National Cancer Centre Singapore](https://onco.cc/institutions/nccs/), [National Institute of Oncology, Hungary](https://onco.cc/institutions/noi-budapest/), [National Taiwan University Hospital](https://onco.cc/institutions/ntuh/), [NCT/UCC Dresden, University Hospital Carl Gustav Carus](https://onco.cc/institutions/nct-dresden/), [Netherlands Cancer Institute (NKI-AvL)](https://onco.cc/institutions/nki/), [Newcastle Cancer Centre / Northern Centre for Cancer Care](https://onco.cc/institutions/newcastle-cancer-centre/), [Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda](https://onco.cc/institutions/niguarda-cancer-center/), [Northern Ireland Cancer Centre, Belfast City Hospital](https://onco.cc/institutions/northern-ireland-cancer-centre/), [Nottingham University Hospitals Cancer Centre (City Hospital)](https://onco.cc/institutions/nottingham-cancer-centre/), [Olivia Newton-John Cancer Wellness and Research Centre](https://onco.cc/institutions/onj-cancer-centre/), [Ontario Institute for Cancer Research](https://onco.cc/institutions/oicr/), [Osaka International Cancer Institute](https://onco.cc/institutions/osaka-international-cancer-institute/), [Oslo University Hospital, The Norwegian Radium Hospital](https://onco.cc/institutions/oslo-radium-hospital/), [Oxford Cancer (Oxford University Hospitals and University of Oxford)](https://onco.cc/institutions/oxford-cancer/), [Peking University Cancer Hospital](https://onco.cc/institutions/pku-cancer-hospital/), [Prince of Wales Hospital / Chinese University of Hong Kong](https://onco.cc/institutions/prince-of-wales-hospital-cuhk/), [Queen's University / Kingston Health Sciences Centre](https://onco.cc/institutions/queens-university-kingston/), [Ramathibodi Hospital, Mahidol University](https://onco.cc/institutions/ramathibodi-hospital/), [Rambam Health Care Campus](https://onco.cc/institutions/rambam/), [Rosalind and Morris Goodman Cancer Institute, McGill University](https://onco.cc/institutions/mcgill-goodman/), [Royal Adelaide Hospital](https://onco.cc/institutions/royal-adelaide-hospital/), [Sahlgrenska University Hospital / Sahlgrenska Center for Cancer Research](https://onco.cc/institutions/sahlgrenska/), [Shaare Zedek Medical Center](https://onco.cc/institutions/shaare-zedek/), [Shizuoka Cancer Center](https://onco.cc/institutions/shizuoka-cancer-center/), [Sidney Kimmel Comprehensive Cancer Center at Jefferson Health](https://onco.cc/institutions/jefferson-kimmel/), [Taipei Veterans General Hospital](https://onco.cc/institutions/taipei-veterans-general-hospital/), [Tawam Hospital](https://onco.cc/institutions/tawam-hospital/), [Tel Aviv Sourasky Medical Center](https://onco.cc/institutions/tel-aviv-sourasky/), [The Ottawa Hospital Cancer Centre / Ottawa Hospital Research Institute](https://onco.cc/institutions/ottawa-hospital/), [The Royal Marsden](https://onco.cc/institutions/royal-marsden/), [Tohoku University Hospital](https://onco.cc/institutions/tohoku-university-hospital/), [TUM Klinikum rechts der Isar / CCC München](https://onco.cc/institutions/tum-munich/), [UMC Utrecht Cancer Center](https://onco.cc/institutions/umc-utrecht/), [University Cancer Center Mainz (UCT Mainz) / Universitätsmedizin Mainz](https://onco.cc/institutions/uct-mainz/), [University Hospitals Birmingham / University of Birmingham Cancer Research Centre](https://onco.cc/institutions/birmingham-cancer-centre/), [University of Alberta](https://onco.cc/institutions/university-of-alberta/), [University of Arizona Cancer Center](https://onco.cc/institutions/arizona-cancer-center/), [University of Malaya Medical Centre](https://onco.cc/institutions/ummc-kuala-lumpur/), [University of Wisconsin Carbone Cancer Center](https://onco.cc/institutions/uw-carbone/), [Uppsala University Hospital / Uppsala University](https://onco.cc/institutions/uppsala-akademiska/), [USC Norris Comprehensive Cancer Center](https://onco.cc/institutions/usc-norris/), [UZ Leuven / Leuven Cancer Institute](https://onco.cc/institutions/uz-leuven/), [Vanderbilt-Ingram Cancer Center](https://onco.cc/institutions/vanderbilt-ingram/), [Vejle Hospital Cancer Centre (Lillebaelt Hospital)](https://onco.cc/institutions/vejle-cancer-centre/), [Velindre Cancer Centre](https://onco.cc/institutions/velindre-cardiff/), [Walter and Eliza Hall Institute of Medical Research](https://onco.cc/institutions/wehi/), [Weizmann Institute of Science](https://onco.cc/institutions/weizmann/), [Wellcome Sanger Institute](https://onco.cc/institutions/wellcome-sanger/), [Zhongshan Hospital, Fudan University](https://onco.cc/institutions/zhongshan-hospital-fudan/)
- pathways: [Antigen presentation & immune editing](https://onco.cc/pathways/antigen-presentation-immunoediting/), [Chromosomal instability & aneuploidy](https://onco.cc/pathways/chromosomal-instability/), [Clonal evolution & minimal residual disease](https://onco.cc/pathways/clonal-evolution/), [Cold tumours: immune deserts and exclusion](https://onco.cc/pathways/immune-desert-exclusion/), [Colorectal cancer (KEGG map)](https://onco.cc/pathways/colorectal-cancer-signalling/), [DNA replication stress](https://onco.cc/pathways/replication-stress/), [Drivers, passengers & the two-hit model](https://onco.cc/pathways/oncogene-activation-two-hit/), [Epigenetic reprogramming](https://onco.cc/pathways/epigenetic-reprogramming/), [Fibroblast activation, desmoplasia & matrix stiffness](https://onco.cc/pathways/caf-activation-desmoplasia/), [Field cancerisation](https://onco.cc/pathways/field-cancerisation/), [Microbiome-tumour interactions](https://onco.cc/pathways/microbiome-tumour/), [Mismatch repair & microsatellite instability](https://onco.cc/pathways/mismatch-repair-msi/), [Mutagenesis & mutational signatures](https://onco.cc/pathways/mutagenesis-signatures/), [MYC](https://onco.cc/pathways/myc/), [Organ tropism: seed and soil](https://onco.cc/pathways/organ-tropism-seed-soil/), [p53 / RB / cell-cycle checkpoint](https://onco.cc/pathways/p53-cell-cycle/), [PD-1 / PD-L1 immune checkpoint & T-cell activation](https://onco.cc/pathways/pd1-checkpoint/), [PI3K / AKT / mTOR](https://onco.cc/pathways/pi3k-akt-mtor/), [RAS / RAF / MEK / ERK (MAPK)](https://onco.cc/pathways/ras-mapk/), [Receptor tyrosine kinase activation](https://onco.cc/pathways/rtk-activation/), [SWI/SNF chromatin remodelling](https://onco.cc/pathways/swi-snf-chromatin/), [TGF-β signalling](https://onco.cc/pathways/tgf-beta/), [The angiogenic switch & tumour vessels](https://onco.cc/pathways/angiogenic-switch/), [The cancer-immunity cycle](https://onco.cc/pathways/cancer-immunity-cycle/), [Tumour microenvironment (TME)](https://onco.cc/pathways/tumor-microenvironment/), [VEGF angiogenesis](https://onco.cc/pathways/vegf-angiogenesis/), [Wnt / β-catenin](https://onco.cc/pathways/wnt/)
- trials: [[18F]FPyQCP PET Imaging of Fibroblast Activation Protein in Selected Oncology Indications](https://onco.cc/trials/nct07432633/), [[68Ga]BED003 PET Imaging of Fibroblast Activation Protein in Selected Oncology Indications](https://onco.cc/trials/nct07702292/), [177Lu-BetaBart in Patients With Relapsed/Refractory, Locally Advanced Inoperable, or Metastatic Solid Tumors](https://onco.cc/trials/nct07189871/), [64Cu-LNTH-1363S in Patients With Sarcoma or Gastrointestinal Tract Cancer](https://onco.cc/trials/nct06298916/), [A Beta-only IL-2 ImmunoTherapY Study](https://onco.cc/trials/nct05086692/), [A Clinical Study of Adebrelimab in Combination With SHR-8068 and Chemoradiotherapy as Perioperative Therapy for Locally Advanced Rectal Cancer](https://onco.cc/trials/nct07454720/), [A Clinical Study of Arfolitixorin in Patients With mCRC](https://onco.cc/trials/nct06922383/), [A Clinical Study of Calderasib (MK-1084) With Targeted Therapy and Chemotherapy in People With Colorectal Cancer (MK-1084-012/KANDLELIT-012)](https://onco.cc/trials/nct06997497/), [A Clinical Study of Iparomlimab and Tuvonralimab Combined With Bevacizumab and Alternating Triweekly CAPOX/mCAPIRI Regimen as First-line Treatment for Unresectable Advanced Colorectal Cancer](https://onco.cc/trials/nct07446387/), [A Clinical Study of MK-2870 Alone or With Other Treatments to Treat Gastrointestinal Cancers (MK-9999-02A)](https://onco.cc/trials/nct06428409/), [A Clinical Study of SHR-A1811 in Combination With Chemotherapy and Bevacizumab Versus Standard Therapy as First-Line Treatment for Advanced Colorectal](https://onco.cc/trials/nct07676162/), [A Clinical Study of SPH5030 Tablets in the Treatment of Her2-positive/Mutated Biliary Tract OR Colorectal Cancer Patients.](https://onco.cc/trials/nct06434597/), [A Clinical Study to Evaluate Efficacy and Safety of Serplulimab（HLX10） Combined With Bevacizumab（HLX04) and Chemotherapy (XELOX) in Patients With Meta](https://onco.cc/trials/nct04547166/), [A Clinical Study to Test if an Investigational Treatment Called BNT314 When Used in Combination With Another Investigational Treatment Pumitamig (BNT3](https://onco.cc/trials/nct07079631/), [A Clinical Trial Evaluating the Efficacy and Safety of IBI310 in Combination With Sintilimab, for Neoadjuvant Treatment of MSI-H/dMMR Resectable Colon Cancer](https://onco.cc/trials/nct05890742/), [A FIH, Phase I/IIa, Trial Assessing Feasibility of Administrations of TIL-based Immunotherapy in Patients With Metastatic CRC and PC](https://onco.cc/trials/nct07255664/), [A