Colorectal cells grown into organoids, stem cell-derived human 'mini-organs' that are used to study human development and disease.
NCI-funded researchers are working to advance our understanding of how to prevent, detect, and treat colorectal cancer. They are also looking at what factors influence screening behaviors, how to address differences in outcomes, and the rising rates of colorectal cancer in younger people.
This page highlights some of the latest colorectal cancer research, including clinical advances that may soon translate into improved care, NCI-supported programs that are fueling progress, and findings from recent studies.
Screening can prevent colorectal cancer through detection of precancerous growths, or polyps, which can be removed before they become cancerous. It can also allow colorectal cancers to be detected early, before they cause symptoms and when treatment may be more effective.
Colorectal cancer screening tests. These include colonoscopy, sigmoidoscopy, stool-based tests to detect hidden blood (fecal immunochemical testing (FIT) or fecal occult blood testing (FOBT)), and virtual colonoscopy. (See Screening Tests to Detect Colorectal Cancer and Polyps for more information.)
Despite the availability of effective colorectal cancer screening tests, some people choose not to get screened. Some reasons may be because of the personal nature of the procedures, a lack of recommendation by their doctor, perceived costs or lack of insurance, or the preparation involved for a colonoscopy.
Blood-based tests. Blood-based tests have been developed that analyze substances shed into the blood by colorectal cancer cells. Although these tests have not yet been included into screening guidelines, the hope is that they will enable simple, fast screening.
In 2024, FDA approved a new blood test called Shield for people at average risk for colon cancer. In a study of 8,000 people, the test detected colorectal cancers in more than 83% of the participants found to have colorectal cancer on colonoscopy.
Repeat screening or follow-up. The guideline for getting a screening colonoscopy is every 10 years as long as results are normal. However, if one or two small, noncancerous polyps are found, people usually get a repeat screening earlier.
NCI’s FORTE Colorectal Cancer Prevention Trial, is now looking at whether some people with one or two small polyps can wait 10 years before returning for another colonoscopy. By comparing two study groups, one with repeat colonoscopy after 5 years, and one with repeat colonoscopy after 10 years, researchers hope to learn whether waiting 10 years is as good at preventing colorectal cancer as follow-up exams after 5 years.
For colorectal cancer screening to be effective people need to follow up on abnormal test results. NCI is funding research to better understand how to increase colonoscopy screening, including how to increase repeat and follow-up screenings. Studies are also being done within the healthcare setting to look at ways to affect the decision to get screened.
Prevention of colorectal cancer. Research is also ongoing in the prevention of colorectal cancer. Studies are looking at how lifestyle factors may reduce the risk of the disease. Examples include research in physical activity, diet, presence of certain gut microbes, calcium intake, and regular aspirin use.
Surgically removing the cancer is the most common treatment for many stages of colorectal cancer. Chemotherapy, radiation, targeted therapy, immunotherapy, radiofrequency ablation, and cryosurgery are other treatments that may be used to treat colorectal cancer, depending on the stage.
Because of an increased risk of recurrence, differences in anatomy, and poorer prognosis, the treatment of rectal cancer may differ from that of colon cancer. Although surgery remains a common type of treatment for local and locally advanced rectal cancer, people with some stages may be treated with radiation, chemotherapy, and/or targeted therapy with or without surgery.
In addition to these standard treatments for rectal cancer, researchers continue to study both new treatments, such as immunotherapies, and new combinations of existing treatments in clinical trials.
Approximately 5% of colorectal cancer cases are due to Lynch syndrome, an inherited DNA repair disorder. People with this disorder have an increased risk of developing colorectal cancer, typically before they reach the age of 50. Lynch syndrome colorectal cancer tumors have many mutations, which may make them more susceptible to immunotherapies.
People whose colorectal tumors have a genetic feature known as microsatellite instability-high (MSI-H) or a defect in a process called mismatch repair also have many mutations in their tumors. About 15 percent of patients with stages II and III colorectal cancer and about 5 percent of those with stage IV disease have MSI-H tumors.
Immune checkpoint inhibitors have been less effective in colorectal cancer patients without Lynch syndrome and whose cancers don't have mismatch repair deficiency and are not MSI-H. (However, if they don't have liver involvement, immunotherapy may benefit advanced colorectal cancer patients.)
Scientists are currently testing various agents, such as chemotherapy drugs, targeted therapies and viruses, in combination with immune-based therapy to determine whether combining different types of treatments would be effective in killing cancer cells.
Using targeted therapies against genetic mutations that may drive tumor growth is another key area of research for metastatic colorectal cancer. The goal is to find agents that can block the activity of the abnormal proteins produced by these mutations. For example:
Liquid biopsies are a promising new approach being explored to detect, analyze, and track DNA, cells, and other substances shed from tumors into bodily fluids, such as blood and urine. Scientists are testing this method to detect colorectal cancer early, measure treatment responses, identify treatment resistance, and monitor for disease recurrence.
One trial found that testing blood for fragments of genetic material (DNA) shed by tumors, known as circulating tumor DNA (ctDNA), could identify patients with stage IIA colon cancer who might benefit from additional treatment with chemotherapy after surgery.
An ongoing trial is studying ctDNA in people with stage II or III colon cancer. The goal is to determine whether and what type of chemotherapy will benefit patients who have had surgery for their colon cancer based on the presence or absence of ctDNA.
Many NCI-funded researchers at the NIH campus, and across the United States and world, are seeking ways to address colorectal cancer more effectively. Some research is basic, exploring questions as diverse as the biological underpinnings of cancer and the social factors that affect cancer risk. And some is more clinical, seeking to translate this basic information into improving patient outcomes. The programs listed below are a sampling of NCI’s research efforts in colorectal cancer.
NCI funds and oversees both early- and late-phase clinical trials to develop new treatments and improve patient care. Trials are available for colorectal cancer screening, colorectal cancer prevention, and treatment for colon cancer and rectal cancer.
The following are some of our latest news articles on colorectal cancer research:
View the full list of Colorectal Cancer Research Results and Study Updates.