By Jedrzej “NJ” Wykretowicz, MD, PhD
Although most colorectal cancer (CRC) patients are still diagnosed after age 50, the disease presents in more young adults who often have overlooked symptoms for months or years.
In many cases, these patients in their 20s, 30s and early 40s have simply assumed that rectal pain or blood in the stool is the result of hemorrhoids or anal fissures. While this may well be the case, a physician should always do a physical exam to be sure.
Younger patients also tend to write off unexplained weight loss and/or fatigue, attributing those symptoms to diet and exercise plans or life stressors such as a new job or family responsibilities. Instead, they could be the result of CRC and related anemia.
Other common signs of CRC are persistent abdominal pain and pressure – gas, cramping, bloating and early satiety – sudden changes in stool color or shape, nausea and vomiting, frequent constipation, diarrhea, or a sensation that the bowel has not emptied fully.
According to a recent American Cancer Society study, 20 percent of CRC diagnoses came in patients younger than 55 in 2019, almost double the 11 percent figure in 1995. Rates of advanced disease climbed by roughly 3 percent a year in patients under 50.
Since current recommendations from the U.S. Preventative Services Task Force do not call for a screening colonoscopy for most adults until age 45, considering CRC as a diagnosis in patients of all ages is crucial.
So is knowing the risk factors for the disease: a family history, obesity, inactivity, a diet heavy in red or processed meat, smoking and heavy alcohol use. Alaska Native, American Indian and Black Americans also have higher rates of CRC than Caucasians.
Thankfully, researchers are working hard to develop simpler, noninvasive and less costly tests to allow for larger-scale population screening. Many of these efforts center on identifying fecal biomarkers of CRC.
Studies are ongoing to pinpoint DNA, RNA and protein biomarkers, as well as microbes and volatile organic compounds excreted in stool samples. Preliminary results on this potentially next generation of tools to catch CRC and precancerous lesions have been promising.
New molecular screening tools have emerged for patients already diagnosed with CRC to help detect disease recurrence at an earlier stage. These tests can spot DNA markers of cancer in a patient’s blood.
On the treatment side, immunotherapy, unfortunately, has not yet proven as effective in CRC and pancreatic cancer as it has in other gastrointestinal cancers, including esophageal, stomach, anal, liver and bile duct disease.
However, clinical trials continue to probe potential novel options in both immunotherapy and other types of treatment. Some of those trials are open to local patients via a partnership between Virginia Oncology Associates and the Sarah Cannon Research Institute.
Meanwhile, the message for everyone is: you’re never too young to have colorectal cancer.
Dr. Wykretowicz is a Medical Oncologist and Hematologist with Virginia Oncology Associates, specializing in gastrointestinal cancers. He is based at the Brock Cancer Center in Norfolk. virginiacancer.com