Young-Onset Colorectal Cancer

 

March is National Colorectal Cancer Awareness Month:

Colorectal cancer, or CRC, is the second deadliest cancer in the United States. Every March, National Colorectal Cancer Awareness Month spotlights this disease and inspires more people to get checked starting at age 45. Two reasons why getting checked matters:

• Screening can find the warning signs of colon and rectal cancer, letting doctors take action to prevent the disease.

• Screening can also find colorectal cancer early, when treatment is most effective.

 

Colorectal cancer is the fourth most commonly diagnosed cancer in adults and the second-leading cause of cancer death in the U.S. The American Cancer Society estimates that 153,000 Americans will be diagnosed this year with CRC and 52,000 will die from the disease.

For more than 30 years, researchers have observed a rising number of younger adults being diagnosed with colorectal cancer. By 2030, Jacqueline Howard reports, colorectal cancer will be the leading cause of cancer-related deaths in Americans between 20-49 years of age:

A report released this month by the American Cancer Society shows that the proportion of colorectal cancer cases among adults younger than 55 increased from 11% in 1995 to 20% in 2019. Yet the factors driving that rise remain a mystery.

There’s probably more than just one cause, said Lawson’s surgeon, Dr. Steven Lee-Kong, chief of colorectal surgery at Hackensack University Medical Center in New Jersey.

He has noticed an increase in colorectal cancer patients in their 40s and 30s within his own practice. His youngest patient was 21 when she was diagnosed with rectal cancer.

 

Having a family history or inheriting a cancer-specific genetic mutation, smoking, drinking alcohol excessively, eating a diet that’s high in red and processed meats and low in fruits, vegetables, and other fiber, obesity, and exposure to air pollution and chemicals in the environment and in our food  and drinking water all increase the risk of colorectal cancers and other cancers — breast, esophagus, kidney, gallbladder, liver, pancreas, prostate, stomach, and thyroid — that have been on the rise since 1990 among adults in their 30s, 40s, and 50s.

Some researchers point to obesity during childhood as the main reason why CRC is rising in younger adults…

“The rise in young-onset colorectal cancer correlates with a doubling of the prevalence of childhood obesity over the last 30 years, now affecting 20% of those under age 20,” Dr. William Karnes, a gastroenterologist and director of high-risk colorectal cancer services at the UCI Health Digestive Health Institute in California, said in an email.

“However, other factors may exist,” he said, adding that he has noticed “an increasing frequency of being shocked” by discoveries of colorectal cancer in his younger patients.

 

… while others are more concerned about the types of foods young people consume…

“I think younger people are on average consuming less healthy food – fast food, processed snacks, processed sugars – and I think that those foods also contain higher concentrations of carcinogens and mutagens, in addition to the fact that they are very fattening,” [medical oncologist, Dr. Shane] Dormady said.

“It’s well-publicized that child, adolescent, young adult obesity is rampant, if not epidemic, in our country,” he said. “And whenever a person is at an unhealthy weight, especially at a young age, which is when the cells are most susceptible to DNA damage, it really starts the ball rolling in the wrong direction.”

 

… leaving some unconvinced:

Yet at the Center for Young Onset Colorectal and Gastrointestinal Cancers at Memorial Sloan Kettering Cancer Center, researchers and physicians are not seeing a definite correlation between the rise in colorectal cancer among their younger adult patients and a rise in obesity, according to Dr. Robin Mendelsohn, gastroenterologist and co-director of the center, where scientists and doctors continue to work around the clock to solve this mystery.

“When we looked at our patients, the majority were more likely to be overweight and obese, but when we compare them to a national cohort without cancer, they’re actually less likely to be overweight and obese,” she said. “And anecdotally, a lot of the patients that we see are young and fit and don’t really fit the obesity profile.”

That leaves many oncologists scratching their heads.

 

Signs and symptoms of CRC include rectal bleeding or blood noticed in the stool, changes in bowel habits (unexplained diarrhea or contipation), persistent abdominal discomfort or pain, weakness, fatigue, and unexplained weight loss.

Unfortunately, it’s never too young to be concerned about CRC. Fortunately, awareness and early screening — even before those signs and symptoms become noticeable — can help save lives:

• Young-onset colon cancer has a preference for the distal colon (the segment of your colon right before the rectum begins) or rectum and often presents at a later stage.

• Screening is recommended to start earlier than age 45 in those with a family history of colorectal cancer or advanced adenomas (noncancerous tumors), and in those with hereditary genetic syndromes associated with increased risk. Patients with inflammatory bowel disease or other conditions increasing risk may also benefit from close follow-up.

• Individuals under 45 who have symptoms that may be consistent with colorectal cancer need to seek medical attention so the appropriate testing can be done and deserve a prompt and thorough examination.

• Physician-related delays (e.g., missed symptoms, initial misdiagnosis) have been estimated to occur in 15-50% of young-onset colorectal cancer cases.

 

Read “Colorectal Cancer Facts & Figures 2023-2025” from the American Cancer Society here.

source https://www.thepediablog.com/2023/03/29/young-onset-colorectal-cancer/