A Systematic Review of Reducing the Burden of Colorectal Cancer through Microbiome Alteration

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 6, November – 2025, Page No. : 217 - 230 Corresponding Author: Sindhu R, ijdsir, Volume – 8 Issue - 6, Page No. : 217 - 230 Page217 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 A Systematic Review of Reducing the Burden of Colorectal Cancer through Microbiome Alteration 1Swetha Varsa M, Undergraduate (Bachelor of Dental Surgery), SRM Dental College, Ramapuram, Bharathi Salai, Chennai, TN, India. 2Sindhu R, Master of Dental Surgery, Senior Lecturer, Department of Public Health Dentistry, SRM Dental College, Ramapuram, Bharathi Salai, Chennai, TN, India. 3Banu Jothi A, Postgraduate, Department of Public Health Dentistry, SRM Dental College, Ramapuram, Bharathi Salai, Chennai, TN, India. 2Lubna Fathima, Master of Dental Surgery, Senior Lecturer, Department of Public Health Dentistry, SRM Dental College, Ramapuram, Bharathi Salai, Chennai, TN, India. 4Prabu D, Master of Dental Surgery, Professor and Head, Department of Public Health Dentistry, SRM Dental College, Ramapuram, Bharathi Salai, Chennai, TN, India. 5Rajmohan M, Master of Dental Surgery, Reader, Department of Public Health Dentistry, SRM Dental College, Ramapuram, Bharathi Salai, Chennai, TN, India. 5Dinesh Dhamodhar, Master of Dental Surgery, Reader, Department of Public Health Dentistry, SRM Dental College, Ramapuram, Bharathi Salai, Chennai, TN, India. 2Indira Nehru, Master of Dental Surgery, Senior Lecturer, Department of Public Health Dentistry, SRM Dental College, Ramapuram, Bharathi Salai, Chennai, TN, India. 3Haripriya R, Postgraduate, Department of Public Health Dentistry, SRM Dental College, Ramapuram, Bharathi Salai, Chennai, TN, India. Corresponding Author: Sindhu R, Master of Dental Surgery, Senior Lecturer, Department of Public Health Dentistry, SRM Dental College, Ramapuram, Bharathi Salai, Chennai, TN, India. Citation of this Article: Swetha Varsa M, Sindhu R, Banu Jothi A, Lubna Fathima, Prabu D, Rajmohan M, Dinesh Dhamodhar, Indira Nehru, Haripriya R, “A Systematic Review of Reducing the Burden of Colorectal Cancer through Microbiome Alteration”, IJDSIRNovember – 2025, Volume – 8, Issue – 6, P. No. 217 – 230. Copyright: © 2025, Sindhu R, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work noncommercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Review Article Conflicts of Interest: Nil Abstract Background: The gastrointestinal tract microorganisms play a very crucial role in colorectal cancer (CRC). While certain bacteria can actually promote cancer growth, there are also beneficial microbes that can help reduce the risk and slow down the progression of CRC. Research has consistently highlighted a strong Sindhu R, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 Page218 connection between the types of gut bacteria present and the likelihood of being diagnosed with CRC. Methods: Following PRISMA 2020 guidelines, this systematic review examined 20 years of peer-reviewed research (PubMed, Google Scholar) on microbiomealtering strategies, such as probiotics and symbiotics, for reducing the risk of colorectal cancer (CRC). Findings: Probiotics greatly enhanced gut health and decreased inflammation. They sped up recovery after CRC surgery by reducing the risk of diarrhoea and other digestive problems. Conclusion: Probiotics containing Lactobacillus and Bifidobacterium improve the gut health of patients with colorectal cancer after surgery without causing significant adverse effects. Future studies ought to concentrate on their capacity for prevention. Keywords: Colorectal cancer, Probiotics, prebiotics, Microbiota, microbiome, gut microbes. Introduction Cancer is a complex illness marked by unchecked cell division and expansion that results in tumour development and metastasis1. In the year 2020, 1.9 million Colorectal cancer (CRC) cases have been reported worldwide2. Approximately 10% of individuals with stage IV colon cancer survive for five years after diagnosis; colorectal cancer claimed the lives of 900,000 people worldwide.3 Based on the study, a mutation in the TP53 gene is associated with colorectal cancer 4. Males record a mortality rate of 11.0 due to CRC, whereas that of females is 7.2. This is closely related to lifestyle changes, such as diet, alcohol consumption and smoking5. When instances recorded in developed nations are more than those recorded in developing nations, the role of lifestyle changes is evident. The rate of incidence is 7.2 in countries with a lower Human Development Index (HDI) and 20.4 in countries with higher HDI.6 Cancer research has come a long way, and we're starting to see some exciting new discoveries7. The cancer treatment timeline showcases the remarkable journey of therapies over the last 170 years 8. These days, oncology is all about creating cancer nanomedicines that are both safe and effective 9. Diving into the role of the microbiome in cancer has become a crucial area of research 10. The human intestine holds trillions of bacteria plays a key role in bodily functions 11. Tumor microenvironment is a multifaceted structure comprising other cell types in addition to the cancer cells 12. The tumor microenvironment helps in cancer progression by creating a complex interaction between cancer cells and the various cellular and acellular components that surround them 13. Thus, the knowledge about different microbiota-host interactions can enhance precision in the application of CRC prevention measures 14. Previous studies suggest a link between a specific gut microbiome and CRC progression. This can occur via neoplastic cell transformation or immune system compromise due to reduced gut bacterial diversity. 