First-in-Human Trial of BLU-924 (SAR449336) in Advanced Solid Tumors Harboring KRAS Mutations](https://onco.cc/trials/nct07629960/), [A First-In-Human Trial of pTTL in Advanced Colorectal Cancer](https://onco.cc/trials/nct05908643/), [A First-in-Human, Phase 1 Study of TST003 in Subjects With Solid Tumors](https://onco.cc/trials/nct05731271/), [A Phase 1 and 2 Study of VMD-102 in Hepatocellular Carcinoma and Other Solid Tumors](https://onco.cc/trials/nct07636785/), [A Phase 1/2 Study of VS-7375 in Patients With KRAS G12D-Mutated Solid Tumors](https://onco.cc/trials/nct07020221/), [A Phase 1/2 Study to Evaluate CHM-2101, an Autologous Cadherin 17 Chimeric Antigen Receptor (CAR) T Cell Therapy](https://onco.cc/trials/nct06055439/), [A Phase 2 Study of SSGJ-707 in Metastatic Colorectal Cancer Patients](https://onco.cc/trials/nct06493760/), [A Phase 2 Study of VS-7375 in Patients With KRAS G12D-Mutated Colorectal Cancer](https://onco.cc/trials/nct07659795/), [A Phase 2 Study of Zanidatamab in Patients With HER2-expressing Tumors](https://onco.cc/trials/nct06695845/), [A Phase Ib/II Clinical Study on AK112 Combined or Not Combined With AK119 in pMMR/MSS Colorectal Cancer](https://onco.cc/trials/nct05846867/), [A Phase Ib/II Trial of HS-20110 Combination Therapies in Advanced Colorectal Cancer Patients.](https://onco.cc/trials/nct07283367/), [A Phase Ib/III Study of Suvemcitug Plus FTD/TPI in Participants With Refractory Metastatic Colorectal Cancer](https://onco.cc/trials/nct07361003/), [A Phase II Clinical Trial Comparing the Efficacy of RO7198457 Versus Watchful Waiting in Patients With ctDNA-positive, Resected Stage II (High Risk) and Stage III Colorectal Cancer](https://onco.cc/trials/nct04486378/), [A Phase II Study of AMT-676 Combination Therapies in Advanced Colorectal Cancer](https://onco.cc/trials/nct07474727/), [A Phase II Study of SHR-8068 Injection in Combination With Anti-tumor Therapies in Colorectal Cancer](https://onco.cc/trials/nct07071714/), [A Phase Ⅱ/Ⅲ Clinical Trial of RC148 Plus Chemotherapy as 1L Therapy for Unresectable or Metastatic Colorectal Cancer](https://onco.cc/trials/nct07462143/), [A Phase II/III Study of HR070803 in Combination With Oxaliplatin, 5-fluorouracil, Calcium Folinate and Bevacizumab Versus FOLFOX in Combination With Bevacizumab for First-line Treatment of Advanced Colorectal Cancer](https://onco.cc/trials/nct05945901/), [A Randomized Phase 2 Trial of Fruquintinib and TAS-102 as Compared to Fruquintinib in Patients With Refractory Advanced/Metastatic Colorectal Cancer](https://onco.cc/trials/nct06992258/), [A Randomized, Double-blind, Placebo-controlled, Parallel-group, Comparative, Phase III Study to Evaluate the Efficacy and Safety of Nuvastatic® 300mg Capsule in Reducing Cancer-Tumor in Patients With Metastatic Colorectal Cancer Receiving Standard Chemotherapy.](https://onco.cc/trials/nct07669454/), [A Study Assessing Adverse Events and Disease Activity of Intravenously (IV) Infused Telisotuzumab Adizutecan in Adult Participants With c-Met Protein Above Cutoff Level Above Refractory Metastatic Colorectal Cancer](https://onco.cc/trials/nct06614192/), [A Study Evaluating FMC-376 in Participants With KRAS G12C Mutated Solid Tumors](https://onco.cc/trials/nct06244771/), [A Study Investigating the Efficacy and Safety of Alcestobart (LBL-007) Plus Tislelizumab in Combination With Bevacizumab Plus Fluoropyrimidine Versus ](https://onco.cc/trials/nct05609370/), [A Study of a Patient-Specific Neoantigen Vaccine in Combination With Immune Checkpoint Blockade for Patients With Metastatic Colorectal Cancer](https://onco.cc/trials/nct05141721/), [A Study of a Selective T Cell Receptor (TCR) Targeting, Bifunctional Antibody-fusion Molecule STAR0602 in Participants With Advanced Solid Tumors](https://onco.cc/trials/nct05592626/), [A Study of ABT-301 Plus Tislelizumab With Bevacizumab in pMMR/Non-MSI-H Locally Advanced or mCRC](https://onco.cc/trials/nct07244705/), [A Study of Aflibercept in Combination With FOLFIRI in Patients With Second-Line Metastatic Colorectal Cancer in Japan](https://onco.cc/trials/nct01882868/), [A Study of AK112 With or Without AK117 in Metastatic Colorectal Cancer](https://onco.cc/trials/nct05382442/), [A Study of Amivantamab and FOLFIRI Versus Cetuximab/Bevacizumab and FOLFIRI in Participants With KRAS/NRAS and BRAF Wild-type Colorectal Cancer Who Have Previously Received Chemotherapy](https://onco.cc/trials/nct06750094/), [A Study of Amivantamab and mFOLFOX6 or FOLFIRI Versus Cetuximab and mFOLFOX6 or FOLFIRI as First-line Treatment in Participants With KRAS/NRAS and BRAF Wild-type Unresectable or Metastatic Left-sided Colorectal Cancer](https://onco.cc/trials/nct06662786/), [A Study of Amivantamab Monotherapy and in Addition to Standard-of-Care Chemotherapy in Participants With Advanced or Metastatic Colorectal Cancer](https://onco.cc/trials/nct05379595/), [A Study of Anlotinib Hydrochloride Capsule Combined With Chemotherapy as First-line Treatment in Subjects With RAS/BRAF Wild Metastatic Colorectal Can](https://onco.cc/trials/nct04854668/), [A Study of ART0380 for the Treatment of Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct04657068/), [A Study of Atezolizumab With or Without Tiragolumab Following Neoadjuvant Chemoradiotherapy in Participants With Locally Advanced Rectal Cancer](https://onco.cc/trials/nct05009069/), [A Study of Bispecific Antibody MCLA-158 in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct03526835/), [A Study of BMS-986340 as Monotherapy and as Combination Therapy in Participants With Advanced Solid Tumors](https://onco.cc/trials/nct04895709/), [A Study of Botensilimab and Balstilimab for the Treatment of Colorectal Cancer](https://onco.cc/trials/nct05608044/), [A Study of CNA3103 (LGR5-targeted, Autologous CAR-T Cells) Administered to Subjects With Metastatic Colorectal Cancer](https://onco.cc/trials/nct05759728/), [A Study of DM002 in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct06751329/), [A Study of Dostarlimab in Participants With Untreated Locally Advanced Rectal Cancer in China](https://onco.cc/trials/nct06640049/), [A Study of DSP107 Alone and in Combination with Atezolizumab for Patients with Advanced Solid Tumors](https://onco.cc/trials/nct04440735/), [A Study of E7386 in Combination With Other Anticancer Drug(s) in Participants With Solid Tumor](https://onco.cc/trials/nct04008797/), [A Study of Encorafenib Plus Cetuximab Taken Together With Pembrolizumab Compared to Pembrolizumab Alone in People With Previously Untreated Metastatic](https://onco.cc/trials/nct05217446/), [A Study of GFH375 Combined With Cetuximab or Chemotherapy in Participants With Solid Tumors Harboring KRAS G12D Mutation](https://onco.cc/trials/nct07259590/), [A Study of HDM2017 Combination Therapy in Advanced Colorectal Cancer](https://onco.cc/trials/nct07805551/), [A Study of HX008 Compared to Chemotherapy in the First-Line Treatment of Subjects With MSI-H/dMMR Metastatic Colorectal Cancer](https://onco.cc/trials/nct05652894/), [A Study of IBI363 in Subjects with Advanced Solid Malignancies](https://onco.cc/trials/nct06281678/), [A Study of JMT203 in Patients With Cancer Cachexia](https://onco.cc/trials/nct06868849/), [A Study of Neoadjuvant Dostarlimab Plus Capecitabine Plus Oxaliplatin (CAPEOX) Vs CAPEOX With Previously Untreated T4N0 or Stage III Mismatch Repair Proficient (MMRp)/Microsatellite Stable (MSS) Colon Cancer](https://onco.cc/trials/nct06567782/), [A Study of Neoadjuvant QL1706 in Participants With Untreated dMMR/MSI-H Resectable Colon Cancer](https://onco.cc/trials/nct06686576/), [A Study of Novel Study Interventions and Combinations in Participants With Colorectal Cancer](https://onco.cc/trials/nct06792695/), [A Study of Oral 7HP349 (Alintegimod) in Combination With Ipilimumab Followed by Nivolumab Monotherapy](https://onco.cc/trials/nct06362369/), [A Study of PARG Inhibitor ETX-19477 in Patients With Advanced Solid Malignancies](https://onco.cc/trials/nct06395519/), [A Study of Poziotinib in Patients With Epidermal Growth Factor Receptor (EGFR) or Human Epidermal Growth Factor Receptor 2 (HER2) Activating Mutations in Advanced Malignancies](https://onco.cc/trials/nct04172597/), [A Study of Precemtabart Tocentecan With or Without Bevacizumab Compared to Trifluridine/Tipiracil Plus Bevacizumab in Participants With Previously Treated Metastatic Colorectal Cancer (PROCEADE-CRC-03)](https://onco.cc/trials/proceade-crc-03/), [A Study of SI-B003, BL-B01D1+SI-B003 and BL-B01D1+PD-1 Monoclonal Antibody in Patients With Locally Advanced or Metastatic Esophageal Cancer, Gastric ](https://onco.cc/trials/nct06008054/), [A Study of Tucidinostat in Combination With Sintilimab and Bevacizumab in MSS/pMMR Colorectal Cancer Patients](https://onco.cc/trials/nct06497985/), [A Study of YL202 in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct07202364/), [A Study to Access Intravenous (IV) Telisotuzumab Adizutecan in Combination With IV Bevacizumab Compared to Standard of Care IV Bevacizumabin Combination With Oral Trifluridine and Tipiracil in Adult Participants With Refractory Metastatic Colorectal Cancer](https://onco.cc/trials/nct07525206/), [A Study to Assess Adverse Events and Change in Disease Activity in Adult Participants Receiving Intravenously Infused Telisotuzumab Adizutecan Alone