WATCH: Colorectal Cancer Screening & Management: What Clinicians Are Seeing, Discussing & Considering

Colorectal cancer is no longer a disease confined to older adults, nor is screening as simple as colonoscopy. Across the U.S., clinicians are confronting earlier presentations, gaps in screening adherence and a growing array of diagnostic and therapeutic tools that require nuanced clinical judgment.

At the same time, advances in noninvasive screening, endoscopic therapy, liquid biopsy and immunotherapy are reshaping the way colorectal cancer is diagnosed and treated.

Against this backdrop, physicians are being asked to do more than follow recommendations: they are weighing risk in younger patients, balancing invasive and noninvasive testing, integrating emerging technologies into practice and navigating uncertainty where evidence is still evolving.

To explore how these challenges are playing out in real‑world practice, Houston Methodist Hospital experts convened a multidisciplinary physician roundtable.

Panel participants included:

• Dr. Eamonn Quigley, David M. Underwood Chair of Medicine in Digestive Health and co-director of the Lynda K. and David M. Underwood Center for Digestive Health at Houston Methodist

• Dr. Svetang Desai, Interventional Gastroenterologist, Houston Methodist Underwood Center for Digestive Health

• Dr. Rachel Schiesser, Gastroenterologist, Houston Methodist Underwood Center for Digestive Health

• Dr. Monisha Singh, Medical Oncologist, Houston Methodist Neal Cancer Center

Key highlights:

• Early detection remains the most impactful intervention in colorectal cancer care. Screening continues to be the primary driver of improved outcomes, with earlier diagnosis strongly associated with higher cure rates and less intensive therapy

• Rising colorectal cancer incidence and mortality in younger patients is a growing clinical concern. Patients in their 20s and 30s are increasingly presenting with advanced disease, often without identifiable germline mutations, underscoring the need for heightened clinical vigilance.

• Symptoms in younger patients warrant a lower threshold for diagnostic evaluation. Rectal bleeding, anemia or persistent abdominal symptoms should not be dismissed as benign based on age alone; close follow‑up and escalation to colonoscopy when symptoms persist is critical.

• Colonoscopy remains the gold standard for both detection and prevention. Its superior adenoma detection rate and ability to remove precancerous lesions in real time continue to distinguish it from noninvasive screening options.

• Advanced endoscopic techniques have reduced the need for surgery in selected patients. High‑resolution imaging, endoscopic mucosal resection (EMR) and related techniques now allow safe removal of large and complex polyps, often during the index procedure.

• Circulating tumor DNA testing is reshaping risk stratification in Stage II colon cancer. Tumor‑informed assays such as Signatera help identify patients at low risk for recurrence who may safely avoid adjuvant chemotherapy, while flagging those who may benefit from additional treatment.

• Immunotherapy represents a major advance for a subset of patients. Patients with mismatch repair–deficient tumors can experience dramatic and durable responses, though effective strategies for mismatch repair–proficient disease remain an active area of research.

• Screening adherence remains suboptimal, even in resource‑rich settings. Open-access colonoscopy pathways and patient education around noninvasive options are essential to improving overall screening rates.