Semantic Segmentation and the Future of Colorectal Cancer Care

Daniel Taylor, DO, medical oncologist at Trinity Health Grand Rapids and University of Michigan Health-West, is a member of the Cancer Network of West Michigan, a collaboration between Trinity Health in Grand Rapids and Muskegon, UM Health-West, and Michigan Medicine. He is one of many specialists and subspecialists who offer cutting-edge treatments, personalized care, and access to the latest research, treatments, and clinical trials.

As colorectal cancer diagnoses continue to rise for younger populations, expected to impact one in 24 men and one in 26 women, understanding prevention and developing treatment options is critical.

Understanding Semantic Segmentation 
Semantic segmentation is a cutting-edge image analysis technique that assigns a label to each pixel in an image. With the advancement of artificial intelligence (AI) and machine learning (technologies that enable systems to improve their performance over time), this method is becoming increasingly precise and efficient.

Medical imaging plays a crucial role in colorectal cancer diagnosis and staging. Pathology slides, MRI scans, and CT images help providers determine the presence and extent of cancer. For example, pathologists examine tissue samples using specialized stains to identify cancerous cells and radiologists analyze imaging scans for signs of tumor growth, lymph node enlargement, or potential cancer spread.

AI-powered semantic segmentation can enhance this process by reducing human error, minimizing diagnostic variability, and addressing image fatigue. Doctors can make more data-driven decisions by integrating advanced image analysis programs into clinical workflows.

AI in Staging and Treatment Decisions
One promising application of semantic segmentation is in evaluating locally advanced rectal cancer. Patients often undergo total neoadjuvant therapy (TNT), which includes chemotherapy and radiation before surgery. While some patients respond well to treatment and surgery may not be necessary, predicting who will need surgery is challenging. As a result, most patients still undergo surgery.

An advanced AI-driven imaging system could analyze thousands of rectal cancer cases to identify patterns and subtle risk factors that might predict treatment outcomes. This could help doctors determine whether a patient would benefit more from surgery or watchful waiting, potentially preventing some individuals from unnecessary procedures.

AI in breast cancer screening has achieved 89% specificity and 76% sensitivity. As research and technology progress, this is expected to grow in more disciplines.

Credibility and Advancements in Semantic Segmentation
Although semantic segmentation for medical imaging has been explored since the 1980s, it only became more available in the last 10 to 15 years. With rapid advancements in machine learning, recent trials have shown promising improvements in diagnostic accuracy, prognosis assessments, and cancer staging. However, these AI-driven methods are still being validated through ongoing clinical trials before they can be widely adopted.

New and Emerging Treatments 
Beyond AI-driven diagnostics, significant progress has been made in colorectal cancer treatment. Targeted therapies for specific genetic mutations transform outcomes for patients with limited options.

Recent FDA-approved treatments include:

•    Panitumumab and sotorasib: FDA-approved drugs to treat metastatic colorectal cancer with KRAS G12C mutations. 
•    Invikafusp-alfa: A new immune therapy drug for tumor mutational burden-high colorectal cancer.

Numerous clinical trials are ongoing to discover new treatment targets that can improve survival rates while minimizing side effects, making this an exciting time for colorectal cancer research.

The Future of Monitoring
Current surveillance guidelines established by the National Comprehensive Cancer Network (NCCN) continue to evolve. One promising development is circulating tumor DNA (ctDNA) testing, a blood test that detects minimal residual cancer cells. As this technology advances, it will likely become a routine part of colorectal cancer monitoring.

While ctDNA testing is most developed for colorectal cancer, it is also used for some lung, breast, and bladder cancers.

Why Early Detection Matters
Recognizing symptoms early can be lifesaving, especially for younger individuals still years away from routine screening. Signs to watch for include:

•    Abdominal cramping
•    Blood in bowel movements 
•    Changes in stool shape 
•    Unexplained persistent diarrhea or constipation

If you experience any of these symptoms, consult your primary care physician immediately and request a referral to a gastroenterologist for a diagnostic colonoscopy. Early detection significantly improves treatment outcomes.

For those with a family history of colorectal cancer, informing your doctor is essential. You may qualify for earlier screenings, which can catch cancer at a more treatable stage.

The Importance of Screening and Multidisciplinary Care
A colonoscopy remains the most effective screening tool. It not only detects cancer but can also prevent it by removing precancerous polyps.

Treatment approaches vary based on cancer stage:

•    Stages I-III and select stage IV cases: Surgery, with or without chemotherapy, is the standard of care.
•    Unresectable Stage IV: Because this cancer is not able to be surgically removed, systemic treatments, including chemotherapy and targeted therapies, are used based on the tumor’s genetic profile.

A multidisciplinary team (including specialists in radiology, pathology, surgical and medical oncology, gastroenterology, genetics, and clinical research) ensures each patient has the best possible care plan.

Advocating for Your Health
Patients should take an active role in their health care by:

•    Seeking medical attention if symptoms arise. Don’t wait months.
•    Knowing their family medical history and discussing it with a doctor.
•    Getting a second opinion if they feel uncertain about their diagnosis or treatment plan.
•    Scheduling regular checkups to catch potential issues early, even in their 20s and 30s.

Prioritizing health is invaluable. Early detection and cutting-edge innovations in colorectal cancer research continue to improve patients’ survival rates and quality of life worldwide.

Learn more about colorectal cancer screenings and cancer care at Trinity Health Michigan.