o](https://onco.cc/trials/nct07023289/), [A Study to Assess IPN01194 When Administered Alone in Adults With Advanced Solid Tumours](https://onco.cc/trials/nct06305247/), [A Study to Assess Safety, Tolerability and Imaging Characteristics of [68Ga]Ga-DPI-4452 and to Assess Safety, Tolerability, and Efficacy of [177Lu]Lu-DPI-4452 in Participants With Unresectable Locally Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct05706129/), [A Study to Determine the Effect of CT3001 in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct06598007/), [A Study to Evaluate Safety and Efficacy of BEY1107 in Combination with Capecitabine in Patients with Metastatic Colorectal Cancer](https://onco.cc/trials/nct05093907/), [A Study to Evaluate the Adverse Events, and Efficacy of Intravenous (IV) of Telisotuzumab Adizutecan in Combination With IV Oxaliplatin, Fluorouracil,](https://onco.cc/trials/nct06820463/), [A Study to Evaluate the Efficacy and Safety of Standard-of-Care Chemotherapy and Bevacizumab With or Without INCA33890 in the First-Line Treatment of Metastatic Microsatellite Stable Colorectal Cancer](https://onco.cc/trials/nct07284849/), [A Study to Evaluate the Efficacy of VVD-133214 in Combination With Pembrolizumab Compared With Pembrolizumab Alone in Participants With Advanced Cancer of the Colon or Rectum](https://onco.cc/trials/nct07811193/), [A Study to Evaluate the Safety and Efficacy of A2B395, an Allogeneic Logic-gated CAR T, in Participants With Solid Tumors That Express EGFR and Have Lost HLA-A*02 Expression](https://onco.cc/trials/nct06682793/), [A Study to Evaluate the Safety and Efficacy of A2B530, a Logic-gated CAR T, in Participants With Solid Tumors That Express CEA and Have Lost HLA-A*02 Expression](https://onco.cc/trials/nct05736731/), [A Study to Evaluate the Safety and Efficacy of Mesothelin-Targeting Logic-gated CAR T, in Participants With Solid Tumors That Express MSLN and Have Lost HLA-A*02 Expression](https://onco.cc/trials/nct06051695/), [A Study to Evaluate the Safety and Efficacy of Pumitamig in Combination With Chemotherapy Versus Bevacizumab in Combination With Chemotherapy in Parti](https://onco.cc/trials/nct07221357/), [A Study to Evaluate the Safety and Efficacy of Two Dose Levels of ONO-4578 With Opdivo®, in Combination With mFOLFOX6 and Bevacizumab Versus Standard ](https://onco.cc/trials/nct06948448/), [A Study to Evaluate the Safety and Therapeutic Activity of GI-102 As a Single Agent and in Combination with Conventional Anti-cancer Drugs, Pembrolizu](https://onco.cc/trials/nct05824975/), [A Study to Evaluate the Safety, Tolerability, and Efficacy of BMS-986523 Alone and in Combination With Anti-Cancer Agents in Participants With Advance](https://onco.cc/trials/nct07223047/), [A Study to Evaluate the Safety, Tolerability, Pharmacokinetics, and Preliminary Antitumor Activity of INV-8989 in Patients With Advanced Solid Tumors Harboring KRAS G12D Mutations](https://onco.cc/trials/nct07610798/), [A Study to Investigate ALE.P03 as Monotherapy in Adult Patients With Selected Advanced or Metastatic CLDN1+ Solid Tumors](https://onco.cc/trials/nct07169734/), [A Study to Investigate APL-5125 in Adults With Advanced Solid Tumors](https://onco.cc/trials/nct06399757/), [A Study to Investigate the Safety and Preliminary Efficacy of GSK5460025 Alone or in Combination With Other Anti-cancer Agents in Participants With Solid Tumors](https://onco.cc/trials/nct07213609/), [A Study to Investigate the Safety, Pharmacokinetics, and Preliminary Effectiveness of GSK4418959 Alone or in Combination With Other Anti-cancer Agents in Participants With Solid Tumors](https://onco.cc/trials/nct06710847/), [A Study to Test DSP107 in Combination With Atezolizumab in Comparison With Fruquintinib as a New Treatment for Colorectal Cancer.](https://onco.cc/trials/nct07235293/), [Add-Aspirin](https://onco.cc/trials/add-aspirin/), [AK112 and Chemotherapy in First-line Metastatic Colorectal Cancer](https://onco.cc/trials/nct06951503/), [ALASCCA](https://onco.cc/trials/alascca/), [Alliance N0147](https://onco.cc/trials/n0147/), [ALTAIR](https://onco.cc/trials/altair/), [AMICO: aerobic or resistance exercise to improve outcome in metastatic colorectal cancer](https://onco.cc/trials/rejuv-trial-amico/), [An Evaluation of NGM120 in a Randomized, Double-blind, Placebo-controlled Study in Participants With Colorectal Cancer Who Have Cancer Cachexia.](https://onco.cc/trials/nct07033026/), [An Open-Label Study to Enable Continued Treatment Access for Subjects Previously Enrolled in Studies of Ruxolitinib](https://onco.cc/trials/nct02955940/), [ATOMIC (Alliance A021502)](https://onco.cc/trials/atomic/), [AVF2107g](https://onco.cc/trials/avf2107g/), [AZUR-1](https://onco.cc/trials/azur-1/), [Basket Study of Entrectinib (RXDX-101) for the Treatment of Patients With Solid Tumors Harboring NTRK 1/2/3 (Trk A/B/C), ROS1, or ALK Gene Rearrangeme](https://onco.cc/trials/nct02568267/), [BEACON CRC](https://onco.cc/trials/beacon-crc/), [Beamion BCGC-1: A Study to Find a Suitable Dose of Zongertinib Used Alone and in Combination With Other Treatments to Test Whether it Helps People Wit](https://onco.cc/trials/nct06324357/), [BESPOKE CRC](https://onco.cc/trials/bespoke-crc/), [BLUE-C](https://onco.cc/trials/blue-c/), [BOLD-100 in Combination With FOLFOX for the Treatment of Advanced Solid Tumours](https://onco.cc/trials/nct04421820/), [Bovine Reinforcement in Stomach, Colorectal and Lung Operation](https://onco.cc/trials/nct06968221/), [BREAKWATER](https://onco.cc/trials/breakwater/), [BXQ-350 in Newly Diagnosed Metastatic Colorectal Carcinoma](https://onco.cc/trials/nct05322590/), [CAIRO3](https://onco.cc/trials/cairo3/), [CAIRO5](https://onco.cc/trials/cairo5/), [CALGB/SWOG 80405](https://onco.cc/trials/calgb-80405/), [CAO/ARO/AIO-12](https://onco.cc/trials/cao-aro-aio-12/), [CAO/ARO/AIO-94 (German Rectal Cancer Study)](https://onco.cc/trials/cao-aro-aio-94/), [CAVE mCRC](https://onco.cc/trials/cave/), [Cediranib (AZD2171, RECENTIN™) in Addition to Chemotherapy in Patients With Untreated Metastatic Colorectal Cancer](https://onco.cc/trials/nct00399035/), [CHALLENGE (CCTG CO.21)](https://onco.cc/trials/challenge/), [CheckMate 142](https://onco.cc/trials/checkmate-142/), [CheckMate 8HW](https://onco.cc/trials/checkmate-8hw/), [CHRONOS](https://onco.cc/trials/chronos/), [CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)](https://onco.cc/trials/circulate-japan/), [CIRCULATE-US](https://onco.cc/trials/circulate-us/), [CLOCC](https://onco.cc/trials/clocc/), [CLOVER - CCR5-targeting Leronlimab With Oral Chemotherapy and VEGF-inhibitor Enriched Regimen](https://onco.cc/trials/nct06699836/), [CodeBreaK 300](https://onco.cc/trials/codebreak-300/), [COLOPEC](https://onco.cc/trials/colopec/), [COLUMBIA-1: Novel Oncology Therapies in Combination With Chemotherapy and Bevacizumab as First- Line Therapy in MSS-CRC](https://onco.cc/trials/nct04068610/), [Combination Chemotherapy and Bevacizumab in Treating Patients With Metastatic Colorectal Cancer](https://onco.cc/trials/nct00628810/), [CONCUR](https://onco.cc/trials/concur/), [CORRECT](https://onco.cc/trials/correct/), [CRYSTAL & FIRE-3](https://onco.cc/trials/crystal-fire3/), [DeeP-C](https://onco.cc/trials/deep-c/), [DESTINY-CRC01](https://onco.cc/trials/destiny-crc01/), [DESTINY-CRC02](https://onco.cc/trials/destiny-crc02/), [Dose Escalation and Dose Expansion Study of MDX2001 in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct06239194/), [Dual-Target CAR-NK Cells for Biomarker-Selected Advanced Colorectal Cancer](https://onco.cc/trials/nct07462650/), [Dual-Targeting CAR-NK Cells in Biomarker-Selected Advanced Colorectal Cancer](https://onco.cc/trials/nct07589517/), [Dutch TME trial](https://onco.cc/trials/dutch-tme-trial/), [DYNAMIC](https://onco.cc/trials/dynamic/), [DYNAMIC-III](https://onco.cc/trials/dynamic-iii/), [ECLIPSE (Shield blood test)](https://onco.cc/trials/eclipse-shield/), [Efficacy and Safety of Tunlametinib Plus Vemurafenib in Patients With BRAF V600E-mutant Metastatic Colorectal Cancer](https://onco.cc/trials/nct06008119/), [Efficacy and Safety Study of Tisotumab Vedotin for Patients With Solid Tumors](https://onco.cc/trials/nct03485209/), [EIK1005-002: A Clinical Research Study Evaluating EIK1005, a Werner Helicase Inhibitor, as Monotherapy and in Combination With Pembrolizumab in Partic](https://onco.cc/trials/nct07262619/), [EORTC 40983](https://onco.cc/trials/eortc-40983/), [Evaluation of Co-formulated Pembrolizumab/Quavonlimab (MK-1308A) Versus Other Treatments in Participants With Microsatellite Instability-High (MSI-H) ](https://onco.cc/trials/nct04895722/), [Evaluation of Gixam's Performance in a FIT Negative Population](https://onco.cc/trials/nct06612281/), [Evaluation of NuvastaticTM in Reducing Cancer-Related Fatigue in Colon Cancer Patients Undergoing First-Line Chemotherapy](https://onco.cc/trials/nct07669519/), [Evaluation of RBS2418 in Patients With Advanced, Metastatic, and Progressive Colorectal Cancer](https://onco.cc/trials/nct06824064/), [Evaluation of the Safety and Efficacy of Treatment w/High Dose Melphalan Given Directly Into the Liver Followed by Treatment w/Approved Cancer Treatme](https://onco.cc/trials/nct06607458/), [Feasibility of the LUM Imaging System for Detection of Gastrointestinal Cancers](https://onco.cc/trials/nct02584244/), [First-in-human