Colorectal Cancer in Young Adults
Colorectal cancer is the second most common cause of cancer death in this country. American Cancer Society estimates that approximately 135,000 new cases will be diagnosed and 50,000 people will die from the disease during 2017. The incidence and the mortality from colorectal cancer have decreased in this country over the last 15 years due to screening colonoscopy. However, the incidence of colorectal cancer in individuals under the ages of 50 has been increasing at an alarming rate. Based on current trends, researches have estimated that more than 1 in 10 colon cancer and 1 in 4 rectal cancer will be diagnosed in individuals under the age of 50 by 2030. You are never too young to develop colorectal cancer.
The current guidelines recommend screening in average risk individuals over the age of 50 unless there is a family history of colon cancer or hereditary syndromes. We have associated colorectal cancer in young adults with hereditary syndrome such as Lynch syndrome or familial adenomatous polyposis. Seventy five percent of colorectal cancer cases in young adults are in people who do not have a family history of colorectal cancer or not members of hereditary syndromes. No definite explanation has been found so far to explain the rising incidence of colorectal cancer among young adults. It was felt that it could be caused by a combination of hereditary risk factors, diet, lifestyle, and environmental exposure. Increasing incidence of obesity and diabetes in young adults parallels the increasing incidence of colorectal cancer in that age group. Consumption of sweetened beverages, processed food, and decrease in the consumption of milk, lack of high fiber diet, obesity, and lack of exercise may all be contributing to the increasing incidence of colorectal cancer in this age group.
Lynch syndrome is predominately characterized by tumors on the right side of the colon where as early onset, nonhereditary cancers are located mainly in the left side of the colon and in the rectum. One study showed that 86% of individuals aged 50 years or younger with colorectal cancers were symptomatic at the time of diagnosis. Symptoms of colorectal cancer in young adults are missed by physician and ignored by the patients. Young patients may not always understand the symptoms and signs of colorectal cancer which could delay their seeking medical attention. The most common symptom is rectal bleeding which is often attributed to hemorrhoids. Other symptoms are change in bowel habits, abdominal pain, and unexplained weight loss which are usually late symptoms. Colorectal cancer should be in the differential diagnosis when a young patient presents with these symptoms.
What can we do to prevent or diagnose colorectal cancer early in young adults? You need to know your family history of colorectal cancer. If there is a family history of colorectal cancer or hereditary syndrome such as Lynch syndrome, you need to have a colonoscopy at an earlier age.
You should not ignore your symptoms such as rectal bleeding or change in bowel habits. If you have any of these symptoms, you need to seek medical advice. You should not be afraid to talk to your doctor about your symptoms. You should not postpone a colonoscopy if your doctor orders a diagnostic colonoscopy to evaluate your symptoms. You should eat fruits, vegetables, and avoid red meat and processed foods. You need to exercise regularly and maintain ideal weight. If you are a smoker, you should quit. These measures will not only reduce the risk of colorectal cancer but also improve overall health of a person. Hopefully, in the future we will have better risk prediction tools that might help us identify these individuals early and initiate better preventive measures.