Unlock Biomarkers | CRC Disease State

Epidemiology

Screening for CRC has likely led to earlier diagnoses, and as such may be responsible for the decrease in diagnosis and mortality rates in older adults. However, diagnosis and mortality rates remain a persistent challenge.²

Percent of Cases by Stage at Diagnosis³

5-year Relative Survival by Stage at Diagnosis³

Localized

Regional

Distant

Unknown

5-year Relative Survival (all stages)

CRC rates have steadily risen among younger adults, particularly those aged 55 and under, with many cases diagnosed at an advanced stage.^2,3 A significant proportion present with distant disease, which carries a poor 5-year survival rate.^2,3 Approximately 60–90% of CRC tumors harbor actionable genomic alterations (AGAs).¹

Pathobiology

CRC typically begins with a polyp⁴

The development of colorectal cancer often begins with polyps that acquire mutations in genes that regulate cell proliferation and tumor suppression.

Uncontrolled cell growth is driven by mutations in genes like p53 and KRAS⁴

Alterations in tumor suppressors like p53 or drivers of proliferation like KRAS can lead to uncontrolled growth and the formation of malignant adenocarcinomas.

In many CRC tumors, genomic aberrations disrupt the DNA mismatch repair system, resulting in deficient MMR (dMMR) and high MSI (MSI-H)^4,5

Genomic aberrations like dMMR and MSI-H in adenocarcinomas are associated with a more positive prognosis following immunotherapy.

Patient and Disease Characteristics

Patient care in CRC relies on the understanding that each patient’s disease is unique. In CRC, testing for tumor and molecular characteristics, such as MMR and circulating tumor cells (CTC), is essential at all stages to help inform the patient care strategy. However, upon metastatic progression, actionable biomarkers should be examined.^6-8

Patient Care Plan

Patient history and characteristics⁹

Stage of disease⁸

CRC subtypes¹⁰

Tumor and molecular characteristics^6-8,10

Genetics

Age

Type 2 diabetes

Obesity

Family history

Early stage

Locally advanced

Metastatic

Colorectal adenocarcinoma

Gastrointestinal carcinoid tumors

Gastrointestinalstromal tumors

MMR and MSI

Actionable biomarkers

ctDNA

Patient history and characteristics⁹

Genetics

Age

Type 2 diabetes

Obesity

Family history

Stage of disease⁸

Early stage

Locally advanced

Metastatic

CRC subtypes¹⁰

Colorectal adenocarcinoma

Gastrointestinal carcinoid tumors

Gastrointestinalstromal tumors

Tumor and molecular
characteristics^6-8,10

MMR and MSI

Actionable biomarkers

ctDNA

References

1. Jan YH, et al. Br J Cancer. 2022;127(7):1304-1311. doi:10.1038/s41416-022-01913-4. 2. American Cancer Society. Colorectal Cancer Statistics. April 28, 2025. Accessed August 12, 2025. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html. 3. National Cancer Institute, Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Colorectal Cancer. Accessed August 12, 2025. https://seer.cancer.gov/statfacts/html/colorect.html. 4. Kasi A, et al. Curr Colorectal Cancer Rep. 2020;16(5):97-106. doi:10.1007/s11888-020-00458-z. 5. Parente P, et al. Dig Dis. 2023;41:746-756. doi:10.1159/000531003. 6. Grillo, et al. Histochem and Cell Biol. 2023;160(2):113-115. doi:10.1007/s00418-023-02202-8. 7. Adekunle AD, et al. JAMA Netw Open. 2024;7(7):e2419110. doi:10.1001/jamanetworkopen.2024.19110. 8. American Cancer Society. Colorectal Cancer Early Detection, Diagnosis, and Staging. January 29, 2024. Accessed August 15, 2025. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/staged.html. 9. American Cancer Society. Colorectal Cancer Risk Factors. April 29, 2025. Accessed August 15, 2025. https://www.cancer.org/cancer/types/colon-rectal-cancer/causes-risks-prevention/risk-factors.html. 10. American Cancer Society. About Colorectal Cancer. January 29, 2024. Accessed August 15, 2025. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/what-is-colorectal-cancer.html.