Trial of STC-1010, an Immunotherapy, in Patients With Unresectable Locally Advanced or Metastatic Colorectal Cancer](https://onco.cc/trials/nct06934538/), [FOCUS4](https://onco.cc/trials/focus4/), [FOG-001 in Locally Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct05919264/), [FOLFIRI and Bevacizumab With or Without Pelareorep for Second-Line Treatment of Metastatic RAS-Mutated, Microsatellite-Stable Colorectal Cancer](https://onco.cc/trials/nct07446322/), [FOxTROT](https://onco.cc/trials/foxtrot/), [FRESCO](https://onco.cc/trials/fresco/), [FRESCO-2](https://onco.cc/trials/fresco-2/), [FUDR/Oxaliplatin HAI Plus Irinotecan vs. FOLFOXIRI Chemotherapy in Treating Initially Unresectable CRCLM](https://onco.cc/trials/nct03678428/), [Funen faecal occult blood screening trial](https://onco.cc/trials/funen-fob/), [G-CSF in Preventing Neutropenia During First-Line Treatment With Chemotherapy and Bevacizumab in Patients With Metastatic Colorectal Cancer](https://onco.cc/trials/nct00541125/), [GEN1042 Safety Trial and Anti-tumor Activity in Participants With Malignant Solid Tumors](https://onco.cc/trials/nct04083599/), [GM103 Intratumoral Injection in Patients With Locally Advanced, Unresectable, Refractory and/or Metastatic Solid Tumors](https://onco.cc/trials/nct06265025/), [HERACLES](https://onco.cc/trials/heracles/), [High-dose FOLFIRI in Advanced Colorectal Cancer Patients With Wild-type UGT1A1*6 and *28](https://onco.cc/trials/nct03329183/), [HSK42360-Na Tablets Combined With Cetuximab With or Without Chemotherapy in BRAF V600-Mutant Metastatic Colorectal Cancer](https://onco.cc/trials/nct07790510/), [IBI363 Combined With Bevacizumab for Advanced Colorectal Cancer](https://onco.cc/trials/nct07722494/), [IDEA collaboration](https://onco.cc/trials/idea-collaboration/), [IMblaze370](https://onco.cc/trials/imblaze370/), [Injection of SHR-A1811 Versus Physician Choiced Treatment in Patients With Advanced Colorectal Cancer Who Had Failed to Respond to Oxaliplatin, 5-fu, ](https://onco.cc/trials/nct06199973/), [International Watch & Wait Database](https://onco.cc/trials/iwwd/), [Intratumoral Injection of IP-001 Following Thermal Ablation in Patients With CRC, NSCLC, and STS](https://onco.cc/trials/nct05688280/), [Isunakinra Alone and in Combination With Pembrolizumab in Patients With Colorectal Cancer (MSS)](https://onco.cc/trials/nct06634875/), [JAB-21822 in Combination With Cetuximab in Patients With Advanced CRC and Other Solid Tumors With KRAS G12C Mutation](https://onco.cc/trials/nct05194995/), [KEYNOTE-177](https://onco.cc/trials/keynote-177/), [Lead-212 PSV359 Therapy for Patients With Solid Tumors](https://onco.cc/trials/nct06710756/), [LYL273 for Patients With Relapsed or Refractory mCRC](https://onco.cc/trials/nct05319314/), [MERCURY](https://onco.cc/trials/mercury/), [Minnesota Colon Cancer Control Study](https://onco.cc/trials/minnesota-fob/), [MOSAIC](https://onco.cc/trials/mosaic/), [MOUNTAINEER](https://onco.cc/trials/mountaineer/), [MOUNTAINEER-03](https://onco.cc/trials/mountaineer-03/), [MRC COIN](https://onco.cc/trials/coin/), [MRC CR07](https://onco.cc/trials/cr07/), [MyPathway](https://onco.cc/trials/mypathway/), [National Polyp Study](https://onco.cc/trials/national-polyp-study/), [NCIC CO.17](https://onco.cc/trials/co-17/), [Nelmastobart in Combination With Trifluridine/ Tipiracil and Bevacizumab in Metastatic/ Recurrent Colorectal Cancer](https://onco.cc/trials/nct06873763/), [Neoadjuvant Treatment of Fulzerasib Plus Cetuximab N01 in KRAS G12C Mutated Locally Advanced Colorectal Cancer With or Without Resectable Metastases](https://onco.cc/trials/nct07581912/), [Neoadjuvant/Adjuvant AK104 in Microsatellite Instability-high or Mismatch Repair-deficient, Resectable Colon Cancer](https://onco.cc/trials/nct07412613/), [Netherlands Cancer Institute HIPEC trial](https://onco.cc/trials/netherlands-hipec/), [New EPOC](https://onco.cc/trials/new-epoc/), [NHS-Galleri](https://onco.cc/trials/nhs-galleri/), [NICHE-2](https://onco.cc/trials/niche-2/), [NordICC (Nordic-European Initiative on Colorectal Cancer)](https://onco.cc/trials/nordicc/), [Nottingham faecal occult blood screening trial](https://onco.cc/trials/nottingham-fob/), [OPRA](https://onco.cc/trials/opra/), [OPUS](https://onco.cc/trials/opus/), [Oxaliplatin and Capecitabine With or Without an Hepatic Arterial Infusion With Floxuridine in Treating Patients Who Are Undergoing Surgery and/or Ablation for Liver Metastases Due to Colorectal Cancer](https://onco.cc/trials/nct00268463/), [Palliative Chemotherapy in Treating Patients With Advanced Colorectal Cancer](https://onco.cc/trials/nct00002893/), [PARADIGM](https://onco.cc/trials/paradigm/), [Performance of SGM-101 for the Delineation of Primary and Recurrent Tumor and Metastases in Patients Undergoing Surgery for Colorectal Cancer](https://onco.cc/trials/nct03659448/), [PETACC-3](https://onco.cc/trials/petacc-3/), [PETACC-8](https://onco.cc/trials/petacc-8/), [Phase 1/2 Dose Finding, Safety and PK Study in Advanced Refractory Solid Tumors](https://onco.cc/trials/nct07145255/), [Phase 1/2 Study Evaluating MCLA-129, a Human Anti-EGFR, Anti-c-MET Bispecific Antibody, in Advanced NSCLC and Other Solid Tumors, Alone and in Combina](https://onco.cc/trials/nct04868877/), [Phase 1/2 Study of BHB810 in Advanced Gastric and GEJ Adenocarcinoma](https://onco.cc/trials/nct07529808/), [Phase 1/2 Study of MRTX849 in Patients With Cancer Having a KRAS G12C Mutation KRYSTAL-1](https://onco.cc/trials/nct03785249/), [Phase 1/2 Study to Evaluate TH9619 in the Treatment of Advanced Solid Tumors](https://onco.cc/trials/nct07151040/), [Phase 1/2a Study of JAB-21822 Plus JAB-3312 in Patients With Advanced Solid Tumors Harboring KRAS p.G12C Mutation](https://onco.cc/trials/nct05288205/), [Phase 1/2a Study to Assess the Safety, Tolerability, Pharmacokinetics, and Preliminary Efficacy of WEF-001 as Monotherapy in Advanced KRAS-Mutant Solid Tumours.](https://onco.cc/trials/nct07148128/), [Phase 2 Study of SR-8541A in Combination With Botensilimab and Balstilimab in Subjects With Refractory Metastatic Microsatellite Stable Colorectal Can](https://onco.cc/trials/nct06589440/), [Phase 2 Trial of Voyager V1 in Combination With Cemiplimab in Cancer Patients](https://onco.cc/trials/nct04291105/), [Phase 3 Study of MRTX849 With Cetuximab vs Chemotherapy in Patients With Advanced Colorectal Cancer With KRAS G12C Mutation (KRYSTAL-10)](https://onco.cc/trials/nct04793958/), [Phase I Study of Autologous CD8+ and CD4+ Engineered T Cell Receptor T Cells in Subjects With Advanced or Metastatic Solid Tumor](https://onco.cc/trials/nct06105021/), [Phase I/II Clinical Study to Evaluate VB15010 Tablets in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct06819215/), [Phase II Study of EMB-01 in Recurrent/Metastatic Colorectal Cancer Patients](https://onco.cc/trials/nct07314294/), [Phase II, Open-label, Multicenter Study to Evaluate the Efficacy and Safety of HLX43 (an Anti-PD-L1 ADC) in Subjects With Advanced Colorectal Cancer](https://onco.cc/trials/nct07106892/), [Phase III Study of Ivonescimab or Bevacizumab Combined With FOLFOX in Patients With Metastatic Colorectal Cancer](https://onco.cc/trials/nct07228832/), [Platform Study of JDQ443 in Combinations in Patients With Advanced Solid Tumors Harboring the KRAS G12C Mutation](https://onco.cc/trials/nct05358249/), [PM8002 (BNT327) in Combination With Chemotherapy in Patients With Metastatic Colorectal Cancer](https://onco.cc/trials/nct07133750/), [Ponsegromab phase 2 in cancer cachexia](https://onco.cc/trials/ponsegromab-phase-2/), [PREEMPT CRC](https://onco.cc/trials/preempt-crc/), [PREHAB: multimodal prehabilitation before colorectal cancer surgery](https://onco.cc/trials/prehab-trial/), [PRIME](https://onco.cc/trials/prime/), [PRODIGE 23](https://onco.cc/trials/prodige-23/), [PRODIGE 7](https://onco.cc/trials/prodige-7/), [PROPHYLOCHIP-PRODIGE 15](https://onco.cc/trials/prophylochip/), [PROSPECT (Alliance N1048)](https://onco.cc/trials/prospect/), [QUASAR](https://onco.cc/trials/quasar/), [RAISE](https://onco.cc/trials/raise/), [RAPIDO](https://onco.cc/trials/rapido/), [RECOURSE](https://onco.cc/trials/recourse/), [SABR-COMET: stereotactic ablative radiotherapy for oligometastatic cancer](https://onco.cc/trials/sabr-comet/), [Safely Optimizing Body Weight With Mifomelatide (TCMCB07) in Patients With Newly Diagnosed Colorectal Cancer (CRC) or Pancreatic Ductal Adenocarcinoma (PDAC) Undergoing Chemotherapy](https://onco.cc/trials/nct06937177/), [Safety and Efficacy of NEO212 in Patients With Astrocytoma IDH-mutant, Glioblastoma IDH-wildtype or Brain Metastasis](https://onco.cc/trials/nct06047379/), [Safety, PK and Efficacy of ONC-392 in Monotherapy and in Combination of Anti-PD-1 in Advanced Solid Tumors and NSCLC](https://onco.cc/trials/nct04140526/), [SCOT](https://onco.cc/trials/scot/), [Shark Cartilage in Treating Patients With Advanced Colorectal or Breast Cancer](https://onco.cc/trials/nct00026117/), [SHR-1701 in Combination With Chemotherapy and Radiotherapy in Locally Advanced Rectal Cancer](https://onco.cc/trials/nct05300269/), [Sotevtamab (AB-16B5) Combined With FOLFOX as Neoadjuvant Treatment Prior to Resection of Colorectal Cancer Liver Metastasis](https://onco.cc/trials/nct06225843/), [SOX Versus XELOX as Adjuvant Chemotherapy for Stage III Colorectal Cancer Patients](https://onco.cc/trials/nct03448549/), [STAR-TREC](https://onco.cc/trials/star-trec/), [STELLAR (rectal cancer)](https://onco.cc/trials/stellar-rectal/), [Stockholm III](https://onco.cc/trials/stockholm-iii/), [Study of AZD5305 as Monotherapy and in Combination With Anti-cancer Agents in Patients With Advanced Solid Malignancies](https://onco.cc/trials/nct04644068/), [Study of CP-383 in Patients With Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct07030257/), [Study of Dato-DXd as Monotherapy and in Combination With Anti-cancer Agents in Patients With Advanced Solid Tumours (TROPION-PanTumor03)](https://onco.cc/trials/nct05489211/), [Study of DECOY20 With or Without Tislelizumab in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct05651022/), [Study of Denikitug (GS-1811) Given Alone or With Nivolumab or With Chemotherapy in Adults With Advanced Colorectal Cancer](https://onco.cc/trials/nct07527858/), [Study of Elironrasib and Daraxonrasib as Monotherapies and Combination Therapy in Participants With Advanced KRAS G12C Mutant Solid Tumors](https://onco.cc/trials/nct06128551/), [Study of IDE196 in Patients With Solid Tumors Harboring GNAQ/11 Mutations or PRKC Fusions](https://onco.cc/trials/nct03947385/), [Study of JDQ443 in Patients With Advanced Solid Tumors Harboring the KRAS G12C Mutation](https://onco.cc/trials/nct04699188/), [Study of JK08 in Patients with Unresectable Locally Advanced or Metastatic Cancer](https://onco.cc/trials/nct05620134/), [Study of JYP0015 in Patients With Advanced Solid Tumors Harboring Specific Mutations in RAS](https://onco.cc/trials/nct06895031/), [Study of LY3537982 in Cancer Patients With a Specific Genetic Mutation (KRAS G12C)](https://onco.cc/trials/nct04956640/), [Study of MCLA-129, a Human Bispecific EGFR and cMet Antibody, in Patients With Advanced NSCLC and Other Solid Tumors](https://onco.cc/trials/nct04930432/), [Study of Onvansertib in Combination With FOLFIRI and Bevacizumab or FOLFOX and Bevacizumab Versus FOLFIRI and Bevacizumab or FOLFOX and Bevacizumab fo](https://onco.cc/trials/nct06106308/), [Study of Pembrolizumab (MK-3475) Versus Chemotherapy in Chinese Participants With Stage IV Colorectal Cancer (MK-3475-C66)](https://onco.cc/trials/nct05239741/), [Study of Perioperative Dostarlimab in Participants With Untreated T4N0 or Stage III dMMR/MSI-H Resectable Colon Cancer](https://onco.cc/trials/nct05855200/), [Study of Petosemtamab Plus Chemotherapy Versus Cetuximab or Bevacizumab Plus Chemotherapy in RAS and BRAF Wild Type, Recurrent, Unresectable or Metast](https://onco.cc/trials/nct07775287/), [Study of Petosemtamab Plus Chemotherapy Versus Cetuximab Plus Chemotherapy in RAS and BRAF Wild-type, Unresectable or Metastatic, Left-sided Colorecta](https://onco.cc/trials/nct07702032/), [Study of RAS(ON) Inhibitors in Combination With Ivonescimab in Patients With Solid Tumors](https://onco.cc/trials/nct07397338/), [Study of RAS(ON) Inhibitors in Patients With Gastrointestinal Solid Tumors](https://onco.cc/trials/nct06445062/), [Study of RMC-6236 in Patients With Advanced Solid Tumors Harboring Specific Mutations in RAS](https://onco.cc/trials/nct05379985/), [Study of RMC-9805 in Participants With KRAS G12D-Mutant Solid Tumors](https://onco.cc/trials/nct06040541/), [Study of Sotorasib, Panitumumab and FOLFIRI Versus FOLFIRI With or Without Bevacizumab-awwb in Treatment-naïve Participants With Metastatic Colorectal](https://onco.cc/trials/nct06252649/), [Study of the Monoclonal Antibody IMT-009 in Patients With Advanced Solid Tumors or Lymphomas](https://onco.cc/trials/nct05565417/), [Study of TU2218 in Combination With KEYTRUDA®(Pembrolizumab) in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct05784688/), [Study of XL092 + Atezolizumab vs Regorafenib in Participants With Metastatic Colorectal Cancer](https://onco.cc/trials/nct05425940/), [Study to Assess Adverse Events and Change in Disease Activity in Previously Treated Adult Participants Receiving Intravenous (IV) ABBV-400 With Unrese](https://onco.cc/trials/nct06107413/), [Study to Evaluate the Diagnostic Performance of GEH300079 (68Ga) Injection PET/CT for Detection of PC in Patients With Colorectal, Gastric, Ovarian, o](https://onco.cc/trials/nct07219238/), [Study to Investigate Outcome of Individualized Treatment in Patients With Metastatic Colorectal Cancer](https://onco.cc/trials/nct05725200/), [SUNLIGHT](https://onco.cc/trials/sunlight/), [Swedish Rectal Cancer Trial](https://onco.cc/trials/swedish-rectal-cancer-trial/), [SWOG S1406](https://onco.cc/trials/swog-s1406/), [Symbiotic-GI-03: A Study to Learn About the Study Medicine Called PF-08634404 in Combination With Chemotherapy in Adult Participants With Metastatic Colorectal Cancer](https://onco.cc/trials/symbiotic-gi-03/), [TAPUR (Targeted Agent and Profiling Utilization Registry)](https://onco.cc/trials/tapur/), [TATE and Pembrolizumab (MK3475) in mCRC and NSCLC](https://onco.cc/trials/nct04701476/), [Tegafur-Uracil and Leucovorin or S-1 in Treating Patients With Stage III Colon Cancer That Has Been Completely Removed by Surgery](https://onco.cc/trials/nct00660894/), [Testing Pump Chemotherapy in Addition to Standard of Care Chemotherapy Versus Standard of Care Chemotherapy Alone for Patients With Unresectable Colorectal Liver Metastases: The PUMP Trial](https://onco.cc/trials/nct05863195/), [The Evaluation of PC14586 in Patients With Advanced Solid Tumors Harboring a TP53 Y220C Mutation (PYNNACLE)](https://onco.cc/trials/nct04585750/), [TL938 and Trastuzumab for Patients With HER2-positive Metastatic Colorectal Cancer](https://onco.cc/trials/nct06589830/), [To Evaluate Dose and Safety of NanoEcho Particle-1 Using NanoEcho Imaging Device Examinations of Rectal Lymph Nodes in Healthy Volunteers and Rectal Cancer Patients.](https://onco.cc/trials/nct06693375/), [TOSCA](https://onco.cc/trials/tosca/), [TQB2922 and TAS-102 Tablets for Injection With or Without Bevacizumab in Chemotherapy-failed RAS/BRAF Wild-type Advanced Colorectal Cancer](https://onco.cc/trials/nct07044908/), [TRACC](https://onco.cc/trials/tracc/), [TRIBE](https://onco.cc/trials/tribe/), [TRIBE2](https://onco.cc/trials/tribe2/), [TRIUMPH](https://onco.cc/trials/triumph/), [UK Flexible Sigmoidoscopy Screening Trial](https://onco.cc/trials/ukfss/), [VELOUR](https://onco.cc/trials/velour/), [Vorbipiprant (CR6086) / Balstilimab (AGEN2034) Combination in Stage IV Refractory pMMR - MSS CRC, and Other Metastatic GI Cancers](https://onco.cc/trials/nct05205330/), [Xian-Lian-Jie-Du Optimization Decoction As an Adjuvant Treatment for Prevention of Recurrence of Colon Cancer](https://onco.cc/trials/nct05709249/), [XNW27011 Study of Advanced Solid Tumor Subjects Who Failed Standard Therapies.](https://onco.cc/trials/nct06792435/)
- people: [Aimery de Gramont](https://onco.cc/people/aimery-de-gramont/), [Alan P. Venook](https://onco.cc/people/alan-venook/), [Alberto Bardelli](https://onco.cc/people/alberto-bardelli/), [Andrea Cercek](https://onco.cc/people/andrea-cercek/), [Andrea Sartore-Bianchi](https://onco.cc/people/andrea-sartore-bianchi/), [Andrés Cervantes](https://onco.cc/people/andres-cervantes/), [Angelita Habr-Gama](https://onco.cc/people/angelita-habr-gama/), [Ann Lurie](https://onco.cc/people/ann-lurie/), [Bert Vogelstein](https://onco.cc/people/bert-vogelstein/), [Carsten Bokemeyer](https://onco.cc/people/carsten-bokemeyer/), [Chadwick Boseman](https://onco.cc/people/chadwick-boseman/), [Charles D. Blanke](https://onco.cc/people/charles-blanke/), [Chee Cheng Ean](https://onco.cc/people/chee-cheng-ean/), [Christina Curtis](https://onco.cc/people/christina-curtis/), [Christopher M. Booth](https://onco.cc/people/christopher-booth/), [Christos Karapetis](https://onco.cc/people/christos-karapetis/), [Cornelis J. H. van de Velde](https://onco.cc/people/cornelis-van-de-velde/), [Dame Deborah James](https://onco.cc/people/deborah-james/), [David Cunningham](https://onco.cc/people/david-cunningham/), [David Sebag-Montefiore](https://onco.cc/people/david-sebag-montefiore/), [Deborah Schrag](https://onco.cc/people/deb-schrag/), [Dion Morton](https://onco.cc/people/dion-morton/), [Dongsheng Tu](https://onco.cc/people/tu-dongsheng/), [Dung T. Le](https://onco.cc/people/dung-le/), [Elena Élez](https://onco.cc/people/elena-elez/), [Eric R. Fearon](https://onco.cc/people/eric-fearon/), [Eric Van Cutsem](https://onco.cc/people/eric-van-cutsem/), [Feng Wang](https://onco.cc/people/wang-feng-sysucc/), [Florian R. Greten](https://onco.cc/people/florian-greten/), [Frank McCormick](https://onco.cc/people/frank-mccormick/), [Geerard Beets](https://onco.cc/people/geerard-beets/), [Gerald W. Prager](https://onco.cc/people/gerald-prager/), [Hagen F. Kennecke](https://onco.cc/people/hagen-kennecke/), [Heinz-Josef Lenz](https://onco.cc/people/heinz-josef-lenz/), [Hermann Brenner](https://onco.cc/people/hermann-brenner/), [Ian Chau](https://onco.cc/people/ian-chau/), [Igor Kiss](https://onco.cc/people/igor-kiss/), [Jaime Feliu](https://onco.cc/people/jaime-feliu/), [Jakob Nikolas Kather](https://onco.cc/people/jakob-nikolas-kather/), [Janja Ocvirk](https://onco.cc/people/janja-ocvirk/), [Jeanne Tie](https://onco.cc/people/jeanne-tie/), [Jin Li](https://onco.cc/people/li-jin-fuscc/), [John Burn](https://onco.cc/people/john-burn/), [John