Colorectal Cancer

Basic Overview

Etiology: Over 85% of CRC arises from adenomatous polyps (precancerous lesions). Key risk factors include inflammatory bowel disease (ulcerative colitis, Crohn’s disease), hereditary cancer syndromes (Lynch syndrome, FAP), high-fat low-fiber diet, obesity, sedentary lifestyle, tobacco smoking, excessive alcohol intake, and type 2 diabetes.
Clinical Manifestations: Early CRC is mostly asymptomatic. Colon cancer commonly presents with abdominal pain, changes in bowel habits, melena, iron-deficiency anemia, unintended weight loss, and bowel obstruction. Rectal cancer presents with hematochezia, tenesmus, changes in stool caliber, and rectal bleeding. Advanced disease presents with bowel obstruction, ascites, jaundice, and distant metastases (most commonly to the liver and lungs).
Diagnosis: Colonoscopy with biopsy is the gold standard for definitive diagnosis. Fecal occult blood test (FOBT) and fecal DNA testing are used for population-based screening. Contrast-enhanced CT, pelvic MRI (for rectal cancer staging), EUS, and PET-CT are used for staging. Mandatory molecular testing includes RAS, BRAF, MSI/MMR, and HER2 status. Staging follows the AJCC TNM system.

Standard Treatment Modalities

Precancerous Lesions/Early CRC (Stage 0-I): Endoscopic resection (EMR/ESD) is the curative standard for adenomas and intramucosal carcinoma. Radical surgical resection (laparoscopic colectomy for colon cancer, total mesorectal excision [TME] for rectal cancer) is indicated for lesions not eligible for endoscopic resection, with no adjuvant therapy required.
Locally Advanced CRC (Stage II-III): For colon cancer, radical colectomy followed by adjuvant chemotherapy is the standard for high-risk stage II and all stage III disease. For mid-to-low rectal cancer, neoadjuvant chemoradiotherapy (long-course or short-course radiotherapy) followed by TME surgery and adjuvant chemotherapy is the standard, to improve sphincter preservation rate and reduce local recurrence.
Advanced/Metastatic CRC (Stage IV): Systemic therapy is the core of management, guided by molecular profiling. For resectable liver/lung metastases, surgical resection of the primary tumor and metastases plus perioperative systemic therapy is the standard, with conversion therapy for initially unresectable disease to achieve resectability. Palliative surgery and radiotherapy are used for symptom control.

Core Advantages of Treatment in China

World-Leading Sphincter-Preserving Surgery for Low Rectal Cancer

: China has the highest volume of low rectal cancer surgeries globally, with Chinese colorectal surgeons pioneering sphincter-preserving techniques including intersphincteric resection (ISR), transanal total mesorectal excision (TaTME), and robotic-assisted TME. For ultra-low rectal cancer within 3-5 cm of the anal verge, top-tier centers achieve a sphincter preservation rate of over 80%, far higher than Western institutions, while maintaining equivalent oncological outcomes and excellent anal function postoperatively.

Widespread Endoscopic Screening and Resection

: AI-assisted colonoscopy systems are widely deployed, improving the detection rate of adenomas and early CRC by over 35%. ESD for colorectal polyps and early cancer is widely standardized, with a curative resection rate of over 98%, avoiding open surgery for thousands of patients annually.

Domestic Innovation in Immunotherapy and Targeted Therapy

: Domestic PD-1 inhibitors are approved for MSI-H/dMMR advanced CRC, with equivalent efficacy to imported agents at 1/4 to 1/5 the cost. Domestic biosimilars of bevacizumab and cetuximab are widely available at a fraction of the cost of imported products, making precision targeted therapy accessible to over 90% of advanced CRC patients in China. Chinese oncology teams also lead global research in targeted therapy for BRAF-mutated and HER2-amplified CRC.

Unmatched Expertise in Metastatic CRC Conversion Therapy

: Chinese colorectal oncology teams have unparalleled experience in conversion therapy for initially unresectable colorectal liver metastases (CRLM), with optimized chemotherapy + targeted + immunotherapy combination regimens achieving an R0 resection rate of over 30% for initially unresectable CRLM, drastically improving 5-year OS rates. Top-tier centers have extensive experience in simultaneous resection of the primary CRC and CRLM, as well as ablation and TACE for liver metastases.

Exceptional Cost-Effectiveness

: The total cost of CRC treatment in China is only 1/4 to 1/6 of that in the U.S. or Europe, with high-quality domestic endoscopic devices, surgical instruments, chemotherapeutics, targeted agents, and immunotherapies available at a fraction of the cost of imported products.