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Colon Cancer in the Young: Aggressive and Dangerous

Colon cancer is the third most common cancer in the United States, and the second most lethal. There has been a lot of progress made in reducing the number of deaths from colorectal cancer (CRC), both in improved treatment and through early and effective screening. When colon cancer is diagnosed at younger ages it generally has a poor long-term outcome, particularly in the hereditary types, and in a cancer in which earlier than normal screening procedures are certainly necessary.

The American Cancer Society guidelines for early detection of CRC state that beginning at age 50 men and woman are considered to be at average risk and it is recommended they have a flexible sigmoidoscopy every five years and a colonoscopy every 10 years.  A rectal digital examination with every physical exam by the doctor on a yearly basis is also advocated.  These are not easy or comfortable exams, but make a big difference in early detection and treatment of colon cancer.

How about people under the age of 50? More than 10% of CRC cases and almost 20% of rectal cancers are now diagnosed in younger individuals with incidence and mortality rates increasing right alongside. Why is this happening? Researchers are suggesting that one cause is a higher obesity rate as well as a higher rate of diabetes, both found to be significant in increasing CRC risk. Another key reason may be the absence of screening at younger ages. Without a standard for recommended testing, people over 50 are having cancers and pre-cancers found earlier and removed at completely curable stages. Cancers in younger age groups are allowed to grow unchecked so that when they are found, it is at a much more advanced stage.

Both inherited and sporadic cases of CRC arise from adenomatous polyps. It’s a slow process that may take five years for the polyp to transform into a significant cancer. When screening is done earlier, the growths can be removed in precancerous stages. When allowed to develop on their own, they can become large and deadly. Villous adenomas are the most common of these, with up 50% having foci of cancer.

Of biggest concern are the early appearing and hereditary forms of colorectal cancer. The growths themselves lack the characteristics of normal tissue (anaplastic) and grow more quickly, and can spread or metastasize to other organs. Major syndromes are familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer, or Lynch syndrome. In FAP, polyps develop in the teenage years and a cancer diagnosis may occur before the age of 40. The risk of extraintestinal cancers also increases. These cancers may have already spread through the colon and beyond when a diagnosis is made. Telling symptoms such as rectal bleeding, blood in a bowel movement, abdominal pain, and change in character of stools may already be a presenting sign in these cases.

The key to successful treatment of colon cancer at younger ages is to screen earlier in high risk individuals. A family history of colon cancer before the age of 60 or in two or more first degree relatives at any age are candidates for early screening. Those who either have a diagnosis of FAP or Lynch syndrome, or who have inflammatory bowel disease (such as ulcerative colitis or Crohn’s) must be screened earlier, either at 40 years of age or 10 years earlier than the youngest age at CRC diagnosis for any first degree relative. These cancers caught early are very amenable to successful treatment and time is of the essence. 

Most people who have survived colon cancer or cancer treated with complete removal at early stages in a polyp, will have similar and favorable outcomes similar to those diagnosed at older ages. Familial syndromes are usually treated with the more drastic step of complete removal of the colon and/or rectum, and even then may be at higher risk for problems of recurrence or of another extraintestinal cancer in later years. Knowing your family history and following through with dedication on recommended screening procedures, even if uncomfortable or inconvenient, can be life saving.

Authored by Dr. Bob Goldstone, M.D.

The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.