The genomic and epigenomic evolution of colorectal cancer
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Updated: Nov 4, 2026

Genome-Wide Analysis of DNA Methylation in Gastrointestinal Cancer
Published on: September 18, 2020
Christopher C T Sng1,2, Naureen Starling1,2, Trevor A Graham3
1Centre for Evolution and Cancer, Institute of Cancer Research, London, UK.
Abstract:
Colorectal cancer (CRC) is a paradigmatic disease for understanding cancer evolution. CRC is common and accessible for sampling, and malignant progression occurs through clearly defined morphological stages. In this Review, we describe how the pattern of somatic alterations that accrue in the genomes and epigenomes of colorectal cells reveal the dynamics and molecular drivers of CRC evolution, from initial transformation through to metastatic dissemination and treatment resistance. We consider the latest evidence of genetic, epigenetic and immune changes that accompany multistep carcinogenesis. We explore the role of the epigenome and cell plasticity in progression and treatment resistance, and their interrelationship with genetic changes. Finally, we discuss how these evolutionary principles are redefining clinical strategies and explore the translational frontiers in evolution-informed therapy.
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