Colorectal cancer: a review


  • Juan José Granados-Romero Departamento de Cirugía General, Hospital General de México. Secretaría de Salud (SSa), Ciudad de México, México.
  • Alan Isaac Valderrama-Treviño Laboratorio de inmunoterapia experimental e ingeniería de tejidos. Facultad de Medicina. UNAM.
  • Ericka Hazzel Contreras-Flores Programa de Apoyo y Fomento de la Investigación Estudiantil (AFINES), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México. México.
  • Baltazar Barrera-Mera Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México. México.
  • Miguel Herrera Enríquez Laboratorio de inmunoterapia experimental e ingeniería de tejidos. Facultad de Medicina. UNAM.
  • Karen Uriarte-Ruíz Programa de Apoyo y Fomento de la Investigación Estudiantil (AFINES), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México. México.
  • Jesús Carlos Ceballos-Villalba Programa de Apoyo y Fomento de la Investigación Estudiantil (AFINES), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México. México.
  • Aranza Guadalupe Estrada-Mata Programa de Apoyo y Fomento de la Investigación Estudiantil (AFINES), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México. México.
  • Cristopher Alvarado Rodríguez Programa de Apoyo y Fomento de la Investigación Estudiantil (AFINES), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México. México.
  • Gerardo Arauz-Peña Programa de Apoyo y Fomento de la Investigación Estudiantil (AFINES), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México. México.



Colorectal cancer, Mortality, Epidemiology, Risk factors, Survival, Tumoral markers


Colorectal cancer (CCR) is the third most common cancer worldwide in men and women, the second largest cause of death related to cancer, and the main cause of death in gastrointestinal cancer. The risk of developing this cancer is related to bad alimentary habits, smoking, intestinal inflammatory disease, polyps, genetic factors, and aging. Of the patients that are diagnosed with colorectal cancer 90% are older than 50, with a median age of 64 years; however, the disease is more aggressive in patients that are diagnosed at younger ages. According to the American Cancer Association, it was accounted for more than 49,700 deaths in 2015. The goal is to reduce the mortality rate with early diagnosis and treatment. Currently, the survival rate is used to predict a patient’s prognosis. The patient is considered to have a positive familial history if a first-degree relative has been diagnosed with colorectal cancer or colonic polyps before the age of 60, or also if two or more first-degree relatives have been diagnosed with cancer or polyps at any age. There are several methods for detecting colorectal cancer, such as the guaiac test, immunochemical test of stool, DNA stool test, sigmoidoscopy, colonoscopy, and barium enema. The stage in which the cancer is detected determines the prognosis, survival, and treatment of the patient. Provide a review about generalities, genetic basis, risk factors, protective factors, clinical course, diagnostic methods, therapy and survival in colorectal cancer. Conducted research from different databases such as PubMed, Medline, MedScape, on the definition, genetic factors, classification, risk factors, protective factors, diagnostic methods, epidemiology, survival and treatment of colorectal cancer. Articles from 2000 to 2017 were included using the following keywords.


Smith RET, Renaud RC, Hoffman E. Colorectal cancer market. Nat Rev Drug Discov. 2004;3:471-2.

Dobre M, Dinu DE, Panaitescu E, Bîrlă RD, Iosif CL, Boeriu M, et al. KRAS gene mutations prognostic factor in colorectal cancer? Rom J Morphol Embryol 2015;56:671-8.

Calva AM, Acevedo Tirado MT. Revisión y actualización general en cancer colorrectal. Revista de Radiología México. 2009;1:99-115.

Siegel RL, Miller K, Jemal A. Cancer Statistics, 2015. CA Cancer J Clin. 2015;65:5-29.

Galano R, Rodríguez Z, Casáus A. Cancer de colon: Seguimiento posoperatorio. Revista Cubana de Cirugía. 1997;36(1):59-63.

Mitchel SC. From Colonic Polyps to Colon Cancer: Pathophysiology, Clinical Presentation and Diagnosis. Clin Lab Med. 2005;25:135-77.

Kelsen D, Daly J, Kern S, Levin B, Tepper J, Van Cutsem E. Principles and Practice of Gastrointestinal Oncology. 2nd Editon. Lippincott Williams and Wilkins; 2008.

DeVita V, Lawrence T, Rosenberg S. Cancer: Principles and practice of Oncol. 9th Editon Lippincott Williams and Wilkins; 2011.

Silva AC, Hara AK, Leighton JA, Heppell JP. Ct Colonography with Intravenous Contrast Material: Varied Appearances of Colorectal Carcinoma. Radiographics. 2005;25:1321-34.

Cancer Mondial. Statistical Information System. International Agency for Research on Cancer; 1977.

Cress RD, Morris C, Ellison GL, Goodman MT. Secular changes in colorectal cancer incidence by subsite, stage at diagnosis, and race/ethnicity, 1992-2001. Cancer. 2006;107(5):1142-52.

Siegel RL, Ward EM, Jemal A. Trends in colorectal cancer incidence rates in the United States by tumor location and stage, 1992-2008. Cancer Epidemiol Biomarkers Prev. 2012;21:411-6.

Centers for Disease Control and Prevention, National Center for Health Statistics. National Health Interview Surveys, 2000, 2013. Public use data files, 2001, 2014.

Juárez-Vázquez C, Rosales-Reynoso M. Cancer colorrectal (CCR): alteraciones genéticas y moleculares. Gaceta Médica de México. 2014;150:154-64.

Russo A, Rizzo S, Bronte G, Silvestris N, Colucci G, Gebbia N, et al. The long and winding road to useful predictive factors for anti-EGFR therapy in metastatic colorectal carcinoma: the KRAS/BRAF pathway. Oncology. 2009;77(1):57-68.

Bazan V, Agnese V, Corsale S, Calò V, Valerio MR, Latteri MA, et al. Specific TP53 and/or Ki-ras mutations as independent predictors of clinical outcome in sporadic colorectal adenocarcinomas: results of a 5-year Gruppo Oncologico dell’Italia Meridionale (GOIM) prospective study. Ann Oncol. 2005;16(4):50-5.

Bazan V, Migliavacca M, Zanna I, Tubiolo C, Grassi N, Latteri MA et al. Specific codon 13 K-ras mutations are predictive of clinical outcome in colorectal cancer patients, whereas codon 12 K-ras mutations are associated with mucinous histotype. Ann Oncol. 2002;13(9):1438-46.

Oliveira C, Velho S, Moutinho C, Ferreira A, Preto A, Domingo E, et al. KRAS and BRAF oncogenic mutations in MSS colorectal carcinoma progression. Oncogene. 2007;26(1):158-63.

Yang YH, Lim SB, Kim MJ, Chung HJ, Yoo HW, Byeon JS, et al. Three novel mutations of the APC gene in Korean patients with familial adenomatous polyposis. Cancer Genet Cytogenet. 2010; 200(1):34-9.

Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell. 1990;61:759-67.

MacDonald B, Tamai K, He X. Wnt/β-catenin signaling: components, mechanisms, and diseases. Dev Cell. 2009;17(1):9-26.

Thorstensen L, Lind GE, Løvig T, Diep CB, Meling GI, Rognum TO, et al. Genetic and epigenetic changes of components affecting the WNT pathway in colorectal carcinomas stratified by microsatellite instability. Neoplasia. 2005;7:99-108.

Tomlinson IP, Webb E, Carvajal-Carmona L, Broderick P, Howarth K, Pittman AM, et al. A genome-wide association study identifies colorectal cancer susceptibility loci on chromosomes 10p14 and 8q23.3. Nat Genet. 2008;40:623-30.

Levy L, Hill CS. Alterations in components of the TGF-beta, superfamily signaling pathways in human cancer. Cytokine Growth Factor Rev. 2006;17:41-58.

Broderick P, Carvajal-Carmona L, Pittman AM, Webb E, Howarth K, Rowan A, et al. A genome-wide association study shows that common alleles of SMAD7 influence colorectal cancer risk. Nat Genet. 2007;39:1315.

