It was known as a disease of the elderly, until recently. A study led by the American Cancer Society last year confirmed what oncologists have seen firsthand: Rates of colorectal cancer, which include colon and rectal cancer, are rising among people in their 20s, 30s and 40s.
It’s a trend that’s baffling doctors. The risk factors for colorectal cancer – such as obesity, diabetes, smoking and drinking – are more prevalent in older populations than younger ones, yet the rates are decreasing in the older and increasing in the younger. Last year’s ACS study showed that 20-somethings have experienced the most dramatic increases, with rates of colorectal cancer rising nearly 4 percent each year between 1987 and 2013.
“It’s a very alarming phenomenon,” says Mohamad Salem, MD, an oncologist with Atrium Health’s (formerly Carolinas HealthCare System’s) Levine Cancer Institute. “Most of the younger patients with colorectal cancer we see in our clinic don’t have these risk factors. Most of them eat healthy, they’re in good shape, they have no family history. Most likely, there’s something else going on causing this.”
A call for colorectal cancer awareness
Because colorectal cancer is associated with older populations, most young people aren’t screened for it – nor do they have much knowledge about the disease. This means that when a younger person is diagnosed, often the diagnosis comes after the cancer has progressed to a later stage. Doctors are also researching whether colon tumors in younger patients may be biologically different than in older patients.
Because younger people are below the recommended age for screening, awareness of the symptoms of colorectal cancer becomes critical. Symptoms include rectal bleeding, changes in bowel habits, consistent nausea and unintended weight loss. Dr. Salem stresses that having any of these symptoms shouldn’t cause alarm – many conditions can cause them – but it should push people to get examined to find out the cause.
“Most patients with colorectal cancer have symptoms,” says Dr. Salem. “The only difference between younger patients and older ones is that most younger people aren’t going to think it’s cancer. They’ll assume they’re too young for cancer to happen to them and assume that it’s due to something else.”
Treating a person, not a disease
Having colorectal cancer at a younger age isn’t just a medical issue – it can impact a person’s finances, family and job. A cancer diagnosis during a person’s 20s, 30s or 40s disrupts life in its busiest and most productive period.
This brings special considerations for Dr. Salem and his colleagues at Levine Cancer Institute in their treatment of colorectal cancer in the young. They learn about their patients’ lives, families and interests, and they adjust treatments as much as possible to accommodate them. Dr. Salem has scheduled chemotherapy treatments around a Disney family cruise and children’s soccer schedules; he’s avoided treatments that could cause peripheral neuropathy and impact finger dexterity for patients who play guitar or piano.
“We look at a patient exactly how we should look at a patient: as a person, not as a disease,” says Dr. Salem. “As physicians, we have to understand who patients are, what they want to achieve, what they enjoy. I ask all of my patients what they do for fun, and I tailor treatments not only according to the biology of their tumor but to the person who’s in front of me.”
Earlier diagnoses, more effective treatments
Levine Cancer Institute actively participates in research of innovative treatments for colorectal cancer, including the TAPUR study, a national clinical trial that matches tumor types with the best medicines to fight them. Immunotherapy is emerging as a promising treatment as well.
But still, Stage IV colon cancer has no cure. Dr. Salem recently treated a woman in her 20s with Stage IV colon cancer who asked about the impact of her disease on having children. He had the difficult conversation with her that chemotherapy and pregnancy aren’t compatible, but that without chemotherapy, her life expectancy would decrease significantly. Dr. Salem recalls the conversation as “hard and heartbreaking.”
Education and awareness, then, are vital to catching colon cancer early. Dr. Salem stresses that if younger people notice unusual health issues, they should visit a doctor for an exam. And if they’ve had a relative with colorectal cancer, they should check with their doctor to learn when to be screened.
“Most of us go around too busy with work, with family, with friends, and we put things aside that come to our health,” says Dr. Salem. “Most likely, your symptoms won’t mean colorectal cancer. But if you experience them, it’s something you need to think about.”