15. Our human microbiome is a fascinating mix of bacteria, viruses, archaea, fungi, and protozoa that resides on our epithelial barriers 16. This complex ecology is key to our well-being and has a great effect on disease. Treatment for dysbiosis, a change in the gut microbiome, are many. 4. Intestinal microbes are pivotal in controlling mucosal inflammation and supporting systemic immunity 17. In addition, the use of probiotics and prebiotics offers another possible approach to altering dysbiosis. Lastly, recommending specific changes in lifestyle can also help to alter the equilibrium of the gut microbiota 18. In the early diagnosis cancer or recognizing potential threats in patients, Faecal Microbiota Transplantation (FMT) can serve as a good treatment regime 19. FMT was found to have suppressed the progression of the tumour and Sindhu R, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 Page219 reduced the tumour cells20. This treatment can be planned along with immunotherapy or chemotherapy for better efficacy 21. Many studies suggested personalised gut microbiota-based CRC treatments. Research indicates that F. nucleatum interacts with a protein called DHX15 for people with KRAS gene mutations; this can be neutralised by other bacteria called P. distasonis, which can slow the progression of CRC in people 22. Some studies suggest that gut bacteria, Fusobacterium nucleatum, Bacteroides fragilis and Escherichia coli, can cause tumours23. Fusobacterium nucleatum nucleatumcreates hypoxic tumour microenvironments through biofilms and creates inflammation to sustain its growth 24. The control of this bacterium needs external antibiotics and oral hygiene to control the development of this bacteria25. Enterotoxigenic Bacteroides fragilis produces toxins that cause inflammation and use gut mucosa for dysbiosis. High-fat diets in humans can promote the growing environment for these bacteria 26. The main control strategies include probiotics and lowfat diets for patients 27. Some bacteria damage DNA through genotoxins or metabolites, which promote tumorigenesis in patients. Bacteria like Escherichia coli and Bilophila wadsworthia produce colibactin or hydrogen sulphide, which attacks epithelial cells' DNA, causing damage. Consuming dietary fibre and probiotics can help control these bacteria and its proliferation. 28. Gut reduced diversity also leads to the growth of some bacteria, which causes CRC risk. Some species of bacteria such as Porphyromonas and Bilophila wadsworthia flourish in people who consume fat-rich diets with low fibre intake. These bacteria produce tumour-promoting metabolites such as butyrate and hydrogen sulphide, which are involved in inflammation and a greater chance of getting colorectal cancer (CRC) 29. On other hand, including probiotics and prebiotics, together with a high fibre diet and low-fat intake, can control the overgrowth of these harmful bacteria 30. Aim: The goal of this systematic review is to thoroughly evaluate how well probiotics, prebiotics, and other microbiome modification techniques lower the risk of colorectal cancer (CRC). The main aim is to assess how well these therapies can improve gut health and reduce the risk of colorectal cancer in at-risk groups. This research will also highlight the benefits and drawbacks of these methods, particularly in relation to CRC surgery and recovery after the operation. Materials and Methods The systematic review process involved identifying the present research problem, developing a plan for carrying out a literature search, searching the literature and identifying articles, extracting data, analyzing, and appraising the evidence found. Research Question Studies investigate the relationship between the gut microbiome and colorectal cancer, with the potential of modulating the microbiome to minimize cancer risk and development. Probiotics, prebiotics, dietary changes, and fecal microbiota transplantation (FMT) show promise in preventing and treating colorectal cancer. These options provide new ways to lessen the impact of this disease. The research question is "What is the efficacy of probiotics, prebiotics, and other microbiome modification strategies in mitigating the risk of colorectal cancer?" PICO  Population: participants with cancer and undergoing cancer treatment  Intervention: microbiome alteration  Comparison: placebo  Outcome: reducing the risk of colorectal cancer Sindhu R, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Page220 Eligibility Criteria This review brings together findings from Englishlanguage randomized controlled trials conducted over the last ten years, specifically looking at microbial changes in patients with colorectal cancer. We left out studies that didn’t use cancer cell lines, focused on non-cancer pathways, or were published in other languages when there were restrictions. Search Strategy The study conducted an extensive search on three important databases, such as Google Scholar, PubMed, and Web of Science, to find the related articles using the various keyword combinations "CRC