DIAGNOSIS AND SCREENING OF COLORECTAL CANCER IN THE ELDERLY

Abstract

Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer-related death worldwide, with older adults representing the main risk group and the primary focus of early diagnosis and screening strategies. Traditional screening, based on colonoscopy and fecal tests, faces challenges related to adherence and invasiveness, driving the search for precision medicine approaches. Recent advances highlight the integration of biomarkers (proteomic and metabolic, such as oleic acid and allocoholic acid) and polygenic risk scores for individualized stratification and optimization of the ideal screening age. Artificial intelligence (AI) has also emerged as a powerful tool, using computed tomography classifiers to stratify recurrence risk in stage II CRC. Furthermore, molecular testing for KRAS and BRAF mutations is mandatory in advanced disease to guide more effective and less toxic targeted therapies. Circulating tumor DNA (ctDNA) stands out as a crucial non-invasive biomarker for detecting minimal residual disease and predicting recurrence, enabling individualized management. It is concluded that the future of CRC screening and diagnosis in the elderly lies in the convergence of liquid biomarkers, genomics, and AI, aiming at detection in curable stages and high-precision treatment.