H. Strickler](https://onco.cc/people/john-strickler/), [Josep Tabernero](https://onco.cc/people/josep-tabernero/), [Julio Garcia-Aguilar](https://onco.cc/people/julio-garcia-aguilar/), [Jürgen Weitz](https://onco.cc/people/jurgen-weitz/), [Katie Couric](https://onco.cc/people/katie-couric/), [Kenneth W. Kinzler](https://onco.cc/people/kenneth-kinzler/), [Kerry S. Courneya](https://onco.cc/people/kerry-courneya/), [Kevan M. Shokat](https://onco.cc/people/kevan-shokat/), [Luis A. Diaz Jr.](https://onco.cc/people/luis-diaz/), [Matt Seymour](https://onco.cc/people/matt-seymour/), [Matthew Meyerson](https://onco.cc/people/matthew-meyerson/), [Michael Bretthauer](https://onco.cc/people/michael-bretthauer/), [Michał Mikula](https://onco.cc/people/michal-mikula/), [Myriam Chalabi](https://onco.cc/people/myriam-chalabi/), [Naureen Starling](https://onco.cc/people/naureen-starling/), [Norman Wolmark](https://onco.cc/people/norman-wolmark/), [Owen Sansom](https://onco.cc/people/owen-sansom/), [Paulo Hoff](https://onco.cc/people/hoff-paulo/), [Peter J. O'Dwyer](https://onco.cc/people/peter-odwyer/), [Rachel Kerr](https://onco.cc/people/rachel-kerr/), [Rebecca Auer](https://onco.cc/people/rebecca-auer/), [René Bernards](https://onco.cc/people/rene-bernards/), [Richard Gray](https://onco.cc/people/richard-gray/), [Rona Yaeger](https://onco.cc/people/rona-yaeger/), [Rui-Hua Xu](https://onco.cc/people/xu-rui-hua/), [Ryan B. Corcoran](https://onco.cc/people/ryan-corcoran/), [Salvatore Siena](https://onco.cc/people/salvatore-siena/), [Sang Joon Shin](https://onco.cc/people/shin-sang-joon/), [Scott Kopetz](https://onco.cc/people/scott-kopetz/), [Semir Beyaz](https://onco.cc/people/semir-beyaz/), [Stephen Sutton](https://onco.cc/people/stephen-sutton/), [Steven A. Rosenberg](https://onco.cc/people/steven-rosenberg/), [Tae Won Kim](https://onco.cc/people/kim-tae-won/), [Tae-You Kim](https://onco.cc/people/kim-tae-you/), [Takayuki Yoshino](https://onco.cc/people/yoshino-takayuki/), [Tanios Bekaii-Saab](https://onco.cc/people/tanios-bekaii-saab/), [Theodore R. Levin](https://onco.cc/people/theodore-levin/), [Thierry André](https://onco.cc/people/thierry-andre/), [Tim Maughan](https://onco.cc/people/tim-maughan/), [Vincenzo Valentini](https://onco.cc/people/vincenzo-valentini/), [Volker Heinemann](https://onco.cc/people/volker-heinemann/), [Yuman Fong](https://onco.cc/people/yuman-fong/)
- bottlenecks: [AI that is built but not validated or deployed](https://onco.cc/bottlenecks/b-ai-validation/), [Cold tumours and the immunosuppressive microenvironment](https://onco.cc/bottlenecks/b-tme-immunosuppression/), [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/), [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/), [Knowledge reaches practice too slowly](https://onco.cc/bottlenecks/b-knowledge-diffusion/), [Lab models that fail to predict what happens in patients](https://onco.cc/bottlenecks/b-preclinical-models/), [Metastasis is understood least and studied last](https://onco.cc/bottlenecks/b-metastasis-biology/), [Misinformation and unproven therapies](https://onco.cc/bottlenecks/b-misinformation/), [No incentive to repurpose cheap drugs](https://onco.cc/bottlenecks/b-generic-repurposing/), [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/), [Not enough oncologists, nurses, pathologists, physicists](https://onco.cc/bottlenecks/b-workforce/), [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/), [The undruggable drivers](https://onco.cc/bottlenecks/b-undruggable-targets/)
- key papers: [A genetic model for colorectal tumorigenesis](https://onco.cc/key-papers/paper-fearon-cell/), [A molecularly annotated platform of patient-derived xenografts identifies HER2 as an effective therapeutic target in cetuximab-resistant colorectal cancer](https://onco.cc/key-papers/paper-bertotti-xenopatients-her2-cetuximab-resistant-colorectal-cancer-discov-2011/), [A phase 2a clinical study on the safety and efficacy of individualized dosed mebendazole in patients with advanced gastrointestinal cancer](https://onco.cc/key-papers/paper-mansoori-mebendazole-gi-cancer-phase-2a-sci-rep-2021/), [Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study (QUASAR)](https://onco.cc/key-papers/paper-quasar-adjuvant-chemotherapy-vs-observation-lancet-2007/), [Alcohol caused an estimated 741,000 cancers worldwide in 2020](https://onco.cc/key-papers/paper-alcohol-cancer-burden-lancet-oncol-2021/), [Allemani 2018: CONCORD-3, global surveillance of cancer survival 2000 to 2014](https://onco.cc/key-papers/paper-allemani-concord-3-lancet-2018/), [Analysis of plasma cell-free DNA by ultradeep sequencing in patients with stages I to III colorectal cancer](https://onco.cc/key-papers/paper-reinert-ctdna-ultradeep-sequencing-colorectal-jama-oncol-2019/), [Assessment of a HER2 scoring system for colorectal cancer: results from a validation study](https://onco.cc/key-papers/paper-valtorta-her2-scoring-colorectal-heracles-mod-pathol-2015/), [Atezolizumab with or without cobimetinib versus regorafenib in previously treated metastatic colorectal cancer (IMblaze370)](https://onco.cc/key-papers/paper-eng-imblaze370-atezolizumab-cobimetinib-colorectal-lancet-oncol-2019/), [Botensilimab plus balstilimab in relapsed/refractory microsatellite stable metastatic colorectal cancer: a phase 1 trial](https://onco.cc/key-papers/paper-bullock-botensilimab-balstilimab-mss-colorectal-nat-med-2024/), [Bray 2018: GLOBOCAN 2018, worldwide incidence and mortality for 36 cancers](https://onco.cc/key-papers/paper-bray-globocan-2018-cacancer-2018/), [Bray 2024: GLOBOCAN 2022, the world's cancer count for 36 cancers in 185 countries](https://onco.cc/key-papers/paper-bray-globocan-2022-cacancer-2024/), [BREAKWATER: encorafenib plus cetuximab with chemotherapy as first treatment for BRAF V600E-mutated colorectal cancer](https://onco.cc/key-papers/paper-breakwater-nejm-2025/), [Calle 2003: overweight, obesity and death from cancer in 900,000 US adults](https://onco.cc/key-papers/paper-calle-obesity-cancer-mortality-nejm-2003/), [CAPP2: two years of aspirin cuts bowel cancer in Lynch syndrome by more than a third over 10 years](https://onco.cc/key-papers/paper-capp2-aspirin-lynch-lancet-2020/), [Cercek 2022: six months of dostarlimab alone made rectal cancer disappear in every patient with mismatch-repair deficiency](https://onco.cc/key-papers/paper-cercek-dostarlimab-rectal-nejm-2022/), [Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer (CRYSTAL)](https://onco.cc/key-papers/paper-van-cutsem-crystal-cetuximab-folfiri-nejm-2009/), [Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status](https://onco.cc/key-papers/paper-kras-colorectal-j-clin-oncol-2011/), [CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer](https://onco.cc/key-papers/paper-challenge-exercise-nejm-2025/), [Chen 2016: Cancer statistics in China, 2015](https://onco.cc/key-papers/paper-chen-cancer-statistics-china-2015-cacancer-2016/), [Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer](https://onco.cc/key-papers/paper-tie-ctdna-minimal-residual-disease-stage-ii-colon-sci-transl-med-2016/), [Circulating tumor DNA in stage III colorectal cancer, beyond minimal residual disease detection, toward assessment of adjuvant therapy efficacy and clinical behavior of recurrences](https://onco.cc/key-papers/paper-henriksen-ctdna-stage-iii-colorectal-improve-it-ccr-2022/), [Circulating tumor DNA-guided treatment with pertuzumab plus trastuzumab for HER2-amplified metastatic colorectal cancer: a phase 2 trial (TRIUMPH)](https://onco.cc/key-papers/paper-nakamura-triumph-ctdna-pertuzumab-trastuzumab-her2-colorectal-nat-med-2021/), [Classifying colorectal cancer by tumor location rather than sidedness highlights a continuum in mutation profiles and consensus molecular subtypes](https://onco.cc/key-papers/paper-loree-tumour-location-continuum-colorectal-ccr-2018/), [Clinical sequencing defines the genomic landscape of metastatic colorectal cancer](https://onco.cc/key-papers/paper-yaeger-metastatic-colorectal-genomic-landscape-cancer-cell-2018/), [Clinical validation of a circulating tumor DNA-based blood test to screen for colorectal cancer (PREEMPT CRC)](https://onco.cc/key-papers/paper-preempt-crc-shaukat-jama-2025/), [CodeBreaK 300: sotorasib plus panitumumab in chemotherapy-refractory KRAS G12C colorectal cancer](https://onco.cc/key-papers/paper-codebreak-300-nejm-2023/), [Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths (National Polyp Study)](https://onco.cc/key-papers/paper-zauber-national-polyp-study-colonoscopic-polypectomy-nejm-2012/), [Colorectal cancer incidence patterns in the United States, 1974-2013](https://onco.cc/key-papers/paper-siegel-colorectal-incidence-birth-cohort-jnci-2017/), [Colorectal cancer statistics, 2023](https://onco.cc/key-papers/paper-siegel-colorectal-cancer-statistics-ca-2023/), [Comprehensive molecular characterization of human colon and rectal cancer](https://onco.cc/key-papers/paper-tcga-colorectal-comprehensive-characterization-nature-2012/), [Coussens and Werb 2002: inflammation and cancer](https://onco.cc/key-papers/paper-coussens-werb-inflammation-cancer-nature-2002/), [CpG island methylator phenotype underlies sporadic microsatellite instability and is tightly associated with BRAF mutation in colorectal