Advances in the understanding and treatment of colorectal cancer.

Colorectal cancer (CRC) is a common malignancy and remains a formidable health burden in the world. Surgery is the cornerstone for curative treatment, and surgical technique has changed considerably for both colon and rectum cancer over the past decades. Laparoscopic approach has become standard for colon cancer in many institutions, and technical developments including robotic-assisted surgery is evolving for rectal cancer. Advances in (neo)adjuvant chemo-radiotherapy have increased survival and reduced recurrences, and the addition of targeted therapies has prolonged life in metastatic disease to considerable extent. The genetic understanding of the disease has led to introduction of molecular classification proposals, which exemplifies knowledge translated from basic science to clinical care. As CRC is a highly prevalent disease it lends itself to both prevention and screening, yet the best and most optimal approach has yet to be determined. Further, the advance of currently available diagnostic, staging, and treatment regimens for both local and metastatic disease calls for improved stratification and prognostication to better allocate resources and justify associated costs while reducing morbidity and even mortality from the disease. Clearly, the need to better stratify and correctly prescribe the best medication for the right patients to optimize outcome, reduce adverse events and costs, and rationalize resources is a mandatory task for current health systems. It is hoped that the increased understanding of colorectal cancer as a heterogeneous disease developing on similar yet diverse genetic and molecular mechanisms will further enhance the way these patients are managed in the future.