Nissar S, Sameer AS, Rasool R, Chowdri NA, Rashid F. Polymorphism of the DNA Repair Gene XRCC1 (Arg194Trp) and its role in Colorectal Cancer in Kashmiri Population: a Case Control Study. Asian Pac J Cancer Prev. 2015;16(15):6385-90.

Moya P, Esteban S, Fernandez-Suarez A, Maestro M, Morente M, Sánchez-Carbayo M. KiSS-1 methylation and protein expression patterns contribute to diagnostic and prognostic assessments in tissue specimens for colorectal cancer. Tumour Biol. 2013;34(1):471-9.

Gala M, Chung DC. Hereditary colon cancer syndromes. Seminars in Oncology. 2011;38:490-9.

Aaltonen L, Johns L, Järvinen H, Mecklin J, Houlston R. Explaining the familial colorectal cancer risk associated with mismatch repair (MMR)-deficient and MMR-stable tumors. Clin Cancer Res. 2007;13:356-61.

Zhang K, Civan J, Mukherjee S, Patel F, Yang H. Genetic variations in colorectal cancer risk and clinical outcome. World J Gastroenterol. 2014;20 (15):4167-77.

Li H, Zhu F, Boardman LA, Wang L, Oi N, Lui K, et al. Aspirin Prevents Colorectal Cancer by Normalizing EGFR Expression. EBioMedicine. 2005;2(5):447-55.

Sánchez AR, Martín FM, Palma MS, López PB, Bermejo LM, Gómez CC. Fiber-type indication among different pathologies. Nutr Hosp. 2015; 31(6):237-83.

Leenders M, Siersma PD, Overvad K, Tjonneland A, Oslen A, Boutron-Ruault MC, et al. Subtypes of fruit and vegetables, variety in consumption and risk of colon and rectal cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2015;1;137(11):2705-14.

National Comprehensive Cancer Network Guidelines (NCCN Guidelines). Colorectal Cancer Screening. Washington: NCCN Guidelines; 2014.

Ashizawa S, Brunicardi FC, Wang XP. PDX-1 and the pancreas. Pancreas. 2004;28:109-20.

Wang XP, Li ZJ, Magnusson J, Brunicardi FC. Tissue MicroArray analyses of pancreatic duodenal homeobox-1 in human cancers. World J Surg. 2005; 29:334-8.

Ballian N, Liu SH, Brunicardi FC. Transcription factor PDX-1 in human colorectal adenocarcinoma: A potential tumor marker? World J Gastroenterol. 2008;14:5823-6.

Jack S. Screening for colorrectal cancer. Gastroenterol Clin North Am. 2008;37:97-115.

Cheng-jin Z, Shuang-kuan D, Xing-bo D, Min G. Expression of Paxillin is Correlated with Clinical Prognosis in Colorectal Cancer Patients. Med Sci Monit. 2015;21:1989-95.

Borda F, Borda A, Jiménez J, Zozaya JM, Prieto C, Gómez M, et al. Predictive value of pre-treatment hypoalbuminemia in prognosis of resected colorectal cancer. Gastroenterol Hepatol. 2014; 37(5):289-95.

Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer Treatment and Survivorship Statistics, 2016. Ca Cancer J Clin. 2016;66:271-89.

Wahyu W, Lars H, Hans G, Hakan M, Mats L, Niklas H, et al. Serum lactate dehydrogenase and survival following cancer diagnosis. British Journal of Cancer. 2015;113(9):1389-96.

Zhu C, Takasu C, Morine Y, Bando Y, Ikemoto T, Saito Y, et al. KISS1 Associates with Better Outcome via Inhibiting Matrix Metalloproteinase-9 in Colorectal Liver Metastasis. Ann Surg Oncol. 2015;22(3):1516-23.

Chao MW, Wang LT, Lai CY, Yang XM, Cheng YW, Lee KH, et al. eIF4E binding protein 1 expression is associated with clinical survival outcomes in colorectal cancer. Oncotarget. 2015; 15;6(27):24092-104.

