Role of NMR Metabolomics and MR Imaging in Colon Cancer

Colon cancer is clinically challenging, heterogeneous, and among the most frequently diagnosed malignancies. The screening for colon cancer is carried out by using procedures such as colonoscopy, sigmoidoscopy, fecal occult blood test, and virtual colonoscopy. These screening methods have some limitations like invasiveness and low sensitivity and specificity. Nuclear magnetic resonance (NMR) metabolomics may play an important role in colon cancer by providing noninvasive metabolite signatures and understanding its metabolism. Metabolic reprogramming is one of the hallmarks of cancer, including deregulated uptake of glucose and amino acids, opportunistic modes of nutrient acquisition, and utilizing glycolysis and tricarboxylic acid (TCA) cycle intermediates providing selective advantage during initiation and progression of cancer. Oncometabolites refer to metabolites which show a marked increase in levels in cancers, like D-2-hydroxyglutarate, L-2-hydroxyglutarate, succinate, and fumarate. Magnetic resonance imaging (MRI) techniques, in particular, dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) have shown potential to study angiogenesis and water diffusion-based parameters, respectively. Additionally, these methods are not only useful for early diagnosis and therapy monitoring and staging of cancer but also for the identification of new therapeutic targets and designing new treatment strategies. In this chapter, we discuss the current state of NMR metabolic profiling and MRI in colon cancer.