References

Remon J, Hendriks LEL, Mountzios G, et al. J Thorac Oncol. 2023;18(4):419-435. doi:10.1016/j.jtho.2022.10.015.
Han Y, Yu Y, Miao D, et al. JTO Clin Res Rep. 2024;5(2):100630. doi:10.1016/j.jtocrr.2023.100630.
Altintas DM, Comoglio PM. Cancers (Basel). 2023;15(18):4672. doi:10.3390/cancers15184672.
Liang H, Wang M. Onco Targets Ther. 2020;13:2491-2510. doi:10.2147/OTT.S231257.
Park S, Choi YL, Sung CO, et al. Histol Histopathol. 2012;27(2):197-207. doi:10.14670/HH-27.197.
Sun W, Song L, Ai T, et al. J Biomed Res. 2013;27(3):220-230. doi:10.7555/JBR.27.20130004.
Socinski MA, Pennell NA, Davies KD. JCO Precis Oncol. 2021;5:PO.20.00516. doi:10.1200/PO.20.00516.
Drusbosky LM, Dawar R, Rodriguez E, Ikpeazu CV. J Hematol Oncol. 2021;14(1)129. doi:10.1186/s13045-021-01138-7.
Sierra JR, Tsao MS. Ther Adv Med Oncol. 2011;3(1 Suppl):S21-35. doi:10.1177/1758834011422557.
Yin W, Guo M, Tang Z, et al. Cancers (Basel). 2022;14(10):2433. doi:10.3390/cancers14102433.
Ding C, Qiu Y, Zhang J, et al. BMC Pulm Med. 2023;23(1):240. doi:10.1186/s12890-023-02482-9.
Coleman N, Hong L, Zhang J, et al. ESMO Open. 2021;6(6):100319. doi:10.1016/j.esmoop.2021.100319.
Settleman J. Curr Biol. 2012;22(2):R43-4. doi:10.1016/j.cub.2011.11.004.
Qin K, Hong L, Zhang J, et al. Cancers (Basel). 2023;15(3):612. doi:10.3390/cancers15030612.
Hartmaier RJ, Markovets AA, Ahn MJ, et al. Cancer Discov. 2023;13(1):98-113. doi:10.1158/2159-8290.CD-22-0586.
Xiang C, Lv X, Chen K, et al. Mod Pathol. 2024;37(4):100451. doi:10.1016/j.modpat.2024.100451.
Heydt C, Ihle MA, Merkelbach-Bruse S. Cancers (Basel). 2023;15(11):2932. doi:10.3390/cancers15112932.
Mazieres J, Vioix H, Pfeiffer BM, et al. Clin Lung Cancer. 2023;24(6):483-497. doi:10.1016/j.cllc.2023.06.008.
Reischmann N, Schmelas C, Molina-Vila MA, et al. iScience. 2023;26(7);107006. doi:10.1016/j.isci.2023.107006.
Friedlaender A, Drilon A, Banna GL, et al. Cancer. 2020;26(22):4826-4837. doi:10.1002/cncr.33159.

CRC

Disease State

EPIDEMIOLOGY

Pathobiology

Patient and Disease Characteristics

Epidemiology

Screening for CRC has likely led to earlier diagnoses, and as such may be responsible for the decrease in diagnosis and mortality rates in older adults. However, diagnosis and mortality rates remain a persistent challenge.²

Percent of Cases by Stage at Diagnosis³

5-year Relative Survival by Stage at Diagnosis³

Pathobiology

CRC typically begins with a polyp⁴

Uncontrolled cell growth is driven by mutations in genes like p53 and KRAS⁴

In many CRC tumors, genomic aberrations disrupt the DNA mismatch repair system, resulting in deficient MMR (dMMR) and high MSI (MSI-H)^4,5

Patient and Disease Characteristics

Patient Care Plan

Patient history and characteristics⁹

Stage of disease⁸

CRC subtypes¹⁰

Tumor and molecular characteristics^6-8,10

Patient history and characteristics⁹

Stage of disease⁸

CRC subtypes¹⁰

Tumor and molecular
characteristics^6-8,10

Learn more about select biomarkers in CRC

CRC

Disease State

EPIDEMIOLOGY

Pathobiology

Patient and Disease Characteristics

Epidemiology

Screening for CRC has likely led to earlier diagnoses, and as such may be responsible for the decrease in diagnosis and mortality rates in older adults. However, diagnosis and mortality rates remain a persistent challenge.2​

Percent of Cases by Stage at Diagnosis3​

5-year Relative Survival by Stage at Diagnosis3​

Pathobiology

CRC typically begins with a polyp4​

Uncontrolled cell growth is driven by mutations in genes like p53 and KRAS4​

In many CRC tumors, genomic aberrations disrupt the DNA mismatch repair system, resulting in deficient MMR (dMMR) and high MSI (MSI-H)4,5​

Patient and Disease Characteristics

Patient Care Plan

Patient history and characteristics9

Stage of disease8​

CRC subtypes10​

Tumor and molecular characteristics6-8,10

Patient history and characteristics9

Stage of disease8​

CRC subtypes10​

Tumor and molecular characteristics6-8,10​

Learn more about select biomarkers in CRC

Screening for CRC has likely led to earlier diagnoses, and as such may be responsible for the decrease in diagnosis and mortality rates in older adults. However, diagnosis and mortality rates remain a persistent challenge.²

Percent of Cases by Stage at Diagnosis³

5-year Relative Survival by Stage at Diagnosis³

CRC typically begins with a polyp⁴

Uncontrolled cell growth is driven by mutations in genes like p53 and KRAS⁴

In many CRC tumors, genomic aberrations disrupt the DNA mismatch repair system, resulting in deficient MMR (dMMR) and high MSI (MSI-H)^4,5

Patient history and characteristics⁹

Stage of disease⁸

CRC subtypes¹⁰

Tumor and molecular characteristics^6-8,10

Patient history and characteristics⁹

Stage of disease⁸

CRC subtypes¹⁰

Tumor and molecular
characteristics^6-8,10