Summary
Cancer is one of the leading causes of deaths in humans worldwide, and the treatment for most cancers remains costly and ineffective. In a hospital field survey, we observed serious side effects on cancer patients after receiving radiotherapy, including alopecia, osteoporosis and severe oral ulcers. What’s worse, according to the medical workers, nowadays, colorectal cancer (CRC) has become more common and occurred among younger ages, with a high mortality rate due to delayed detection. These gave us the idea of developing a new therapy to help millions of these patients.

To confirm that the phenomenon we observed is a relatively common problem and that the treatment of colorectal cancer is in dire need of improvement, we conducted a series of surveys including online researches and offline consultations.

Through online inquiries, we understand that colorectal cancer is the third most common cancer worldwide, just behind breast and lung cancer. According to the Global Cancer Observatory released by the International Agency for Research on Cancer (IARC) of World Health Organization, the number of new cases of colorectal cancer worldwide in 2020 (The latest edition) was 1,930,000, and the deaths number 916,000.[1] China’s economy has developed rapidly but its cancer prevention and control have not progressed at the same speed. In recent years, the annual numbers of confirmed cases and deaths of colorectal cancer are still on the rise, and the age of onset tends to be younger, 10 years younger than that of western countries on average. According to the statistics released by the National Cancer Center, the number of colorectal cancer cases in China was 400,000 in 2016, second only to lung cancer (830,000); and its deaths number in the same year was 190,000, ranking the fifth among other cancers.[2]

In offline consultations, in order to confirm the reliability of the information we attained, we decided to go into the hospital once again to further communicate with the doctors. We know that the current treatment of colorectal cancer mainly includes surgery, radiotherapy and chemotherapy. Overall, surgery is the most common treatment, which can remove the tumor and its metastases. Radiotherapy and chemotherapy are often used as adjuvant therapies, mainly functioning to reduce the risk of tumor recurrence and spread. However, every coin has two sides. The surgery also brings disadvantages, such as surgical trauma, high costs and the risk of infection during postoperative recovery period; chemotherapy has side effects which seriously affect the quality of life; and gene therapy takes a large expense but only has a small number of target patients. In short, the existing treatment options, more or less, have some defects, which cannot further improve the overall welfare of the patients, and it is urgent to explore new options.

Ultimately, combining all the information we gathered from different sources, we believe that the new treatment of colorectal cancer is in dire need. In addition, we have determined the final topic and core objective of our project, which is TO RELIEVE, TO CRUE, TO COMFORT. From the work of these three parts, we expect that we can focus on cancer patients and, through our efforts, finally make an achievement to reduce their pain and improve their knowledge about cancer and new drugs.

Our methods
As the project developed, we conducted a string of communications with doctors and patients to decide our project goals and the ways to achieve these goals. After repeated modifications, we finally divided our work into three steps and three parts. On the final web page, we also expected to present our work from three different perspectives: our timeline, work classification and our communication parties.

Work steps
As we started to push forward our project, we thought it was best to develop a work calendar to conduct our work, which could allow us to clarify what kind of help was needed at each stage.

The first step: find our problems
When we started our project, we realized that we needed to find out the problems that our project expected to solve.

• What treatments are currently being adopted?
• What are the problems with the current treatments?
• What problems should we focus on solving?

In order to obtain the answers to the above questions, we have taken several measures: first, we browsed many data in the literature to obtain the preliminary answers to these questions. Second, we contacted many hospitals, including the Fudan University Shanghai Cancer Center (FUSCC), The First Affiliated Hospital of Sun Yat-sen University, The Sixth Affiliated Hospital of Sun Yat-sen University, Changhai Hospital and Kunshan Hospital of Traditional Chinese Medicine, to learn about the current use of various treatments. Third, we participated in the 13th International Summit Forum about Digestive Cancer held in Beijing, namely the Annual Meeting of China Gastrointestinal Oncology Group (CGOG), hoping to understand the first-line treatment strategies for colorectal cancer in China. Fourthly, we participated in the fifth China International Biological & Chemical Pharmaceutical Expo, and through the communication with the senior managers from the enterprises, we knew the current conditions of China’s pharmaceutical industry.

