A Review on Theranostic Advancements in Colorectal Cancer: Integrating Molecular Imaging and Nanotechnology for Precision Oncology

Colorectal cancer is still among the leading causes of morbidity and mortality globally, thereby creating an urgent need for innovative diagnostic and therapeutic strategies. Theranostics is an integrated approach combining diagnosis and therapy within a single platform; this offers enhanced precision in tumor detection, targeted drug delivery, and treatment monitoring. This review synthesizes literature from 2020 to 2025 to examine key developments in CRC theranostics, including molecular imaging modalities, targeted therapy platforms, and advanced nanotechnology-based systems. PET/CT, PET/MRI, MRI, and optical imaging modalities significantly improve staging, localization, and intraoperative visualization. Accordingly, these nano theranostic platforms, such as gold nanoparticles, liposomes, polymeric nanoparticles, SPIONs, mesoporous silica nanoparticles, and quantum dots, have been shown to contain dual capabilities for imaging enhancement and controlled drug release. Despite this progress, translation into clinical practice remains limited due to challenges pertaining to nanotoxicity, scalability barriers, and restrictive regulatory status. Future progress requires standardized toxicity testing, advanced molecular imaging integration in clinical trials, and scalable nanoparticle manufacturing. Theranostics heralds a potentially transformative shift toward personalized and image-guided CRC management.