Early Onset Colorectal Cancer

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Colorectal Cancer Is Now Also a Young Person’s Disease

Colorectal cancer develops in the large intestine, known as the colon. It consists of the final section of the digestive tract and the rectum, which makes up the last several inches of the colon, according to the Mayo Clinic. Historically, colorectal cancer has been considered a disease of middle age, with 90 percent of cases occurring in people over age 50.

But, increasingly, patients look a lot like Spill.

Colorectal cancer is now the third leading cause of cancer death in young adults. In fact, about 20 percent of people diagnosed with colorectal cancer are between ages 20 and 54, according to the Colon Cancer Coalition. Compared with people born in 1950, people born after 1990 are twice as likely to develop colon cancer and 4 times as likely to develop rectal cancer, the coalition reports.

Doctors are still piecing together why this is. Researchers are looking at certain environmental exposures, such as food additives, stress, inflammation, and even overuse of antibiotics during childhood, as potential colorectal cancer causes for the significant jump in colorectal cancer risk in the younger population.

Some believe it may have something to do with changes in the gut microbiome caused by eating a diet high in processed foods, which are difficult to avoid in today’s food system.

“Many people have attributed it to obesity, metabolic syndrome, or diabetes, but we don’t think that’s playing as much of a role as people thought, because there are a lot of people who are getting colorectal cancer who don’t have these comorbidities,” says Folasade P. May, MD, PhD, an assistant professor of medicine at the University of California in Los Angeles. “It is our big mystery.”

Diagnoses in Young People Often Happen Too Late

What many experts, including Dr. May, do know for sure is that colorectal cancer should no longer be treated as a disease found only in older adults. Unfortunately, not every doctor knows about the change in risk patterns, and stories like Spill’s are not uncommon.

Spill’s best friend met someone in graduate school who was diagnosed with colorectal cancer at age 27.

“She had a similar experience with having to go from doctor to doctor before being taken seriously,” Spill says.

May says she wants patients to feel empowered to seek a second opinion and to know that if they believe something is wrong, they should continue to look for a doctor who will look into the situation further.

“It’s your life. You need to feel empowered to bring this up time and time again. And if you feel that a doctor isn’t addressing your issues, you have the right to see another,” May says. “We need to not just assume that just because a person is young, or because a woman just had a baby, that it’s something benign, like hemorrhoids. Anyone who is having symptoms should have a colonoscopy.”

What Colorectal Cancer Symptoms Should Young People Be Aware Of?

Many people don’t have any colorectal cancer symptoms until their cancer has reached a late stage, according to May, but there are a few telltale signs to watch for.

Blood in your stool is a common symptom of the disease. Other colorectal cancer signs include “pencil stool,” which describes stool that is long and thin, potentially because a tumor is constricting the colon or rectum, as well as cramping, abdominal pain, and new diarrhea or constipation. Decreased appetite, fatigue, and weight loss typically don’t occur until colorectal cancer is in an advanced stage, May says.

She implores young women, especially, to advocate for themselves if they think something is wrong, because there are issues that make it easy to dismiss symptoms of colorectal cancer in women.

In this population, some warning signs of colorectal cancer, such as anemia, may be attributed to pregnancy or menstruation. “A lot of women have low blood counts or anemia because of menstruation, and their primary care doctor makes the assumption that [menstruation is] the culprit. Meanwhile, there are many causes of anemia, including blood in the rectum.”

“If you are concerned that you may have colorectal cancer, talk to your provider in earnest. Tell them that you have heard about this disease, and you want to make sure you aren’t having the symptoms,” May says. “If you have tried that a couple times, and your doctor still doesn’t want to send you for a colonoscopy, you should feel empowered to ask for a second opinion.”

A Happy Ending

Spill says the weeks after her diagnosis, as she visited different cancer treatment centers, felt as though she had been picked up by a tornado and set down in chairs in different offices throughout New York and New Jersey.

“I got pushed and shoved to all these different scans. We talked about my future and what would be happening. We talked about doing oral chemo for six months and radiation for six months, and freezing my eggs before starting treatment,” Spill says.

Before she started chemotherapy at Memorial Sloan Kettering Cancer Center, Spill’s doctors tested her tumor for a mutation that would qualify her for a clinical trial of an immunotherapy drug the center was overseeing.

It was positive. Spill became the fourth person in the United States to try the therapy, which has far fewer side effects than traditional radiation and chemotherapy, and it preserved her ability to conceive in the future.

She was scheduled for nine treatments over the course of six months. By her fourth, the tumor had shrunk by half. It was then that her doctor told her that the therapy had completely cleared the tumors in the three other women enrolled in the trial. By the final treatment, her tumor had completely disappeared.

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