International Journal of Molecular Medical Science, 2024, Vol.14, No.5, 274-292 http://medscipublisher.com/index.php/ijmms 275 deaths (Siegel et al., 2024). In addition, it is estimated that there are 376.3 new cases of colorectal cancer diagnosed per 100 000 people each year in China (Chen et al., 2015). The development and progression of colon cancer involve a complex interplay of genetic, epigenetic, and environmental factors. Figure 1 Potential multi-omics markers can be used for early diagnosis of colon cancer 2.1 Pathogenesis and progression of colon cancer The pathogenesis of colon cancer is a multistep process that involves the accumulation of genetic and epigenetic alterations. The transformation from normal colonic epithelium to invasive carcinoma takes several years, with the most common features being the accumulation of genetic mutations, adenoma formation, and subsequent carcinogenesis (adenoma-carcinoma sequence) (Gajendran et al., 2019; Sokic-Milutinovic, et al., 2019; Xiao et al., 2019). Genetic and epigenetic alterations lead to the transformation of normal colonic epithelium into adenomatous polyps and eventually into invasive carcinoma. The transition from normal colonic epithelium to dysplasia involves the accumulation of genetic changes over time, ultimately leading to carcinoma. Colorectal cancer can develop through three main genetic pathways: chromosomal instability (CIN), mismatch repair (MMR) deficiencies, and CpG island methylator phenotype (CIMP). These pathways are not mutually exclusive but exhibit significant overlap. Key genetic changes include mutations in oncogenes, tumor suppressor genes, and genes involved in DNA repair mechanisms. For instance, mutations in the APC gene, KRAS, and TP53 are commonly observed in colon cancer (Sun et al., 2021). Epigenetic modifications, such as DNA methylation and histone modifications, also play a crucial role in the progression of colon cancer. Aberrant DNA methylation patterns can lead to the silencing of tumor suppressor genes and activation of oncogenes, contributing to tumorigenesis (Coppede, 2014). Apolipoprotein C1 (APOC1) promotes tumor progression in colorectal cancer through the MAPK signaling pathway (Ren et al., 2019). MicroRNAs (miRNAs) can also alter cellular signaling pathways and act as either oncogenes or tumor suppressors, contributing to tumorigenesis or recurrence (Lovat et al., 2011; Saliminejad et al., 2019). With advances in gene sequencing, miRNAs are considered potential biomarkers not only for early cancer detection but also for prognostic prediction (Nassar et al., 2017; Dieckmann et al., 2019; Moya et al., 2019). Additionally, the tumor microenvironment, including interactions with immune cells and stromal cells, influences cancer progression and metastasis. 2.2 Importance of early detection Early detection of colon cancer significantly improves the prognosis and survival rates of patients. When detected at an early stage, colon cancer is often curable with surgical resection and adjuvant therapies. Brenner et al. found
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