Colorectal cancer: It’s not an old person’s disease

Colorectal cancer rates are rising in young people, but symptoms are often ignored.

People under 50 may assume symptoms like rectal bleeding are simply related to hemorrhoids and only seek over-counter fixes. Likewise, they may be told their abdominal pain is only gas or related to constipation. Studies show that, in some cases, physicians diagnose hemorrhoids and prescribe anti-hemorrhoidal medications without proper follow-up exams to make sure the initial diagnosis was correct.

As a surgeon who sees firsthand the ramifications of a delayed diagnosis of colorectal cancer, I advocate patients, regardless of age, pay extra attention to symptoms such as bleeding, change in bowel habits, abdominal pain, or unexplained weight loss.

Bleeding or abdominal pain could indeed stem from fairly simple problems. But not always. Conversations about the signs and symptoms of colorectal cancer – especially in young people – need to happen, and they need to happen now.

That’s why Prisma Health–Upstate is setting the stage for this conversation by joining with community partners to host “Stages,” a one-man show about playwright David Nelson’s diagnosis with Stage 4 colorectal cancer at the age of 38. In “Stages,” he focuses his trademark humor on his life-changing diagnosis to create a hilarious and heartrending story about finding hope in the most unlikely of places. A post-show talkback panel discussion, in which experts take questions from the audience, will include Prisma Health physicians.

Colorectal cancer remains the second leading cause of cancer deaths in the United States, with 1 out of 20 people being affected at some point in their lifetime. Over the past 15 years, the incidence in the United States has decreased by approximately 3-4% per year.

Despite our success in decreasing the overall incidence of colorectal cancer, the incidence in those under the age of 50 is increasing. But why?

So far, we just don’t know. There is no clear reason to explain the increased numbers of younger patients are being diagnosed with colorectal cancer. Discussions center on environmental exposures. A recent study in Lancet explored the influence of obesity as a carcinogen. As younger patients are exposed to the extra-adipose tissue seen in obesity earlier in life, they are then exposed to a carcinogen (excess body weight) for a longer period of time throughout their life, which may influence their risk of cancer.

But excess weight clearly isn’t the only mechanism at play with these earlier-occurring cancers. Other theories involve the influence of diet and tobacco use.

In the past, screenings did not begin until age 50. Younger patients (with no family history of colorectal cancer) were not screened. In 2018, the American Cancer Society changed its recommendation to begin screening for colorectal cancer to begin at 45 instead of 50, discussed in a previous post.

If you have a family history of colorectal cancer, you should be screened earlier. Talk with your physician about timing to begin screening exams, which should ideally begin 10 years before the age of diagnosis of your family member.

Finally, if you have rectal bleeding, a change in bowel habits, abdominal pain, or unexplained weight loss, talk to your doctor. Tell your doctor if symptoms persist despite medical treatment. If necessary, seek a second opinion. It’s that important.

Cedrek McFadden, MD, is a colorectal surgeon with Prisma Health–Upstate.

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