Fecal volatile organic compounds for early detection of colorectal cancer: where are we now?
The fecal volatolome, which is composed of fecal volatile organic compounds (VOCs), seems to hold potential as non-invasive biomarker for the detection of colorectal cancer (CRC) and its precursor lesions advanced adenomas (AA). The potential of the fecal volatolome has been subject of various studies using either chemical analytical or pattern-recognition techniques. The available literature on the potential of the fecal volatolome as CRC and AA biomarker was reviewed.
A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, Google Scholar and ResearchGate using the following keywords: Colorectal Cancer, Advanced Adenoma, Volatile Organic Compound, Metabolome, Gas Chromatrography–Mass Spectrometry, Selected-Ion Flow-Tube Mass Spectrometry, eNose, and Fecal Biomarkers.
Eighty-eight titles or abstracts were identified from the search, of which 11 papers describing the potential of the fecal volatolome for CRC detection were selected. In these studies, different techniques were used for the headspace analyses of fecal VOCs, limiting the possibility to compare outcomes. Increased levels of amino acids and short chain fatty acids, and decreased levels of bile acids and polyol alcohols in the gas phase of feces were observed repeatedly. All selected papers reported high diagnostic value for the detection of both CRC and AA based on fecal VOCs.
Based on the included studies, fecal VOC analyses seem promising for future screening of CRC and AA, with potentially improved test performances allowing for earlier detection of AA and CRC and consequently earlier initiation of treatment, possibly reducing morbidity and mortality rates next to lower rates of (unnecessary) colonoscopies.
KeywordsColorectal carcinoma Advanced adenoma Volatile organic compounds Biomarker Screening
Area under the curve
Fecal immunochemical testing
Fecal occult blood test
Gas chromatography–mass spectrometry
Gas chromatography–mass selective detector
Gas chromatography–sulfur chemiluminescence detector
Gas chromatography–thermal conductivity detector
Short chain fatty acid
Selected ion flow tube linked to mass spectrometry
Volatile organic compounds
There was no funding required for the performance of this study.
Compliance with ethical standards
Conflict of interest
S. Bosch declares that she has no conflict of interest. D. J. Berkhout declares that he has no conflict of interest. I. Ben Larbi declares that she has no conflict of interest. Tim G. de Meij served in the advisory board of Danone. Nanne K. de Boer has served as a speaker for AbbVie and MDS. He has served as consultant and principal investigator for TEVA Pharma BV and Takeda. He has received a (unrestricted) grant from Dr. Falk and Takeda.
Human and animal rights statement
This article does not contain any studies with human participants or animals performed by any of the authors.
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