treatment AND probiotics", "CRC treatment AND RCT AND probiotics", and "CRC treatment AND symbiotic". The studies are sorted into years of publishing, and the most relevant articles are selected. Only research papers published in the past 10 years that have control doublemasked studies are taken into consideration. Discussion Using cytokine levels as a gauge, Zaharuddin L et al. (2019) performed a double-blind RCT on CRC patients to evaluate the effects of probiotics. The probiotics, which contained strains of Lactobacillus and Bifidobacterium, showed an anti-inflammatory effect by lowering IFN-γ and inflammatory cytokines (TNF, IL-6, 10, 12, 17A, 17C, and 22). Since no adverse effects were noted, probiotics containing these strains might be appropriate for the treatment of colorectal cancer. However, the study's small sample size necessitates more investigation.31 Hibberd et al. (2017) looked into how probiotics affect the microbiota in both cancerous (ER) and non-cancerous control groups. They discovered unique microbial patterns among colon cancer patients. Interestingly, the group taking probiotics had fewer butyrate-promoting microbes. The study indicated that probiotics didn’t cause any side effects and might actually enhance treatment outcomes for patients with gut cancer. 32. The effect of symbiotic supplements (probiotics and prebiotics) on the balance of the gut microbiota was examined in a study by Komatsu et al. (2018). For seven to eleven days following surgery, participants were given either a placebo or Lactobacillus casei and Bifidobacterium breve. The supplement group's samples contained ten times as many bacterial cells per gram, according to the results. Additionally, their blood showed fewer bacteria that promote cancer and a greater percentage of good bacteria.33. Yang et al. (2015) carried out a placebo-controlled study involving sixty cancer patients at stages 0-III to explore the effects of probiotics on infections. In this trial, thirty patients were given probiotics (specifically Bifidobacterium longum, Lactobacillus acidophilus, and Enterococcus faecalis), while the other thirty received a placebo made of sucrose. Although there were no notable changes in bowel movements, the use of probiotics led to a 50% reduction in diarrhea frequency, highlighting their impressive role in balancing the microbiome.34. In a study by Park et al. (2020), researchers looked into how probiotics can affect bowel issues, inflammation, and overall quality of life after colon surgery. Patients took a probiotic powder—featuring Bifidobacterium animalis subsp. lactis, Lactobacillus casei, and Lactobacillus plantarum—four times a day for four weeks. While there was a notable improvement in ARS scores, the patients didn’t see a significant change in their overall quality of life. The findings indicate that a longerterm study would be beneficial for gaining deeper insights.35 A study conducted in 2023 by Mohebian F and colleagues revealed that combining yogurt with Sindhu R, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 Page221 probiotics can significantly alleviate chemotherapyrelated diarrhea (CRD). Patients who took this combination saw a remarkable drop in their daily bowel movements, going from an average of 4.63 to just 2.26. They also reported a decrease in diarrhea intensity, which fell from 1.47 to 0.16 by the sixth day, along with better stool consistency.36 Huang, F. et al. (2023) looked into how a combination of four probiotics—Lactobacillus acidophilus, Enterococcus faecalis, Bacillus cereus, and Bifidobacterium infantis— could help ease gastrointestinal issues caused by chemotherapy in patients with colorectal cancer (CRC). Their findings indicated that these probiotics were effective in reducing abdominal pain and diarrhea while also boosting fatty acid production. However, one downside is that the study's findings may not apply broadly, as it focused on a specific age group and demographic.37 Conclusion Probiotics, especially Lactobacillus and Bifidobacterium strains, show significant promise in managing CRC both before and after surgery. 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Effects of PrObiotics on the Symptoms and Surgical ouTComes after Anterior REsection of Colon Cancer (POSTCARE): A Randomized, Double-Blind, Placebo-Controlled Trial. Journal of Clinical Medicine. 36. Mohebian, F., Mohammadzadeh Zarankesh, S., Jenabian, A., & Ranjbar, H. (2023). The effectiveness of yogurt+ probiotics on chemotherapyrelated diarrhea in patients with colorectal cancer: A randomized clinical trial. Middle East Journal of Cancer, 14(1), 127-135. 37. Huang, F., Li, S., Chen, W., Han, Y., Yao, Y., Yang, L., ... & Deng, X. (2023). Postoperative probiotics administration attenuates gastrointestinal complications and gut microbiota dysbiosis caused by chemotherapy in colorectal cancer patients. Nutrients, 15(2), 356. 38. Appendix F. Cochrane Risk of Bias Tool. Available at: file:///C:/Users/drgou/Downloads/appf-fm1%20 (2).pdf (Accessed: 03 August 2024). Sindhu R, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 Page224 39. Handbook for Conducting a Literature-Based Health Assessment Using OHAT Approach for Systematic Review and Evidence Integration. Office of Health Assessment and Translation (OHAT) Figure 1: Sindhu R, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Page225 Result Table 1: Features of study’s intervention