cancer](https://onco.cc/key-papers/paper-weisenberger-cimp-braf-mlh1-colorectal-nat-genet-2006/), [Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7)](https://onco.cc/key-papers/paper-quenet-prodige-7-hipec-peritoneal-colorectal-lancet-oncol-2021/), [Deficient mismatch repair system in patients with sporadic advanced colorectal cancer](https://onco.cc/key-papers/paper-koopman-deficient-mismatch-repair-advanced-colorectal-bjc-2009/), [Distal and proximal colon cancers differ in terms of molecular, pathological, and clinical features](https://onco.cc/key-papers/paper-missiaglia-distal-proximal-colon-cancers-ann-oncol-2014/), [Dual-targeted therapy with trastuzumab and lapatinib in treatment-refractory, KRAS codon 12/13 wild-type, HER2-positive metastatic colorectal cancer (HERACLES)](https://onco.cc/key-papers/paper-sartore-bianchi-heracles-trastuzumab-lapatinib-lancet-oncol-2016/), [Duration of adjuvant chemotherapy for stage III colon cancer (the IDEA collaboration)](https://onco.cc/key-papers/paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018/), [DYNAMIC: a blood test safely halved chemotherapy use after surgery for stage II colon cancer](https://onco.cc/key-papers/paper-dynamic-nejm-2022/), [Effect of first-line chemotherapy combined with cetuximab or bevacizumab on overall survival in KRAS wild-type advanced or metastatic colorectal cancer (CALGB/SWOG 80405)](https://onco.cc/key-papers/paper-venook-calgb-80405-cetuximab-vs-bevacizumab-jama-2017/), [Emergence of KRAS mutations and acquired resistance to anti-EGFR therapy in colorectal cancer](https://onco.cc/key-papers/paper-misale-kras-acquired-resistance-anti-egfr-colorectal-nature-2012/), [Encorafenib, binimetinib, and cetuximab in BRAF V600E-mutated colorectal cancer (BEACON CRC)](https://onco.cc/key-papers/paper-kopetz-beacon-encorafenib-braf-colorectal-nejm-2019/), [Estimated Projection of US Cancer Incidence and Death to 2040](https://onco.cc/key-papers/paper-rahib-projection-us-cancer-2040-jama-netw-open-2021/), [First trial of a vaccine against the shared neoantigens of mismatch-repair-deficient cancers](https://onco.cc/key-papers/paper-lynch-frameshift-vaccine-ccr-2020/), [FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3)](https://onco.cc/key-papers/paper-heinemann-fire-3-cetuximab-vs-bevacizumab-lancet-oncol-2014/), [FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of TRIBE](https://onco.cc/key-papers/paper-cremolini-tribe-folfoxiri-bevacizumab-lancet-oncol-2015/), [Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2)](https://onco.cc/key-papers/paper-dasari-fresco-2-fruquintinib-lancet-2023/), [GALAXY: tumour DNA in blood four weeks after bowel cancer surgery predicts relapse tenfold](https://onco.cc/key-papers/paper-galaxy-signatera-nat-med-2023/), [Galon 2006: the type, density and location of immune cells in colorectal tumours predict outcome](https://onco.cc/key-papers/paper-galon-immune-contexture-colorectal-science-2006/), [Genetic alterations during colorectal-tumor development](https://onco.cc/key-papers/paper-vogelstein-genetic-alterations-colorectal-tumor-development-nejm-1988/), [Genetic instability in colorectal cancers](https://onco.cc/key-papers/paper-lengauer-genetic-instability-colorectal-nature-1997/), [Genetic mechanisms of immune evasion in colorectal cancer](https://onco.cc/key-papers/paper-grasso-immune-evasion-colorectal-cancer-discov-2018/), [Genomic correlates of immune-cell infiltrates in colorectal carcinoma](https://onco.cc/key-papers/paper-giannakis-genomic-correlates-immune-colorectal-cell-rep-2016/), [Geographic and age variations in mutational processes in colorectal cancer](https://onco.cc/key-papers/paper-diaz-gay-colibactin-geographic-age-mutational-processes-nature-2025/), [Germline mutations affecting the proofreading domains of POLE and POLD1 predispose to colorectal adenomas and carcinomas](https://onco.cc/key-papers/paper-palles-germline-pole-pold1-proofreading-nat-genet-2013/), [HER2 overexpression and amplification as a potential therapeutic target in colorectal cancer: analysis of 3256 patients enrolled in the QUASAR, FOCUS and PICCOLO colorectal cancer trials](https://onco.cc/key-papers/paper-richman-her2-amplification-quasar-focus-piccolo-j-pathol-2016/), [Heritable somatic methylation and inactivation of MSH2 in families with Lynch syndrome due to deletion of the 3' exons of TACSTD1](https://onco.cc/key-papers/paper-ligtenberg-epcam-deletion-msh2-silencing-nat-genet-2009/), [Hollstein 1991: p53 mutations in human cancers](https://onco.cc/key-papers/paper-hollstein-p53-mutations-science-1991/), [Hurwitz 2004: bevacizumab with chemotherapy for metastatic colorectal cancer, the first anti-angiogenic drug to extend life](https://onco.cc/key-papers/paper-hurwitz-bevacizumab-crc-nejm-2004/), [IARC verdict: excess body fat causes 13 cancers](https://onco.cc/key-papers/paper-body-fatness-iarc-nejm-2016/), [Identification of Lynch syndrome among patients with colorectal cancer](https://onco.cc/key-papers/paper-moreira-lynch-syndrome-identification-jama-2012/), [Impact of consensus molecular subtype on survival in patients with metastatic colorectal cancer: results from CALGB/SWOG 80405](https://onco.cc/key-papers/paper-lenz-cms-calgb-swog-80405-jco-2019/), [Improved survival with preoperative radiotherapy in resectable rectal cancer (Swedish Rectal Cancer Trial)](https://onco.cc/key-papers/paper-swedish-rectal-cancer-trial-preoperative-radiotherapy-nejm-1997/), [Inactivation of the type II TGF-beta receptor in colon cancer cells with microsatellite instability](https://onco.cc/key-papers/paper-markowitz-tgfbr2-inactivation-msi-colon-science-1995/), [Incidence and functional consequences of hMLH1 promoter hypermethylation in colorectal carcinoma](https://onco.cc/key-papers/paper-herman-mlh1-promoter-hypermethylation-colorectal-pnas-1998/), [Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years](https://onco.cc/key-papers/paper-vuik-early-onset-colorectal-europe-gut-2019/), [Integrative analyses of colorectal cancer show Immunoscore is a stronger predictor of patient survival than microsatellite instability](https://onco.cc/key-papers/paper-mlecnik-immunoscore-msi-colorectal-immunity-2016/), [International validation of the consensus Immunoscore for the classification of colon cancer](https://onco.cc/key-papers/paper-pages-immunoscore-international-validation-lancet-2018/), [K-ras mutations and benefit from cetuximab in advanced colorectal cancer](https://onco.cc/key-papers/paper-karapetis-kras-cetuximab-colorectal-nejm-2008/), [KEYNOTE-177: pembrolizumab instead of chemotherapy as first treatment for mismatch-repair-deficient metastatic colorectal cancer](https://onco.cc/key-papers/paper-keynote-177-nejm-2020/), [KRAS G12C metastatic colorectal cancer: specific features of a new emerging target population](https://onco.cc/key-papers/paper-schirripa-kras-g12c-metastatic-colorectal-clin-colorectal-cancer-2020/), [KRYSTAL-1: adagrasib with or without cetuximab in KRAS G12C-mutated colorectal cancer](https://onco.cc/key-papers/paper-krystal-1-crc-yaeger-nejm-2023/), [Le 2015: PD-1 blockade works in tumours with mismatch-repair deficiency, whatever the organ](https://onco.cc/key-papers/paper-le-mmr-deficiency-pd1-nejm-2015/), [Le 2017: mismatch-repair deficiency predicts response to PD-1 blockade across twelve tumour types, leading to the first tissue-agnostic drug approval](https://onco.cc/key-papers/paper-le-mmr-deficiency-science-2017/), [Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma](https://onco.cc/key-papers/paper-moertel-levamisole-fluorouracil-adjuvant-colon-nejm-1990/), [Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up](https://onco.cc/key-papers/paper-esmo-localised-colon-cancer-guideline-ann-oncol-2020/), [Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up](https://onco.cc/key-papers/paper-atkin-flexible-sigmoidoscopy-17-year-follow-up-lancet-2017/), [Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up](https://onco.cc/key-papers/paper-esmo-metastatic-colorectal-cancer-guideline-ann-oncol-2023/), [Minnesota trial: a yearly stool blood test cuts bowel cancer deaths by a third](https://onco.cc/key-papers/paper-minnesota-fobt-nejm-1993/), [Mismatch repair status and BRAF mutation status in metastatic colorectal cancer: a pooled analysis of the CAIRO, CAIRO2, COIN and FOCUS studies](https://onco.cc/key-papers/paper-venderbosch-mmr-braf-metastatic-colorectal-pooled-ccr-2014/), [Molecular biomarkers for the evaluation of colorectal cancer: guideline from ASCP, CAP, AMP and ASCO](https://onco.cc/key-papers/paper-sepulveda-molecular-biomarkers-colorectal-guideline-jco-2017/), [Multitarget stool DNA testing for colorectal-cancer screening](https://onco.cc/key-papers/paper-imperiale-multitarget-stool-dna-screening-nejm-2014/), [Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23)](https://onco.cc/key-papers/paper-conroy-prodige-23-neoadjuvant-folfirinox-rectal-lancet-oncol-2021/), [NICHE-2: a month of nivolumab and ipilimumab before surgery clears mismatch-repair-deficient colon cancer in most patients](https://onco.cc/key-papers/paper-niche-2-nejm-2024/), [Nivolumab in patients with metastatic DNA mismatch repair-deficient or microsatellite instability-high colorectal cancer (CheckMate 142)](https://onco.cc/key-papers/paper-overman-checkmate-142-nivolumab-dmmr-colorectal-lancet-oncol-2017/), [Nivolumab