Den Oudsten BL, Traa MJ, Thong MS, et al. Higher prevalence of sexual dysfunc- tion in colon and rectal cancer survivors compared with the normative population: a population-based study. Eur J Cancer. 2012;48:3161-70.

Liu L, Herrinton LJ, Hornbrook MC, Wendel CS, Grant M, Krouse RS. Early and late complications among long-term colorectal cancer survivors with ostomy or anastomosis. Dis Colon Rectum. 2010;53:200-12.

Song L, Li Y. SEPT9: A Specific Circulating Biomarker for Colorectal Cancer. Adv Clin Chem. 2015;72:171-204.

Arribas-Martin A, Díaz-Pizarro-Graf JI, Muñoz-Hinojosa JD, Valdés-Castañeda A, Cruz-Ramírez O, Bertrand MM. Laparoscopic versus open surgery for colorectal cancer. A comparative study. Cir Cir. 2014;82(3):274-81.

Herbert H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus Irinotecan, Fluorouracil, and Leucovorin for Metastatic Colorectal Cancer. N Engl J Med. 2004; 2335-42.

Ferrara N, Gerber HP, LeCouter J. The biology of VEGF and its receptors. Nat Med. 2003;9:669-76.

Kim KJ, Li B, Winer J, Armanini M, Gillett N, Phillips HS, et al. Inhibition of vascular endothelial growth factor-induced angiogenesis suppresses tumour growth in vivo. Nature. 1993;362:841-4.

Willett CG, Boucher Y, di Tomaso E, Duda DG, Munn LL, Tong RT, et al. Direct evidence that the VEGF-specific antibody bevacizumab has antivascular effects in human rectal cancer. Nat Med. 2004;10:145-7.

Kabbinavar F, Hurwitz H, Fehrenbacher L, Meropol NJ, Novotny WF, Lieberman G, et al. Phase II, randomized trial comparing bevacizumab plus fluorouracil (FU)/leucovorin (LV) with FU/LV alone in patients with metastatic colorectal cancer. J Clin Oncol. 2003;21:60-5.

Yang JC, Haworth L, Sherry RM, Hwu P, Schwartzentruber DJ, Topolian SL, et al. A randomized trial of bevacizumab, an anti-vascular endothelial cell growth factor antibody, for metastatic renal cancer. N Engl J Med. 2003 349(5):427-34.

Jain RK. Normalizing tumor vasculature with anti-angiogenic therapy: a new paradigm for combination therapy. Nat Med. 2001;7:987-9.

Lièvre A, Bachet JB, Le Corre D, Boige V, Landi B, Emile JF, et al. KRAS mutation status is predictive of response to cetuximab therapy in colorrectal cancer. Cancer Res. 2006;66(8):3992-5.

Knijn N, Mekenkamp LJ, Klomp M, Vink-Börger ME, Teerenstra S, Meijer JW, et al. KRAS mutation analysis: a comparison between primary tumours and matched liver metastases in 305 colorectal cancer patients. Br J Cancer. 2011; 104(6):1020-6.

Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg. 2006;244:254-9.

Adam R, Hoti E, Bredt LC. Estrategias oncoquirúrgicas en el cancer hepático metastásico. Cir Esp. 2011;89(1):10-9.

Mahmoud N, Bullard Dunn K. Metastasectomy for Stage IV Colorectal Cancer. Dis Colon Rectum. 2010;53(7):1080-92.

de Jong MC, Pulitano C, Ribero D, Strub J, Mentha G, Schulick RD, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastases. An international multi-institutional analysis of 1669 patients. Ann Surg. 2009;250(3):440-8.




How to Cite

Granados-Romero, J. J., Valderrama-Treviño, A. I., Contreras-Flores, E. H., Barrera-Mera, B., Herrera Enríquez, M., Uriarte-Ruíz, K., Ceballos-Villalba, J. C., Estrada-Mata, A. G., Alvarado Rodríguez, C., & Arauz-Peña, G. (2017). Colorectal cancer: a review. International Journal of Research in Medical Sciences, 5(11), 4667–4676.



Review Articles