Colorectal cancer (CRC) is a paradigmatic disease for understanding cancer evolution. CRC is common and accessible for sampling, and malignant progression occurs through clearly defined morphological stages. In this Review, we describe how the pattern of somatic alterations that accrue in the genomes and epigenomes of colorectal cells reveal the dynamics and molecular drivers of CRC evolution, from initial transformation through to metastatic dissemination and treatment resistance. We consider the latest evidence of genetic, epigenetic and immune changes that accompany multistep carcinogenesis. We explore the role of the epigenome and cell plasticity in progression and treatment resistance, and their interrelationship with genetic changes. Finally, we discuss how these evolutionary principles are redefining clinical strategies and explore the translational frontiers in evolution-informed therapy. This Review describes the genomic and epigenomic evolution of colorectal cancer, and the implications of evolutionary mechanisms for treatment strategies and patient management.
The Baveno VIII consensus, published in 2026, builds on the framework established by Baveno VII, adding new recommendations that refine the management of advanced chronic parenchymal and vascular liver diseases and further establish portal hypertension as a continuum across disease stages.
