Colon Cancer in Young People: A Growing Concern

Over the past few decades, the incidence of colorectal cancer (including colon and rectal cancer) in people under 50 has been increasing. While the majority of colorectal cancer cases still occur in older adults, the rise among younger populations is alarming.

According to the American Cancer Society, 1 in 5 colorectal cancer cases in 2019 occurred in people under 55 compared to 1 in 10 in 1995. The trend is shifting to young people.

Assar A. Rather, MD, Bayhealth colorectal surgeon, said incidences in younger adults can be more aggressive because they are ignoring warning signs, thinking that they are too young to get cancer, and are busy with work and their personal lives.

“When screening is delayed, the cancer progresses before it gets caught and is much more difficult to treat,” said Dr. Rather. “If detected early, it is curable.”

Warning Signs of Colorectal Cancer (ASCRS)

• Blood in the stool, which can be bright red or very dark
• Changes in bowel habits, such as diarrhea or constipation
• Stools that are narrower than usual
• Gas pains or cramps
• Feeling full or bloated
• Weight loss with no known reason
• Fatigue
• Nausea or vomiting

“Because these symptoms can be mistaken for less serious conditions like irritable bowel syndrome or hemorrhoids, colorectal cancer in young adults is often diagnosed at a later stage,” added Dr. Rather.

Risk Factors for Young Adults

Several factors may contribute to the increased incidence of colorectal cancer in young adults:

• Genetics and Family History: Inherited genetic conditions such as Lynch syndrome, familial adenomatous polyposis (FAP), and others can significantly increase the risk of colorectal cancer at a younger age.
• Family history of colorectal cancer or other cancers (like endometrial cancer in the case of Lynch syndrome) can also heighten the risk.
• Lifestyle Factors:
  • Diet: A diet high in red or processed meats, low in fiber, and lacking in fruits and vegetables has been linked to a higher risk of developing colorectal cancer.
  • Physical Inactivity: Lack of regular physical activity can increase the risk.
  • Obesity: Being overweight or obese is a known risk factor for colorectal cancer.
  • Smoking and Alcohol: Excessive alcohol consumption and smoking can also raise the risk of colorectal cancer.
• Health conditions include:
  • Inflammatory Bowel Disease
  • Crohn’s disease
  • Ulcerative colitis
  • Type 2 diabetes

Diagnosis and Screening

Because the rise in cases of colorectal cancer among young adults is relatively new, there are no universal screening recommendations for individuals under 50 unless they have specific risk factors (such as a family history or genetic conditions). However, it’s important for young adults to be vigilant about their health and speak with their healthcare provider if they experience any concerning symptoms.

• Colonoscopy is the most common screening tool for colorectal cancer. For those with family history or other risk factors, early screening may be recommended.
• Stool tests can also detect hidden blood in the stool, which can be an early sign of colorectal cancer.
• Imaging studies (like CT scans) may be used to further evaluate suspected cases.

Treatment

Treatment options for young adults with colorectal cancer are similar to those for older adults and depend on the stage and location of the cancer. The primary treatment options include:

• Surgery to remove the tumor or part of the colon if necessary.
• Chemotherapy, especially for more advanced stages or if cancer has spread to other parts of the body.
• Radiation therapy may be used for rectal cancer or when surgery is not feasible.
• Targeted therapies and immunotherapy are emerging options, particularly for cancers with specific genetic mutations.

Outlook and Prognosis

Young adults diagnosed with colorectal cancer tend to have a better overall prognosis than older adults, largely due to the fact that they are generally healthier and may have fewer co-existing health conditions. However, because colorectal cancer in young adults is often diagnosed at a later stage due to a lack of awareness and screening, outcomes can vary widely.
“While colorectal cancer in young adults is still relatively rare compared to older adults, the increasing incidence is a cause for concern,” explained Dr. Rather. “Awareness, early detection and lifestyle changes are key to improving outcomes and reducing the impact of this disease on younger populations. If you or someone you know is at increased risk, discussing early screening and preventive measures with a healthcare provider is crucial.”

NAPRC Accreditation

Bayhealth Hospital, Kent Campus, is accredited by the American College of Surgeons National Accreditation Program for Rectal Cancer (NAPRC). Bayhealth was the first in the state to earn this accreditation in 2022. Accreditation by the NAPRC is granted only to those programs that are committed to providing the best possible care to patients with rectal cancer. The NAPRC provides the structure and resources to develop and operate a high-quality rectal center, and accredited programs follow a model for organizing and managing a rectal center to ensure multidisciplinary, integrated, comprehensive rectal cancer services.

Visit Bayhealth.org/Cancer to learn more about the comprehensive cancer care provided by the Bayhealth Cancer Institute.