Cancer / Oncology/MSS colorectal cancer
Gastrointestinal · subtype
MSS colorectal cancer
Subtype of Colorectal cancer
Clinical / Scientific
Most CRCs are MSS/pMMR, immune-colder, and checkpoint-refractory as monotherapy. Wnt, RAS and remain dominant maps. Adjunctive immune-modulation hypotheses should not be presented as equivalent to MSI-high checkpoint success.
Core Biological Drivers
APC/Wnt
Canonical chromosomal-instability path.
RAS/RAF
dependence in a large subset.
Immune-cold stroma
TGF-β and myeloid exclusion.
Key Pathways
Scientific explanation
Canonical Wnt signalling stabilizes β-catenin, driving TCF/LEF . APC loss is a classic colorectal initiating event; the pathway also contributes to stemness in several tissues.
Scientific explanation
RAS GTPases and RAF kinases are frequent oncogenic nodes. KRAS, NRAS and BRAF mutations lock mitogenic signalling on in a ligand-independent way in many tumours.
Scientific explanation
The RAS–RAF–MEK–ERK cascade transmits mitogenic RTK signals to programmes for proliferation and differentiation.
Scientific explanation
TGF-β is cytostatic in intact epithelium but later supports , immune suppression and stromal . Context switches its role during progression.
Scientific explanation
family ligands drive endothelial sprouting and vascular permeability, a canonical tumour axis.
Scientific explanation
-2–PGE2 signalling can promote , immune suppression and epithelial proliferation, notably in colorectal neoplasia.
Scientific explanation
Epithelial–mesenchymal plasticity, driven by TWIST/SNAIL/ZEB and TGF-β/Wnt/Notch inputs, reduces adhesion and increases motility and stem-like features.
Pathway Convergence
Target → pathway → downstream effect → biological consequence. Shared intersections are mechanistic maps, not protocols.
Growth-factor signalling
Ligand or mutation-driven RTK input feeds PI3K/AKT and mTORC1, supporting anabolic growth. This is a map of signalling, not a treatment protocol.
Hypoxia to vessels
Low oxygen stabilizes HIF-1α, inducing VEGF and endothelial sprouting. Anti-angiogenic pharmacology intersects this axis but does not erase the tumour ecosystem.
Inflammatory survival
Chronic cytokine tone activates NF-κB and STAT3 transcriptional programmes that favour survival, invasion and sometimes immune evasion.
Metabolic Vulnerabilities
Aerobic supports ATP, biomass and acidification even when oxygen is available. Extent varies by tumour and remains a vulnerability hypothesis rather than a uniform target.
Tumor Microenvironment
Cancer-associated fibroblasts, TGF-β and extracellular-matrix stiffness can compress vessels and exclude T cells, especially in desmoplastic tumours.
Tumour-associated macrophages and myeloid-derived suppressor cells secrete cytokines that support invasion and blunt cytotoxic T cells.
Metastasis Module
, protease-mediated invasion, , circulating tumour-cell survival and organ-specific colonization form the metastatic cascade. Pre-metastatic niches and vascular permeability influence tropism.
Resistance Biology
Resistance can arise from drug efflux, secondary mutations, bypass RTK signalling, apoptotic threshold elevation, -mediated survival, metabolic adaptation and lineage plasticity.
Cancer Stemness
Wnt, Notch, Hedgehog, ALDH and CD44-associated programmes can mark stem-like fractions with quiescence and therapy tolerance. These markers are not interchangeable across tumour types.
Mechanism-Based Adjunctive Strategies
Compounds appear only where a mechanistic overlap exists for this cancer. Evidence tiers are not equivalent. Nothing here is a treatment recommendation.
Target / Mechanism
uncoupler in cestodes; mammalian models report , Wnt/β-catenin and modulation. Those host-signalling findings are investigational/preclinical.
Cancer relevance
Models report Wnt/β-catenin, and effects. Host signalling findings remain investigational.
Wnt / STAT3 signalling models. Convergence: Wnt/β-catenin, JAK/STAT, mTOR.
Celecoxib
Target / Mechanism
Selective -2 reducing PGE2. Relevant to -associated epithelial neoplasia; cardiovascular risk and lack of broad anticancer approval constrain interpretation.
Cancer relevance
-2/PGE2 biology is relevant in some epithelial neoplasias. Cardiovascular risk and lack of broad anticancer approval apply. Do not equate polyp or biomarker studies with tumour cure.
Inflammation-associated epithelial neoplasia research. Convergence: COX / inflammatory signalling, Angiogenesis.
Target / Mechanism
Modest complex I inhibition raises AMP:ATP, activating and restraining hepatic and -linked anabolism. Direct antineoplastic efficacy is not established from that pharmacology alone.
Cancer relevance
activation and restraint provide a metabolic rationale in - and -linked tumours. Human data are mixed and do not establish metformin as cancer therapy.
Metabolic adjunctive research context. Convergence: AMPK, mTOR, Glycolysis.
Losartan
Target / Mechanism
AT1- . In desmoplastic models, angiotensin blockade can reduce TGF-β-linked stromal compression and improve perfusion; this is adjunctive stromal biology, not cytotoxic oncology.
Cancer relevance
AT1 blockade can reduce TGF-β-linked desmoplasia and improve perfusion in models, notably pancreatic. Stromal decompression is not cytotoxicity.
Stroma / perfusion adjunctive research. Convergence: TGF-β, Angiogenesis.
Curcumin
Target / Mechanism
Polyphenol with promiscuous in-vitro NF-κB, and ROS effects. Bioavailability is poor; dish activity does not establish clinical anticancer efficacy.
Cancer relevance
In-vitro NF-κB/ effects are frequent. Poor bioavailability and absence of robust clinical anticancer efficacy keep this pathway-level.
Inflammatory-signalling dish models. Convergence: NF-κB, JAK/STAT.
Research Context
- CRC adenoma-carcinoma. Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell. 1990;61(5):759-767. https://doi.org/10.1016/0092-8674(90)90186-I
- CRC TCGA. The Cancer Genome Atlas Network. Comprehensive molecular characterization of human colon and rectal cancer. Nature. 2012;487(7407):330-337. https://doi.org/10.1038/nature11252
This oncology atlas is educational. Pathway maps, adjunctive strategies, and compound listings describe mechanistic relevance. They do not establish clinical efficacy, do not recommend treatment, and are not a substitute for oncology care. Evidence tiers are not equivalent.