title: Predictive and prognostic biomarkers in colorectal cancer: A systematic review of recent advances and challenges.
abstract: BACKGROUND
  Colorectal cancer (CRC) is one of the leading cause of cancer deaths worldwide. Since CRC is largely asymptomatic until alarm features develop to advanced stages, the implementation of the screening programme is very much essential to reduce cancer incidence and mortality rates. CRC occurs predominantly from accumulation of genetic and epigenetic changes in colon epithelial cells, which later gets transformed into adenocarcinomas.
  
  
  METHODS
  The current challenges of screening paradigm and diagnostic ranges are from semi-invasive methods like colonoscopy to non-invasive stool-based test, have resulted in over-diagnosis and over-treatment of CRC. Hence, new screening initiatives and deep studies are required for early diagnosis of CRC. In this regard, we not only summarise current predictive and prognostic biomarkers with their potential for diagnostic and therapeutic applications, but also describe current limitations, future perspectives and challenges associated with the progression of CRC.
  
  
  CONCLUSIONS
  Currently many potential biomarkers have already been successfully translated into clinical practice eg. Fecal haemoglobin, Carcinoembryonic antigen (CEA) and CA19.9, although these are not highly promising diagnostic target for personalized medicine. So there is a critical need for reliable, minimally invasive, highly sensitive and specific genetic markers of an individualised and optimised patient treatment at the earliest disease stage possible.
  
  
  CONCLUSIONS
  Identification of a new biomarker, or a set of biomarkers to the development of a valid, and clinical sensible assay that can be served as an alternative tool for early diagnosis of CRC and open up promising new targets in therapeutic intervention strategies.
authors.affiliation: Biotechnology Division, CSIR-North East Institute of Science and Technology, Jorhat, Assam 785006, India.
authors.forename: Vishal
authors.initials: V
authors.lastname: Das
authors.affiliation: Biotechnology Division, CSIR-North East Institute of Science and Technology, Jorhat, Assam 785006, India.
authors.forename: Jatin
authors.initials: J
authors.lastname: Kalita
authors.affiliation: Biotechnology Division, CSIR-North East Institute of Science and Technology, Jorhat, Assam 785006, India. Electronic address: mpal24@yahoo.com.
authors.forename: Mintu
authors.initials: M
authors.lastname: Pal
mesh_terms: D000818:Animals; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism*; D002272:Carcinoembryonic Antigen / Q000235:genetics / Q000378:metabolism; D003113:Colonoscopy / Q000639:trends; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism*; D044127:Epigenesis, Genetic / Q000502:physiology; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen
keywords: Challenges and future directions; Colorectal cancer; Molecular biomarkers; Prevention; Screening techniques; Signalling pathways