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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2026; 18(1): 114502
Published online Jan 15, 2026. doi: 10.4251/wjgo.v18.i1.114502
Published online Jan 15, 2026. doi: 10.4251/wjgo.v18.i1.114502
Molecular mosaic of colorectal cancer: Why one classification system is no longer enough?
Sunita Ahlawat, Sumanta Das, Department of Pathology, Agilus Diagnostics Ltd, Fortis Memorial Research Institute, Gurugram 122002, Haryana, India
Sumanta Das, Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong 793018, Meghalaya, India
Author contributions: Ahlawat S and Das S were responsible for data collection, review, and editing of the manuscript; Das S was responsible for the concept of the editorial manuscript, writing, and interpretation; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The authors have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sumanta Das, Consultant Histopathologist, Department of Pathology, Agilus Diagnostics Ltd, Fortis Memorial Research Institute, Sector 44, Opposite Huda City Centre, Gurugram 122002, Haryana, India. sumantad755@gmail.com
Received: September 22, 2025
Revised: November 3, 2025
Accepted: November 27, 2025
Published online: January 15, 2026
Processing time: 113 Days and 9.8 Hours
Revised: November 3, 2025
Accepted: November 27, 2025
Published online: January 15, 2026
Processing time: 113 Days and 9.8 Hours
Core Tip
Core Tip: Colorectal cancer (CRC) is not a single disease but a molecular mosaic. The consensus molecular subtypes brought important progress, yet nearly a decade of experience highlights its limitations - heterogeneity, unclassified cases, and bulk transcriptomic biases. Emerging systems such as CRC intrinsic subtypes, pathway-derived subtypes, and stem cell-based frameworks reveal complementary biological perspectives. Precision oncology for CRC requires abandoning the search for one “best” classification and instead embracing a pluralistic, multi-omic, and adaptive taxonomy that aligns with distinct clinical needs.