Colon cancer is one of the most common cancers. According to recent data, it ranks third among the most prevalent cancers worldwide and second in terms of mortality, with over two million new cases diagnosed each year and 700,000 deaths. It affects the large intestine and rectum, which are located in the final part of the digestive system.
Although historically more prevalent in older adults, a worrying phenomenon has emerged in recent decades: an increase in cases among young people, particularly in developed countries. The cause of this rise is not entirely clear, but it may be related to lifestyle and dietary changes, physical inactivity, alterations in the gut microbiome and exposure to unfavourable environmental factors.
One of the biggest challenges in tackling colon cancer is early detection. Survival rates vary drastically depending on the stage at which the disease is diagnosed, exceeding 90 % when diagnosed in the early stages but falling below 10 % if diagnosed in advanced stages. Screening programmes, which combine faecal occult blood tests and colonoscopies, have proven to be effective, although low participation, especially among men aged 50 to 60, remains an obstacle to their success.
Colorectal cancer has specific characteristics that complicate its management. It emerges in a tissue, the intestinal mucosa, where it proliferates very rapidly. Around 70 % of diagnosed patients have a localised tumour that can be removed through surgery. However, in one out of three patients who undergo this procedure, the tumour eventually recurs, leading to metastases and worsening the prognosis. This phenomenon is due to the ability of the primary tumour cells to evade the immune system and migrate to other organs, such as the liver or lungs, highlighting the urgent need to develop more effective therapies that prevent relapses and the spread of metastases. Between 20 % and 30 % of patients with colon cancer already have metastases at the time of diagnosis, and 50 % eventually develop metastases during the course of the disease. Metastasis, for which no specific drugs are currently available, represents a major public health issue as it is responsible for 90 % of cancer-related deaths.
Prevention is a crucial tool for reducing the incidence of this disease. Maintaining a diet high in fibre and low in saturated fats, engaging in regular physical activity and avoiding processed foods, tobacco and alcohol are key strategies. Additionally, extending screening programmes to include younger age groups could be essential in addressing the rising number of cases among those under 50. In the United States for example, the recommended starting age for screening has already been lowered from 50 to 45.
This debate will feature four researchers who are leading projects supported by the ”la Caixa” Foundation, focused on improving early diagnosis and treatment of colorectal cancer. What do these projects involve? What progress has been made?
Routine screening of populations above a certain age is being implemented worldwide (50 years old in the case of Spain). Current detection systems involve a two-step procedure, with a non-invasive test (which detects the presence of haemoglobin in the stool) followed by a colonoscopy if the test is positive. This approach is effective, but results in many false positives and places a significant burden on both the healthcare system and patients. The team led by Toni Gabaldón is developing a non-invasive early detection system that combines gut microbiota analysis with artificial intelligence algorithms. Its implementation in screening campaigns could reduce unnecessary colonoscopies by up to 30 %, improve the accuracy of screening programmes and optimise healthcare system resources.
Eduard Batlle and his team are working to understand how tumour cells generate metastases. They have developed experimental models that replicate the behaviour of human colorectal cancer. These models will enable them to study the different states that metastatic cells adopt during their spread throughout the body and to understand the mechanisms that allow them to change their properties in response to the environmental signals they encounter. The ultimate goal is to design new immunotherapies that prevent the formation of metastases.
Elena Élez is working on the development of new therapies to treat metastatic colon cancer. Although colorectal cancer has a good prognosis when diagnosed in its early stages, once it spreads and causes metastasis, treatment options become limited, and it is difficult to predict how each patient will respond to therapy. To address this challenge, Elena is involved in a project that combines 3D bioprinting and liquid biopsy in an organ-on-chip device. 3D bioprinting allows the creation of three-dimensional cellular models that accurately replicate the patient’s tumour and its environment, facilitating the testing of new therapeutic strategies in the laboratory. On the other hand, liquid biopsy enables real-time analysis of the tumour cells present in the blood, which are responsible for metastasis. This innovative combination of technologies helps improve understanding of the progression of the disease and optimise treatments.
Angélica Figueroa and her team are developing a drug to halt the metastasis of colon cancer. Their work focuses on the protein Hakai, whose alteration they have identified as a key factor in the onset of metastasis. They have developed several molecules that target this protein and inhibit tumour progression in both cell cultures and animal models. They are currently evaluating and refining the drug candidates to select the most promising one, optimise it and move towards regulatory preclinical trials, with the aim of initially testing the therapy against metastatic colon cancer.
Speakers:
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Eduard Batlle, ICREA researcher, head of the Colorectal Cancer Laboratory at the IRB Barcelona and group leader at the Cancer CIBER (CIBERONC).
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Angélica Figueroa, R4 Researcher, leader of the Epithelial Plasticity and Metastasis Group at the Biomedical Research Institute (INBIC), in the University Hospital Complex of A Coruña (CHUAC).
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Toni Gabaldón, ICREA researcher and head of the Comparative Genomics Laboratory at IRB Barcelona and the Barcelona Supercomputing Center (BSC).
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Elena Élez, medical oncologist at Vall d’Hebron University Hospital in Barcelona (HUVH) and head of the Colorectal Cancer Group at the Vall d’Hebron Institute of Oncology (VHIO).
Moderator:
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Beatriz Pérez, health editor at El Periódico de Catalunya.
Projects supported by CaixaResearch:
