What Doctors Want Young People To Know About Colorectal Cancer—Including How Screenings Can Save Your Life

Photo: Getty Images/Maskot
Colorectal cancer in young people is on the rise. One in five cases diagnosed today occur in people younger than 55, compared to one in 10 cases in 1995, according to a study published in March by the American Cancer Society. Researchers estimate that in 2023, 153,000 people in the United States will be diagnosed with colorectal cancer. They estimate that 19,550 of those cases will be in individuals younger than 50 years—a nine percent increase in cases in this age group since 2020.

“Colorectal cancer is the third-most-commonly diagnosed cancer in men and women and second-most-lethal cancer,” says Yi-Qian Nancy You, MD, professor of colon and rectal surgery, director of the young-onset colorectal cancer program and associate medical director of the clinical cancer genetics program at The University of Texas MD Anderson Cancer Center. “It is also the number-one cause of death in men under the age of 50.”

Colorectal cancer includes colon and rectal cancer, and typically starts as a polyp or growth on the inner lining of the colon. While not all polyps form into cancer, some can. Dr. You says that these cancer cells can progress or start spreading, and typically colorectal cancer will grow deeper into the wall of the colon and rectum becoming stage two cancer.

Symptoms to look out for if you suspect you may have colorectal cancer?

Colorectal cancer can present itself in many ways, and some patients can even be asymptomatic and not know they’re sick.

Theodore R. Levin, MD, research scientist at the Kaiser Permanente Division of Research in Oakland, Calif. and clinical lead for colorectal cancer screening at The Permanente Medical Group says that some of the main symptoms to look out for include: rectal bleeding, abdominal pain, weight loss, anemia, or change in bowel habits—particularly narrowing of the stools.

Extreme fatigue, weakness, and persistent pain in the abdomen that leads to excessive gas or cramps are also symptoms to keep an eye on, according to the Mayo Clinic.

Are there any lifestyle choices or factors that increase your risk?

Like most cancers there are modifiable and unmodifiable risk factors. Dr. You says that predictors that are out of a patient’s control can include a medical genetic predisposition due to family history. This can include inherited colorectal cancer syndromes such as Lynch syndrome, and your risk of getting colorectal cancer also increases as you get older.

But there are risk factors that can be brought on by lifestyle choices. “This includes smoking, high alcohol consumption, an unhealthy diet, or the so called ‘western diet pattern,’ lack of exercise, a sedentary lifestyle, and being overweight,” Dr. You says.

There is an association between drinking sugar sweetened beverages and an increased risk of colorectal cancer, according to new research conducted by the Harvard T.H. Chan School of Public Health.

Are there specific things young people can do to prevent colorectal cancer?

Dr. You has three major tips for young people: She recommends learning what the symptoms of colorectal cancer are, paying attention to your body and not ignoring anything that may seem off.

“Young adults are busy and are not thinking they can get cancer,” she says. “They don’t always have a primary care physician at a phone call’s reach, and sometimes even the first physician they reach out to may not think of cancer. It is important to learn the symptoms, not ignore them, and seek care.”

Second, she recommends learning about your family history. She says that up to 20 percent of the young onset of colorectal cancer arises in patients with an inherited predisposition, so it is critical to make the diagnosis of the underlying syndrome, so that all at-risk blood relatives can have an opportunity to be proactive about their health.

Finally, make routine screenings part of your self-care practice.

“People tend to think of colon screening in terms of colonoscopy,” Dr. Levin says. “However, with the availability of non-invasive tests like the fecal immunochemical test and fecal DNA tests, it’s never been easier to protect yourself through screening.”

There are two main types of screening tests for colorectal cancer: stool-based tests and visual exams.

Stool-based tests can be done in the comfort of one's home and involve sending in your stool to a lab for analysis. Because these do not involve a doctor looking at you physically, these are less invasive and typically less expensive.

Visual exams involve a doctor directly examining the inside of the colon or rectum, and this includes the colonoscopy. These do involve a certain amount of preparation and are performed generally every five to 10 years. If something abnormal is found, further diagnostic or treatment procedures, such as removing a polyp, can be done right away.

Why routine screenings are so important in early detection and prevention, specifically in younger people?

Colorectal cancer staging describes how much cancer is in the body, and diagnosis is the most powerful predictor of survival for long-term quality of life in survivorship.

There is opportunity for interception, which is why routine screenings are key. “It takes time for a polyp to develop into cancer and for a cancer to progress through the stages, so removing a precancerous lesion can completely prevent cancer, and diagnosing a cancer as early as possible can improve outcomes,” Dr. You says.

If you’re unsure what age you should start getting screened, experts agree you should consult with your doctor first. Some patients have  non-modifiable risk factors and others may have high-risk factors. Dr. You says that patients with Lynch syndrome should start screening around ages 22 to 25, patients with the chronic inflammatory bowel disease ulcerative colitis should follow strict guidelines, and patients with a first-degree relative that has or has had colorectal cancer should start screening at least 10 years before the relative’s age at diagnosis. The majority of the young patients who are at an average or normal risk should start screening at age 45.

“Being diagnosed with young onset colorectal cancer can feel scary, shocking, and isolating,” Dr. You says. “It is important to know that you are not alone. There are other young adults going through the cancer journey, and there are experts who are here to walk with you.”

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