Young-Onset Colorectal Cancer

Colorectal cancer is increasingly affecting younger individuals, challenging the previous notion that it primarily concerns older adults. Known as young-onset colorectal cancer, this condition refers to diagnoses in those under the age of 50. 

Its rise is alarming, with recent trends revealing a near doubling of cases since the 1990s among this age group, according to the American Cancer Society. This shift necessitates a closer look at early detection and treatment, as young-onset cases tend to be more aggressive and are often discovered at advanced stages.

The growing incidence contrasts with the declining rates in older populations, highlighting the urgent need for awareness and adjusted screening guidelines. In response to this trend, the U.S. Preventive Services Task Force recently updated its recommendation, advising that screenings for colorectal cancer start at age 45 for those at average risk. This adaptation aims to better capture and reduce the incidence of young-onset colorectal cancer, yet there's recognition that further research and possibly earlier screening could enhance detection and outcomes for this demographic.

Identifying the causes and risk factors for early-onset colorectal cancer is vital for prevention and early intervention. While the exact causes remain elusive, researchers have pinpointed several potential risk factors that contribute to developing this disease in young individuals.

Genetic Predispositions:

• Lynch syndrome
• Familial adenomatous polyposis (FAP)
• Other hereditary cancer syndromes

Lifestyle Factors:

• High intake of processed and red meats
• Low-fiber diets
• Sedentary lifestyle
• Obesity

Medical Conditions:

• History of inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• Type 2 diabetes

Environmental Exposures:

• Increased interaction with environmental toxins
• Shifts in gut microbiota possibly due to dietary changes or antibiotics

Other Considerations:

• Age (increased risk for individuals under 50)
• Family history of colorectal cancer
• High alcohol consumption
• Smoking

Early detection of young-onset colorectal cancer hinges on recognizing its symptoms and screening those who are at increased risk early. Unfortunately, these signs can be subtle or mimic other common ailments, leading to delays in diagnosis. Here's what young adults should be vigilant about:

Changes in Bowel Habits:

• Persistent diarrhea or constipation
• A feeling that your bowel doesn't empty completely
• Frequent gas pains, bloating, fullness, or cramps

Rectal Symptoms:

• Rectal bleeding with bright red blood
• Blood in the stool, which might make it look dark brown or black

Abdominal Discomfort:

• Persistent abdominal pain or discomfort, such as cramps or aches

Systemic Symptoms:

• Unexplained weight loss
• Fatigue or weakness
• Nausea or vomiting

Anemia:

• Symptoms caused by a decrease in healthy red blood cells, leading to paleness and additional fatigue

It is crucial for anyone experiencing these symptoms persistently to consult with a healthcare provider. While these symptoms can be indicative of less serious conditions, it's important to rule out colorectal cancer as a cause, particularly in individuals with risk factors for the disease.

For individuals presenting these symptoms, especially alongside risk factors like a family history of colorectal cancer, initiating the diagnostic process is critical.

The diagnostic process for young patients suspected of having young onset CRC includes colonoscopy, the gold standard for colon cancer screening, and comprehensive evaluation to ensure accurate staging and treatment planning.

Here are the steps taken in our thorough diagnostic process:

Initial Evaluation:

• Medical history review and physical examination
• Discussion of symptoms and risk factors, including family history

Diagnostic Tests:

• Colonoscopy, the most comprehensive diagnostic method, allows for direct visualization and biopsy of suspicious areas

Genetic Counseling and Testing:

• Assessment for hereditary cancer syndromes when a strong family history or specific symptoms are present
• Genetic testing for mutations in genes associated with increased cancer risk

Further Evaluation:

• Blood tests to check for anemia and other signs that might indicate cancer
• Additional imaging tests, such as MRI or CT scans, to assess the extent of the disease

Timely access to these diagnostic services is essential. If colorectal cancer is suspected, a referral to a specialized young-onset colorectal cancer center can provide patients with access to a multidisciplinary team experienced in treating this disease in younger populations.

Once a diagnosis of young-onset colorectal cancer is confirmed, a personalized treatment plan is developed, considering the stage of cancer and the patient's overall health. 

