Abstract
Colorectal cancer (CRC) remains a major global health challenge due to its high incidence and mortality rates. The development and progression of CRC are driven by complex molecular mechanisms involving genetic alterations in proto-oncogenes such as BRAF, PIK3CA, and K-ras, as well as tumor suppressor genes including APC, p53, and PTEN. These genetic changes are further compounded by the dysregulation of key signaling pathways such as Wnt/β-Catenin, PI3K/Akt, and STAT3, which collectively promote tumor cell proliferation, invasion, and metastasis. Additionally, chronic inflammation mediated by pro-inflammatory cytokines like TNF-α, IL-6, and IL-8, along with disruptions in gut microbiota homeostasis, play critical roles in CRC pathogenesis by facilitating immune evasion and tumor progression.In recent years, significant advancements in therapeutic strategies have improved outcomes for CRC patients. Immunotherapy, including immune checkpoint inhibitors, tumor vaccines, and adoptive cell therapy, has shown promising results, particularly in patients with specific molecular profiles. Targeted therapies directed against biomarkers such as EGFR, VEGF, KRAS, and BRAF have also demonstrated efficacy, while complementary approaches like traditional Chinese medicine have gained attention for their potential to enhance treatment outcomes. However, challenges such as tumor heterogeneity, drug resistance, and the complex tumor microenvironment continue to hinder therapeutic success, underscoring the need for further research to overcome these barriers and improve patient survival. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12672-026-04796-6.