Newswise — PHILADELPHIA—Colorectal cancer cases have dropped significantly in the U.S. over the last decade, but one group continues to see an uptick: young adults. Every year since 1992, the number of people under 50 diagnosed with the disease has increased by 2 percent.
At just 25, Jessica Nixon from Conshohocken, Pa. was diagnosed with rectal cancer, after severe stomach cramps and constipation for six months took her to the doctor. Later, a colonoscopy revealed stage III cancer, and after six weeks of chemotherapy and radiation, Jessica had colon resection surgery to remove the shrunken tumor and that was six years ago. The cancer eventually spread and showed up in her liver and lungs, and she had to undergo further surgery last year and chemotherapy, which she still endures today to keep the cancer at bay.
“We’re seeing a growing trend of more colorectal cancer patients under 50, some even under 40,” said Scott D. Goldstein, M.D., Director of the Division of Colorectal Surgery at Thomas Jefferson University Hospital. “Screening isn’t recommended until age 50, so many of these cases aren’t caught early. The problem is the younger they are, the more likely they are to ignore symptoms of more advanced stages of the disease. Who thinks they have colon cancer at 40, 35 or even 25?”
Jessica certainly didn’t. “I was definitely shocked when I found out,” said Jessica, now 30, and a patient of Dr. Goldstein and medical oncologist Edith P. Mitchell, M.D., FACP, of Jefferson’s Kimmel Cancer Center (KCC). “But I am living with it, and I am fighting it. Even though this is a chronic disease for me in many ways, I have a pretty normal life: I work and travel. That’s the reason I am doing it, to have my life.”
Kristine P. is also pushing forward after her recent diagnosis. A year after the 38-year-old wife and mother from Mount Laurel, N.J., had her third child, she periodically saw blood in her stool. She assumed it was hemorrhoids, a common occurrence for women during and after pregnancy.
“I never thought it could be colon cancer,” said Kristine, a patient of Dr. Goldstein who had surgery in late February to remove a cancerous tumor in her colon. “My parents never had colon cancer, only my grandfather, who had it in his 60s—which isn’t abnormal.”
It’s true that colon cancer is more common in elderly people—the average age to be diagnosed with colon cancer is 71. So to help better explain Kristine and Jessica’s diagnoses, they were sent for genetic counseling.
“It’s important to look for hereditary components to colon cancer, so that patients and their family members can benefit from effective treatments, screening, and prevention,” said Sarah Charles, M.S., a genetic counselor at the KCC.
Most colon cancer is thought to be sporadic in nature, with no apparent evidence of being due to an inherited disorder. A large fraction (about 25 percent) of people with colon or rectal cancer have a family history that suggests a genetic contribution to the disease, common exposures among family members, or a combination of both. A small fraction (about 5 percent) of cases overall are due to established genetic syndromes, like hereditary nonpolyposis colorectal cancer (HNPCC), also called Lynch syndrome, and familial adenomatous polyposis (FAP). Lynch syndrome is associated with an increased risk for other cancers, including uterus, ovary, stomach, and pancreas.
No hereditary syndromes were identified in Jessica or Kristine, but the sit down with a counselor hits home and highlights the need for other family members to be screened.
“When colorectal cancer is diagnosed in a young person, close family members are at a higher risk, and protecting children is usually a big concern,” said Charles. “However, if children get screened at the recommended time—usually10 years prior to the age at which a parent was diagnosed—they may not ever have to go through what their parent went through.”
People should discuss colorectal cancer screening with their physician, said Dr. Mitchell, who also serves as Director of the Center to Eliminate Cancer Disparities. Some individuals may undergo routine screening at age 50, but others may need screening examinations at an earlier age, especially if there is a family history of colon cancer or if the individual is African American. The disease tends to occur about five years earlier in this group.
If a person sees any change in bowel habits or blood in the stool, they should consult their doctor, said Dr. Mitchell, who recommends that primary care physicians consider practice utilization of the new American College of Physicians colorectal cancer screening guidelines. “The more we know sooner, the better. Colon cancer can be treatable and beatable,” she said.
Screening and early detection of colon and rectal cancer hold tremendous promise for reducing the toll of colon and rectal cancer, the third leading cause of cancer death in this country with more than 140,000 new cases diagnosed each year.
It is National Colorectal Cancer Awareness Month and starting March 19 Jefferson physicians specializing in the screening, prevention, diagnosis and treatment of colorectal cancer will be answering questions from patients, family members and others online in our Ask the Experts about Colorectal Cancer forum: www.JeffersonHospital.org/AskTheExperts/ColorectalCancer.
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