plus ipilimumab in microsatellite-instability-high metastatic colorectal cancer (CheckMate 8HW)](https://onco.cc/key-papers/paper-andre-checkmate-8hw-nivolumab-ipilimumab-nejm-2024/), [Non-V600 BRAF mutations define a clinically distinct molecular subtype of metastatic colorectal cancer](https://onco.cc/key-papers/paper-jones-non-v600-braf-colorectal-jco-2017/), [Nonoperative management of mismatch repair-deficient tumors](https://onco.cc/key-papers/paper-cercek-nonoperative-management-mismatch-repair-deficient-tumours-nejm-2025/), [NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected](https://onco.cc/key-papers/paper-nordicc-nejm-2022/), [Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial](https://onco.cc/key-papers/paper-atkin-once-only-flexible-sigmoidoscopy-lancet-2010/), [Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results](https://onco.cc/key-papers/paper-habr-gama-nonoperative-stage-0-rectal-ann-surg-2004/), [Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA)](https://onco.cc/key-papers/paper-garcia-aguilar-opra-organ-preservation-jco-2022/), [Ostrem and Shokat: the hidden pocket that made KRAS G12C druggable](https://onco.cc/key-papers/paper-ostrem-kras-g12c-nature-2013/), [Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer (MOSAIC)](https://onco.cc/key-papers/paper-mosaic-oxaliplatin-adjuvant-colon-nejm-2004/), [Panitumumab vs Bevacizumab Added to Standard First-line Chemotherapy and Overall Survival Among Patients With RAS Wild-type, Left-Sided Metastatic Colorectal Cancer: A Randomized Clinical Trial](https://onco.cc/key-papers/paper-paradigm-jama-2023/), [Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer (PRIME)](https://onco.cc/key-papers/paper-douillard-prime-panitumumab-ras-nejm-2013/), [Parkin 2005: Global cancer statistics, 2002](https://onco.cc/key-papers/paper-parkin-global-cancer-statistics-2002-cacancer-2005/), [Performance of a multi-cancer early detection test in the randomized controlled NHS-Galleri trial](https://onco.cc/key-papers/paper-nhs-galleri-performance-nat-med-2026/), [Ponsegromab for the Treatment of Cancer Cachexia](https://onco.cc/key-papers/paper-groarke-ponsegromab-cancer-cachexia-nejm-2024/), [Preoperative chemotherapy for operable colon cancer: mature results of an international randomized controlled trial (FOxTROT)](https://onco.cc/key-papers/paper-foxtrot-preoperative-chemotherapy-colon-jco-2023/), [Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer (Dutch TME trial)](https://onco.cc/key-papers/paper-kapiteijn-dutch-tme-preoperative-radiotherapy-nejm-2001/), [Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016)](https://onco.cc/key-papers/paper-sebag-montefiore-cr07-preoperative-radiotherapy-lancet-2009/), [Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer: retrospective analyses of the CRYSTAL and FIRE-3 trials](https://onco.cc/key-papers/paper-tejpar-tumour-location-crystal-fire3-jama-oncol-2017/), [Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials](https://onco.cc/key-papers/paper-arnold-primary-tumour-side-ras-wild-type-ann-oncol-2017/), [Quality indicators for colonoscopy and the risk of interval cancer](https://onco.cc/key-papers/paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010/), [Rahib 2014: projecting US cancer incidence and deaths to 2030](https://onco.cc/key-papers/paper-rahib-projecting-cancer-deaths-2030-cancerres-2014/), [Randomised controlled trial of faecal-occult-blood screening for colorectal cancer (Nottingham)](https://onco.cc/key-papers/paper-hardcastle-nottingham-faecal-occult-blood-lancet-1996/), [Randomised study of screening for colorectal cancer with faecal-occult-blood test (Funen)](https://onco.cc/key-papers/paper-kronborg-funen-faecal-occult-blood-lancet-1996/), [Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer](https://onco.cc/key-papers/paper-verwaal-cytoreduction-hipec-peritoneal-colorectal-jco-2003/), [Randomized trial of TAS-102 for refractory metastatic colorectal cancer (RECOURSE)](https://onco.cc/key-papers/paper-mayer-recourse-tas-102-nejm-2015/), [Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up](https://onco.cc/key-papers/paper-esmo-rectal-cancer-guideline-ann-oncol-2017/), [Recurrent R-spondin fusions in colon cancer](https://onco.cc/key-papers/paper-seshagiri-rspo-fusions-colon-nature-2012/), [Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT)](https://onco.cc/key-papers/paper-grothey-correct-regorafenib-lancet-2013/), [Sato 2009: single Lgr5 stem cells build crypt-villus organoids](https://onco.cc/key-papers/paper-sato-lgr5-organoids-nature-2009/), [Sauer 2004: chemoradiotherapy before rather than after surgery for rectal cancer (CAO/ARO/AIO-94)](https://onco.cc/key-papers/paper-sauer-preoperative-chemoradiotherapy-rectal-nejm-2004/), [Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO)](https://onco.cc/key-papers/paper-bahadoer-rapido-short-course-radiotherapy-lancet-oncol-2021/), [Siegel 2024: Cancer statistics, 2024, the American Cancer Society's annual US report](https://onco.cc/key-papers/paper-siegel-cancer-statistics-2024-cacancer-2024/), [Somatic POLE proofreading domain mutation, immune response, and prognosis in colorectal cancer](https://onco.cc/key-papers/paper-domingo-somatic-pole-proofreading-colorectal-lancet-gastro-2016/), [Stromal contribution to the colorectal cancer transcriptome](https://onco.cc/key-papers/paper-isella-stromal-contribution-colorectal-transcriptome-nat-genet-2015/), [Stromal gene expression defines poor-prognosis subtypes in colorectal cancer](https://onco.cc/key-papers/paper-calon-stromal-gene-expression-poor-prognosis-colorectal-nat-genet-2015/), [Sugar-sweetened beverage intake in adulthood and adolescence and risk of early-onset colorectal cancer among women](https://onco.cc/key-papers/paper-hur-sugar-sweetened-beverages-early-onset-colorectal-gut-2021/), [Sung 2021: GLOBOCAN 2020, the year breast cancer overtook lung cancer as the most diagnosed cancer](https://onco.cc/key-papers/paper-sung-globocan-2020-cacancer-2021/), [Terminology, molecular features, epidemiology, and management of serrated colorectal neoplasia](https://onco.cc/key-papers/paper-crockett-nagtegaal-serrated-neoplasia-gastroenterology-2019/), [TGF-beta drives immune evasion in genetically reconstituted colon cancer metastasis](https://onco.cc/key-papers/paper-tauriello-tgfbeta-immune-evasion-colorectal-nature-2018/), [The consensus molecular subtypes of colorectal cancer](https://onco.cc/key-papers/paper-cms-guinney-nat-med-2015/), [The landscape of somatic mutation in normal colorectal epithelial cells](https://onco.cc/key-papers/paper-lee-six-somatic-mutation-normal-colorectal-crypts-nature-2019/), [The mesorectum in rectal cancer surgery: the clue to pelvic recurrence?](https://onco.cc/key-papers/paper-heald-mesorectum-rectal-cancer-surgery-br-j-surg-1982/), [The molecular evolution of acquired resistance to targeted EGFR blockade in colorectal cancers](https://onco.cc/key-papers/paper-diaz-molecular-evolution-egfr-resistance-colorectal-nature-2012/), [The serrated pathway to colorectal carcinoma: current concepts and challenges](https://onco.cc/key-papers/paper-bettington-serrated-pathway-colorectal-histopathology-2013/), [Trastuzumab deruxtecan (DS-8201) in patients with HER2-expressing metastatic colorectal cancer (DESTINY-CRC01)](https://onco.cc/key-papers/paper-siena-destiny-crc01-trastuzumab-deruxtecan-lancet-oncol-2021/), [Trastuzumab deruxtecan in patients with HER2-positive advanced colorectal cancer (DESTINY-CRC02): primary results from a multicentre, randomised, phase 2 trial](https://onco.cc/key-papers/paper-destiny-crc02-lancet-oncol-2024/), [Trifluridine-tipiracil and bevacizumab in refractory metastatic colorectal cancer (SUNLIGHT)](https://onco.cc/key-papers/paper-prager-sunlight-trifluridine-tipiracil-bevacizumab-nejm-2023/), [Tucatinib plus trastuzumab for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic colorectal cancer (MOUNTAINEER)](https://onco.cc/key-papers/paper-strickler-mountaineer-tucatinib-trastuzumab-lancet-oncol-2023/), [Use of alternative medicine for cancer and its impact on survival](https://onco.cc/key-papers/paper-johnson-alternative-medicine-jnci-2018/), [Wild-type KRAS is required for panitumumab efficacy in patients with metastatic colorectal cancer](https://onco.cc/key-papers/paper-kras-colorectal-j-clin-oncol-2008/)
- journals: [Clinical colorectal cancer](https://onco.cc/journals/clinical-colorectal-cancer/), [Gastroenterology](https://onco.cc/journals/gastroenterology/), [Gut](https://onco.cc/journals/gut/), [Journal of gastrointestinal cancer](https://onco.cc/journals/journal-of-gastrointestinal-cancer/)
- pairings: [Anti-EGFR antibody + chemotherapy in left-sided RAS/BRAF wild-type mCRC](https://onco.cc/pairings/anti-egfr-left-sided/), [BRAF inhibitor + MEK inhibitor](https://onco.cc/pairings/braf-plus-mek/), [ctDNA MRD → adjuvant therapy decision](https://onco.cc/pairings/ctdna-mrd-to-adjuvant/), [KRAS G12C inhibitor + anti-EGFR antibody (colorectal)](https://onco.cc/pairings/kras-plus-egfr-crc/), [Neoadjuvant checkpoint inhibitor → surgery (or no surgery) in dMMR colorectal cancer](https://onco.cc/pairings/neoadjuvant-io-dmmr/)

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JSON: https://onco.cc/api/v1/entities/colorectal.json