The second step: push forward the project
After determining the general direction of the project, our team decided on our project plan during the discussion and then assigned tasks among the team members. We often discussed our progress with relevant experts who occasionally provided us with feedback to guide us to the right path. At the same time, we constantly communicated with the public to track people’s understandings of colorectal cancer and new drugs. Based on the survey, we planned to conduct an array of interviews to dig into people’s needs for colorectal cancer treatment. In addition, we hoped to conduct educational activities to provide a platform for the public to better understand cancer, so as to fight cancer.

The third step: plan for the future
At the end of the project, we wanted to make a future plan for our project, so we decided to seek help from companies, lawyers and the National Drug Administration to get advice on marketing as well as patent application and approval. In addition, we deeply realized that “early detection, early diagnosis, early treatment” is the best strategy for cancer treatment. We developed a plan to offer the public some related education, so that people could better understand the disease and recognize the importance of early and regular screening. We talked with the head of the physical examination center of Kunshan Hospital of Traditional Chinese Medicine and found that a more long-term and realistic plan could be made to affect our community. We hope that we can finally enlarge the scale of fecal occult blood test (FOBT) to cover the whole city by 2028, and the whole province by 2035. In this way, more and more residents can enjoy the convenient digestive tract disease detection services. At the same time, we expect to hold colorectal cancer screening camps to provide people with an opportunity to self-screening.

Work classification
We expected to achieve our core goal of alleviating patients’ suffering through multiple components that were different from but closely related to each other. Since our project hoped to put emphasis on patients and pay attention to the current circumstances of diagnosis and treatment in China, we finally decided to divide our work into three parts according to the disease treatment principle-- “To cure sometimes, to relieve often, to comfort always”.

TO RELIEVE
In this part, we expected to deeply explore the problems we needed to solve based on our understandings of the patients. Our biggest goal was to know the needs and the suffering of the patients in cancer treatment and to address or mitigate their suffering as much as possible. To this end, we hoped to have in-depth communication with them. From a full range of contact with patients, We hoped to understand them, also the care-givers, family members and a series of groups directly or indirectly related to them.

TO CURE
In this part, we focused on the question that whether our project itself could meet the needs of the patients as well as our own program planning. We expected to find out our own shortcomings by communicating with teams from different schools and exchanging project processes. We also hoped to be able to communicate with experts in related fields, constantly improve our projects, and finally achieve our therapeutic goals to the fullest.

TO COMFORT
In this part, we hoped we can reduce people’s fear of cancer and worry about new drugs by improving their awareness. We also hoped to communicate with enterprises, governments and other stakeholders to make a blueprint for our project. In the continuous interviews, we find that in our country, people have fear and worry about large diseases. This is a key reason why cancer treatment has obstacles. The core goal of our work is to spread the background information and educate the public, pay attention to people’s worries about new drugs, and try to reduce their concerns. In addition, we find that many projects lack the attention to human beings, and we also hope to make future students realize the importance of humanistic attention through our efforts.

Assessment
Every step of the project is the product of a huge literature review and many exchanges between ourselves, our collaborators, experts and stakeholders. Human Practices are inevitable in any iGEM project, as they are the bridge between the researchers and the community. Our varied interactions helped us to discover the multiple dimensions and complexities associated with the problem we were trying to solve. We realised that as student researchers, since we are unable to progress our projects to the product stage, we tend to lose sight of how our products will affect stakeholders. Interacting with different stakeholders and different teams has provided the necessary foundation for our research to realise the wider impact of our project. Our initiative is still in its early stages, and we hope that our proposed Disease Screening Programme and Physical Examination Programme will actually help people in our surrounding communities in the future.

After the project was completed, we asked Prof. Xu to evaluate the project. First, she evaluated the project design as a whole. She believes that our project design is relatively complete and has reached a logical closed loop. She praises our design for keeping the patient's perspective in mind and considering safety at every step. In terms of the details of the project, she pointed out that our design of using the principle of pilus self-assembly to achieve bacterial targeting is very clever, which is the innovation of this project. At the same time, she also pointed out our shortcomings. Although our project design is complete, the framework is too large to be fully verified in a short time. However, she saw the development potential of our project, expressed her willingness to continue to give us financial support, and hoped that we could continue to carry out the project after the competition.

Reflection, Responsibility and Responsiveness