Treatment options for young onset colorectal cancer patients range from surgical interventions to advanced therapies like immunotherapy, emphasizing the importance of personalized care plans and participation in clinical trials when appropriate

Here are the primary treatments listed once more:

Surgical Interventions:

• Polypectomy during a colonoscopy for early-stage cancers for select cancers that could be fully removed with adequate margins at the time of colonoscopy and the pathology did not harbor high-risk lesions
• Advanced endoscopic techniques like endoscopic mucosal resection (EMR) for large precancerous lesions that cannot be removed with conventional colonoscopy.
• Transanal minimally invasive surgery (TaMIS) for large rectal polyps or very early rectal cancers.
• Partial colectomy to remove part of the colon when there is a true cancer that is growing into the bowel wall.
• An ostomy is a temporary or permanent measure depending on the extent of the disease and the patient’s baseline comorbidity burden. Most patients with colorectal cancer do not need an ostomy.

Chemotherapy:

• Utilized to shrink the tumor before surgery if needed or to eliminate remaining cancer cells post-surgery
• Can be used as the main treatment if surgery isn't an option

Radiation Therapy:

• Often combined with chemotherapy (chemoradiation) for rectal cancer
• Can be used to reduce tumor size before surgery or to target cancer cells that remain afterward

Targeted Therapy:

• Drugs designed to target specific abnormalities within cancer cells
• Can be used alone or in combination with chemotherapy

Immunotherapy:

• Employs the body's immune system to fight cancer
• Particularly effective for cancers with certain genetic markers

Clinical Trials:

• Access to new treatments or treatment paradigms that are being tested for effectiveness.

Supportive care:

• Social workers
• Fertility specialists who can talk you about fertility preservation options before treatment if needed.
• Genetic counselors
• Registered Dieticians
• Integrative medicine who can take a holistic approach to your wellness during cancer care
• Oncology primary care

Each treatment strategy is tailored to the individual, and decisions are made collaboratively by a team of specialists, including oncologists, surgeons, and other healthcare providers. Treatment plans for young patients also consider factors such as the impact on fertility, quality of life, and long-term health.

While the genetic factors influencing young-onset colorectal cancer cannot be controlled, adopting healthy lifestyle changes can significantly mitigate risk.

Adopting preventive measures such as a high-fiber diet, regular exercise, and early colorectal cancer screening can significantly reduce the risk for young adults, underscoring the role of lifestyle in cancer prevention.

Here is a full list of preventative health measures to be aware of:

Dietary Modifications:

• Increase fiber intake from fruits, vegetables, and whole grains.
• Limit red meat and processed foods.
• Incorporate more fish and lean poultry into your diet.

Regular Exercise:

• Engage in at least 30 minutes of moderate to vigorous activity most days of the week.
• Reduce sedentary time and include strength training exercises.

Weight Management:

• Strive for a healthy weight to lower the risk of various cancers, including colorectal cancer.

Limit Alcohol and Avoid Smoking:

• Keep alcohol consumption to moderate levels.
• Quit smoking, as it's linked to an increased risk of many cancers.

Colorectal Cancer Screening and Surveillance:

• Adhere to screening guidelines, especially if you have a family history of the disease.
• Discuss with your doctor the right age to begin screening, which may be earlier than the general population if you have additional risk factors.

Awareness of Family History:

• Know your family's health history and discuss it with your healthcare provider to assess your personal risk.

Preventive strategies are not only about lowering the risk of developing cancer but also about improving overall health, which can contribute to better outcomes if cancer does occur.

The fight against young-onset colorectal cancer is a collaborative endeavor, with significant contributions from national organizations and local institutions alike. The American Cancer Society (ACS) leads with preventive screening guidelines and patient support resources, advocating for individuals to begin colorectal cancer screenings at age 45. Their efforts are complemented by the National Cancer Institute (NCI), which provides a wealth of research, educational materials, and access to clinical trials and cancer research. The NCI's guidelines and resources offer invaluable support to healthcare providers, enhancing the quality of care and informing public health policies.

A local beacon in this effort is the University of Cincinnati Cancer Center, which is advancing care and research for colorectal cancer. Our specialized programs and services focus on the unique needs of younger patients, including genetic counseling, advanced diagnostic technologies, and access to the latest treatment options. Our center's multidisciplinary approach brings together experts from various fields to offer comprehensive care and to support patients through every step of their journey, from diagnosis to treatment and beyond.

These organizations' collective mission is not only to treat cancer but also to empower patients and providers with the knowledge and tools to prevent it. Through education, advocacy, and research, they aim to understand the rising rates of early-onset colorectal cancer and to develop targeted strategies to reduce its impact. The involvement of local centers like the University of Cincinnati Cancer Center ensures that patients have access to high-quality care and the support they need closer to home.