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Explore Biomarker Testing

Colorectal Cancer

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Biomarker tests can make an impact on colorectal cancer.

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While speed matters when diagnosing colorectal cancer (CRC), biomarker testing is an important step in revealing what makes each subtype unique. It can help doctors move from one-size-fits-all care to more personalized treatment plans. Even if tests show no biomarkers, it’s still important and helps your care team better evaluate treatment options.

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Did you know?

Your treatment plan can be based on your biomarkers.

Your plan could include targeted therapy — treatment designed to act on specific features of cancer cells, such as proteins or gene changes identified through biomarker testing, although it can also affect some normal cells.

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About biomarker testing

What are CRC biomarkers?

Cancer biomarkers are small signals in tumor cells, like gene changes or certain levels of proteins, that can show how your cancer behaves and how it may change, grow, or respond to treatment. Even two people with the same type of CRC can have very different biomarkers.

By testing for them, your care team can create an individualized treatment plan — and adjust it if the disease changes over time. In CRC, a few biomarkers to be aware of are KRAS, NRAS, and BRAF.

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Let’s go over a few of the basics.

Biomarker testing can make a difference in your CRC care. You probably have questions. We have answers.

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Who should get tested?

Anyone who's been newly diagnosed with CRC, or is starting new or alternative care, should ask about biomarker testing.

It’s important for CRC because the tumor can grow quickly. By looking at the makeup of your cancer, testing can help predict whether the tumor will grow slowly or aggressively — and can help your doctor assess the risk of recurrence if you've already had surgery to remove tumor tissue.

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What will my results show?

In CRC, biomarker testing can show your subtype and reveal if you have actionable biomarkers that can guide more personalized care.

Biomarkers can also highlight important insights: which mutations help cancer cells grow, and immune-related markers that show how well you may respond to immunotherapy. If your results are inconclusive or negative for biomarkers, a test still helps your team assess your care options and need for a retest.

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Does this impact my care?

If you have any known biomarkers, your doctor can use that information to create, inform, or adjust a personalized treatment plan.

That's because certain biomarkers, like KRAS and BRAF, have unique characteristics that can indicate the type of treatment you're more likely to respond to. This can help determine your eligibility for targeted therapy, how you might respond to immunotherapies — and can help reduce the need for repeated biopsies.

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When do I talk to a doctor?

Ask about biomarker testing as soon as you’re diagnosed with CRC, if you start discussing new treatments, or when switching your treatment.

As you talk, your doctor may recommend comprehensive biomarker testing that looks for all recommended mutations at once, instead of single-gene testing that looks for one biomarker at a time over a longer period.

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What do I need to start asking about testing?

We know talking about biomarker testing can feel overwhelming. Knowing what to ask, and having a few talking points, can help.

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Here’s how they’re tested.

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Tissue Biopsies

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Liquid Biopsies

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Tissue Biopsies

A tissue biopsy is the first strategy in CRC cases. The procedure involves collecting a small piece of a tumor for closer examination.

Bits of tissue called polyps are removed using small tools passed through an endoscope during a colonoscopy. A pathologist then examines the samples in a lab. They’ll measure how much your cancer has progressed, look for gene and protein mutations that could point to targeted therapies, and check if immunotherapy may work for you.

Tissue biopsies are usually an outpatient procedure and do not require an overnight stay, however there are more invasive tissue biopsies that may require a hospital visit.

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Liquid Biopsies

Liquid biopsies analyze traces of cancer found in blood, urine, cerebrospinal fluid, and saliva. For CRC, it usually involves a blood sample.

Simpler samples, especially urine or blood, can usually be taken at a clinic or your doctor’s office. Since these types of biopsies are less invasive, they’re also faster to complete and more easily repeated than a tissue biopsy.

While liquid biopsies can provide similar insights as tissue testing, it still has its limits — the results may not always match tissue biopsies and may miss some cancer changes.

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Build your knowledge

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Biomarkers can change over time.

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Biomarker changes can occur over time and can reveal the way your tumor is growing or changing, or if it’s developing a resistance to treatment.

New biomarkers can indicate alternative treatment options that may work more effectively. That’s why it’s important to talk to your doctor about retesting before starting a new treatment plan.

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It’s actually true!

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Talk to your doctor

Do you have an appointment soon?

Get a full list of questions to ask about biomarkers, testing, and how it could impact your treatment plan.

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Still have questions?

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What biomarkers do doctors look for in colorectal cancer?

Some important colorectal cancer (CRC) biomarkers are KRAS/NRAS, BRAF, and HER2. However, there are several other biomarkers that your doctor may test for as well. Make sure to ask about which biomarkers they’ll be looking for.

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Where do I go to get tested?

Where you begin biomarker testing will depend on your need for a liquid biopsy or tissue biopsy.

A tissue biopsy is typically the first strategy in CRC cases. It is usually an outpatient procedure and does not require an overnight stay, however there are more invasive tissue biopsies that may require a hospital visit. The procedure can involve surgically collecting bits of tissue, called polyps, using small tools passed through an endoscope during a colonoscopy. They're then sent to a specialized lab for analysis before being sent back to your care team.

In CRC, liquid biopsies analyze traces of cancer cells found in blood, urine, cerebrospinal fluid, and saliva. Simpler, less invasive samples, especially urine or blood, can usually be taken at a clinic or your doctor’s office.

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What should I understand about my test results?

When you get your test results, your doctor will go over them with you to help you understand what they mean and how they can be used to determine your treatment options. You’ll most likely discuss:

What biomarkers were found — or if no biomarkers showed up
What treatment options match those specific biomarkers, and which ones may be available to you
If there aren’t treatment matches — what potential clinical trials may be available for those biomarkers, or other treatment options

Build a biomarker discussion guide you can take to your next appointment.

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Will I need to get retested?

Depending on how well your current treatment is working, your doctor may want to have you retested for any changes to your disease and the biomarkers that may show up.

Since changes can occur over time, it can reveal the way your tumor is growing or changing, or if it’s developing a resistance to treatment.

New biomarkers can indicate alternative treatment options that may work more effectively.

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Are there communities and advocacy groups I can join?

There are many patient advocacy and support groups in the colorectal cancer community. Here are a couple to get you started with connecting to other patients and caregivers, as well as resources to support you during your journey:

colorectalcancer.org

globalcca.org

fightcolorectalcancer.org

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