Building a clearer picture of colorectal cancer
Although colorectal cancer has traditionally been associated with older adults, there is growing concern about the number of people developing the disease at younger ages.
“There are still major gaps in what is known about colorectal cancer in South African populations. We want to understand what causes the disease, how it can be detected earlier, why it is being seen in younger people and why some treatments work better for certain patients than for others,” says Dr Lisa Campbell-Roper, DGMI Project Manager.
CoRECT is a longitudinal clinical cohort and biorepository. The study will include people who have been diagnosed with colorectal cancer (known as cases), as well as people without the disease, who will form a healthy control group.
The study’s aim is to create a rich dataset on clinical, sociodemographic, occupational and dietary details from participants. There will be an overlay of lab information (histopathology), other investigations (such as diagnostic imaging) and then samples to create a biorepository for unpacking the molecular architecture of these tumours.
Furthermore, the study will unpack the genetic drivers of tumour formation and the role of lifestyle factors, as well as the molecular signatures that determine how individuals respond to treatment and why some don’t respond to treatment.
Genomic research will examine DNA while transcriptomic and proteomic studies will investigate gene activity and proteins. Microbiome research will explore the communities of microorganisms living in the gut and oral cavity, and how they may be associated with colorectal cancer.
“The broader vision for CoRECT is to create a platform for Wits to drive this understudied research forward and to use what we find to create African-informed precision oncology diagnostics and ideally therapeutics”, says Dr June Fabian, Director of the DGMI.
Why are younger people developing colorectal cancer?
Although colorectal cancer has traditionally been associated with older adults, there is growing concern about the number of people developing the disease at younger ages.
Early-onset colorectal cancer is generally defined as colorectal cancer diagnosed before the age of 50. A South African analysis published in 2024, based on National Cancer Registry data, found that a quarter of patients with colorectal adenocarcinoma were younger than 50. The researchers also found that younger patients were more likely to be of African ancestry and called for further investigation into the genetic, epigenetic and socioeconomic factors shaping the disease in South Africa.
“CoRECT is not limited to early-onset disease, but places particular emphasis on understanding colorectal cancer in younger people and individuals of African ancestry. Continental Africans are underrepresented in studies, with assumptions that diaspora populations, like African Americans, can be used as a proxy,” explains Campbell-Roper.
This focus is important because much remains unknown about whether colorectal cancers developing in younger African patients have distinct biological characteristics, environmental drivers or patterns of treatment response.
From the operating theatre to the laboratory
Tissue collected from a tumour and from the adjacent “normal” bowel offers researchers a unique opportunity to compare the tumour at a molecular level, examine its genetic features, gene activity, proteins and surrounding microbial environment and compare this to unaffected tissue in the same patient.
As the cohort grows, researchers will be able to compare findings across patients of different ages and backgrounds, and between people with and without colorectal cancer.
“The value of the platform will build over time. Each patient contributes another layer of information, while longitudinal follow-up will help researchers connect what they see in the laboratory with the course of the disease and its response to treatment,” says Fabian.
A platform for collaboration
Wits has provided the platform for the CoRECT Cancer Study, with specialist colorectal surgeons as the clinical leads of the project: Dr Brendan Bebington from the Colorectal Unit at Wits Donald Gordon Medical Centre and Dr Vuyo Soldati, Head of Colorectal Surgery at the Chris Hani Baragwanath Academic Hospital. The project investigators are supported by a multidisciplinary healthcare team.
“We hope to support wider national, regional, and international collaborations focused on colorectal cancer and early-onset disease,” says Bebington.
The next step is to grow the number and range of participants so that colorectal cancer in South Africans can be studied with the depth and sustained attention it has long lacked.
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