The face of colorectal cancer is changing. Today, incidence rates of colon and rectal cancer are on the rise in young people (those under the age of 50) while decreasing in older adults (those over the age of 50). The Young-Onset Colorectal Cancer Center at Dana-Farber Brigham Cancer Center was developed to address the unique challenges facing this age group.
While older adults still make up the majority of cases, recent studies suggest this trend will continue: According to a 2015 study in JAMA Surgery, researchers predict colon cancer rates will increase by 90 percent in people ages 20 to 34 and by nearly 28 percent in people 35 to 49 by 2030. A 2017 study from the American Cancer Society and National Cancer Institute found similar trends.
Why are colon and rectal cancers on the rise in young adults?
Researchers are still trying to determine the reason for the trend, according to Marios Giannakis, MD, PhD, an oncologist at the Center for Gastrointestinal Oncology at Dana-Farber Brigham Cancer Center.
The development is not believed to be a result of a change in our inherited DNA, as the human genome does not evolve that quickly. Researchers are exploring many other possibilities, including a potential link to changes in our lifestyle habits, obesity, the microbiome, or new environmental exposures — the chemicals and compounds we come into contact with on a daily basis.
“What’s important to know is that colon and rectal cancers aren’t diseases just for older adults anymore,” explains Giannakis. “It’s vital for everyone to listen to their bodies, and not ignore the symptoms.”
What are the signs and symptoms of colorectal cancer?
The signs and symptoms of colon and rectal cancer vary and depend on a variety of factors including the size of the tumor and where it is located. Many people — particularly those with polyps or early stages of colorectal cancer — may not experience any signs or symptoms, making the disease difficult to detect.
Symptoms that are persistent (lasting longer than a few days), or are getting progressively worse, should be examined by a medical professional. Remember: the following signs and symptoms have many causes and are often a result of a non-cancerous condition.
- A change in bowel habits.
- Blood (either bright red or very dark) in the stool.
- Diarrhea, constipation, or feeling that the bowel does not empty all the way.
- Stools that are narrower than usual.
- Stools that are a different shape.
- Frequent gas pains, bloating, fullness, or cramps.
- Unintentional weight loss.
- Feeling very tired.
- Vomiting.
- Anemia (low red blood cell count).
Are colorectal cancer symptoms the same regardless of age?
Yes, colorectal cancer typically has the same symptoms regardless of an individual’s age. In younger patients, the tumor usually originates near the distal portion (end) of the colon and in the rectum, so these patients could exhibit symptoms of constipation, bleeding, or thin stool.
Oftentimes, young-onset colorectal cancer is originally misdiagnosed or ignored by both patients and doctors. You know your body better than anyone, and if something doesn’t feel right, or you are unsatisfied with the original diagnosis you were given, be sure to advocate for yourself and seek a second opinion.
Should I get a colonoscopy?
The CDC recommends that adults age 50 to 75 get regularly screened for colorectal cancer. However, some organizations (such as the American Cancer Society) recommend screenings begin at the age of 45 due to the rise in young-onset colorectal cancer. This is another reason why it is important to alert a medical professional if you experience any concerning symptoms.
What can I do to lower my risk of colorectal cancer?
Researchers are still working to understand the associated risk factors for colorectal cancer. While more information is needed, many believe living an overall “healthy” lifestyle can reduce your risk. This includes:
- Exercising regularly.
- Limiting your alcohol, processed meat, and animal fat intake.
- Eating a diet high in fruits, vegetables, and whole grains.
Do colorectal cancer treatments vary based on the patient’s age?
No, the overall standard of care does not usually vary based on a patient’s age. However, your age and overall health will be factors when it comes to determining the best treatment plan for you.
What should I be aware of as a young colorectal cancer patient?
A colorectal cancer diagnosis can be overwhelming at any age, but those diagnosed before 50 face a unique set of challenges. Your care should include the supportive services you need. The Young-Onset Colorectal Cancer Center at Dana-Farber Brigham Cancer Center, one of the first centers in the country dedicated to young patients with colorectal cancer, offers a variety of programs designed to address everything from fertility concerns to sexual health and psychological support.
It’s also important for all cancer patients to know they are not alone, and to communicate with others who have been through a similar diagnosis. If you feel it would be beneficial, be sure to ask your oncologist about available support groups.
What research is being done to study young-onset colorectal cancer?
Multiple efforts are underway to learn more about the causes of young-onset colorectal cancer, and how doctors can more effectively treat it. At Dana-Farber Brigham Cancer Center, researchers are working to characterize the unique genomic, molecular, and immune features of this disease to better understand factors that may put someone at a higher risk of developing colon cancer. This research also aims to identify new and effective interventions for both prevention and treatment of the disease.
Examples of ongoing work include:
- The GI TARGET Program, which maps out mutations in young-onset colon and rectal tumors. By identifying mutations, oncologists may be able to recommend personalized, targeted therapies to patients diagnosed with the disease.
- The Living Biobank: Tumor tissue and other specimens are collected from patient volunteers to help determine the most promising new treatments for testing in clinical trials.
- Laboratory models of cancer: Laboratory models are created to mimic the human tumor and study the efficacy of new therapies to target the cancer cells, the immune system and the microbiome.
- Microbiome research: A collection of trillions of microorganisms, the microbiome is most prevalent in the gut. Researchers are working to explore the differences between a healthy microbiome and one associated with colorectal cancer as well as how the microbiome may impact treatment efficacy and toxicity. By doing so, they hope to uncover how it may play a role in the tumor’s development and ensuing therapies.
- Screening and early detection research: Ongoing efforts include introducing non-invasive tests to better identify individuals who are at a higher risk of colon cancer and would benefit from early disease screening.
There are also many clinical trials available to patients diagnosed with young-onset colorectal cancer. If you’d like to learn more about available trials, be sure to connect with your care team.
About the Medical Reviewer
Dr. Giannakis received his undergraduate degree from the University of Toronto in 2001 and his medical and doctoral degrees from Washington University School of Medicine in 2009. He subsequently completed his Internal Medicine residency at Brigham and Women’s Hospital and his fellowship in Medical Oncology and Hematology at Dana-Farber Cancer Institute.
Dr. Giannakis is a medical oncologist and clinical investigator at the Dana-Farber Gastrointestinal Cancer Center. He also conducts research at Dana-Farber and the Broad Institute of MIT and Harvard to understand the molecular mechanisms of colorectal cancer formation and develop novel targeted and immune-based treatments for gastrointestinal cancers.
Very helpful and timely article, Mario.