Dr Ajay Goel Explains Effectiveness of Liquid Biopsies, Tissue-Based Biomarkers in Treating CRC

Ajay Goel, PhD, AGAF, discusses study findings that could help in earlier detection of lymph node metastases and colorectal cancer (CRC).

Ajay Goel, PhD, AGAF, professor and chair of the Department of Molecular Diagnostics and Experimental Therapeutics at City of Hope, a cancer research and treatment organization, explains the importance of new studies, presented at Digestive Disease Week, thatfound the presence and likelihood of lymph node metastases in patients with colorectal cancer (CRC) could be predicted, therefore allowing for more personalized treatment. He also discusss how a new blood test could help predict CRC in patients as young as age 30 years.


How can your research help in determining recurrence in T1 CRC?

The third study1 we are presenting is also about colon cancer, but on a different type of colon cancer, something we refer to as T1 colon cancer, which means pathological T1 colon cancer. These cancers happen very, very early, [and] they are very aggressive. We typically treat these patients very, very aggressively. The problem with this is that anybody who gets diagnosed with T1 colon cancer, we worry that doing a localized tumor resection is probably not enough.

Out of abundance of caution, we typically tend to take a big part of the colon out or in many cases, we take a large part of the colon out, which is not good, because now a bigger segment of colon comes out, these individuals will have some sort of metabolic and other disorder issues they will have to deal with for the rest of their life. This is a problem. But we do this because of the worry that these patients may have something we call lymph node metastases, which means the cancer is already in the lymph nodes. So just to eliminate the possibility that this cancer may spread to other parts of the body, we typically take a big part of the colon out so that we can take all the lymph nodes out as well, because these patients will have recurrence.

Now we have developed basically a marker which can actually tell which of these patients truly have lymph node metastases, which one of these need aggressive surgical treatments, and which of those can simply be left alone because there is no disease in their lymph nodes. This test can basically segregate which patients who have the disease in the lymph nodes, which will require more extensive treatment, and the others who do not have disease in their lymph nodes, and those who can be simply monitored rather than taking a large part of the colon out.

What were the findings of your study testing the effectiveness of a blood test in detecting CRC earlier?

The last study2 is probably one of the most important studies, where we have developed a liquid biopsy, a blood test, for early detection of colon cancer and advanced polyps. Because for colon cancer screening, there are many commercial tests available, but most of these tests do not do a very good job of finding advanced polyps or highest polyps or stage I cancers. All of these commercial tests which are out there, they do very well in finding somebody who has stage III or IV colon cancer.

But if you're developing a screening marker for colon cancer, the target lesion should be high-risk polyps and stage I cancers and that's where most of the commercial tests fail. So we have developed a liquid biopsy, we have developed a blood test, actually, which does a remarkable job with very high degree of sensitivity and specificity. Our tests are almost 94% accurate for finding high-risk polyps and almost 96% accurate in finding patients with colon cancer using this blood-based liquid biopsy.


1. Noma T, de Gordoa KS, Miyazaki K, et al. Tissue-based transcriptome signature to predict recurrence after local resection in T1 colorectal cancer. Presented at: Digestive Disease Week; May 18-21, 2024; Washington, DC.

2. Mannucci A, Hernandez G, Uetake H, et al. Development and validation of a miRNA-based signature, powered by machine learning, for predicting 5-year disease-free survival after surgery in early-onset colorectal cancer. Presented at: Digestive Disease Week; May 18-21, 2024; Washington, DC.

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