Questions and Answers About Early-Onset Colon Cancer

Do you know why colon cancer diagnoses are increasing in young people?

Since the 1950s, we have seen rates of young-onset colorectal cancer increase globally. We have identified several risk factors, but they do not fully explain the uptrend. A variety of factors may be involved, including lifestyle and eating habits, as well as environmental or other factors that can affect health. We know that lifestyle and dietary patterns play a role in increasing risk, so it’s important to remember that these risks are within our control. Diets high in processed and ultra-processed foods and low in fiber, obesity, a sedentary lifestyle, smoking and alcohol consumption lead to all kinds of health problems, including colon cancer.

Are there differences in symptoms and survival rates between early-onset and late-onset colon cancer?

Although the symptoms of the cancer itself are not necessarily different, younger people are less likely to be screened for colon cancer, so they are more likely to have symptoms at the time of diagnosis. Symptoms such as abdominal pain, weight loss, iron deficiency anemia, and changes in bowel habits may be signs of colon cancer. Additionally, younger people are more likely to develop cancer in the left side of the rectum or colon. Therefore, the stool is more likely to contain bright red blood cells, which are more common in rectal and left-sided tumors.

Survival rates are surprisingly controversial. Patients with early-onset colorectal cancer have a higher mortality rate because their cancer is more likely to be at a more advanced stage. About 7 in 10 young people are diagnosed at a later stage, compared with 6 in 10 people after the age of 50. However, by stage, some recent studies have shown that survival rates are higher for younger people compared to those diagnosed later because they receive more intensive treatment. However, other studies have found no difference or worse survival rates. We see that in very young patients, such as those under 30 or 35 years of age, the condition is generally worse.

Are certain mutations more common in early-onset colorectal cancer?

Although 10% of colon cancers diagnosed after age 50 are caused by inherited genetic mutations (also called “germline mutations”), genes have been found to play a bigger role in early-onset colon cancer. Approximately 15 to 30 percent of early-onset colorectal cancers are associated with inherited genetic mutations that cause familial cancer syndromes. Lynch syndrome is the most common of these, but there are other genetic syndromes that also contribute to this risk. We are also discovering more new mutations in the tumors of patients with early-onset colon cancer. These mutations, known as “somatic mutations,” are mutations in the tumor itself rather than in the patient’s genetics. Patients with early-onset cancer typically have different types of mutations than older patients, which can affect outcomes.

WATCH: Understanding Lynch Syndrome: What Women Need to Know >>

What are the most common treatments for early-onset colon cancer?

Treatment usually involves a combination of surgery, chemotherapy, and radiation therapy. Another treatment option, if applicable for diagnosis, is immunotherapy, which fights cancer by targeting genetic mutations.

We said earlier that people diagnosed younger tend to receive more aggressive treatment, but this isn’t always the case. Some of it depends on where the cancer is and how aggressive it is. It also depends on how well the patient can afford the treatment.

Is there a difference in treatment if a 45-year-old and a 68-year-old are both healthy?

no. However, if a patient has another health condition or cannot handle certain treatments, we tailor the treatment to fit the patient’s needs. In general, younger patients are more likely to tolerate and receive multiple treatments.

Is there anything young people can do to protect themselves from colon cancer?

While leading a healthy lifestyle can help, it’s important to remember that you can’t really control whether or not you develop cancer. We have seen many young patients who are triathletes who are doing everything right. I recommend eating a healthy diet rich in fiber, exercising, quitting smoking, and drinking less. I think awareness also helps.

It’s important to know that colon cancer isn’t just a cancer that affects people over 50. Young people should consult their health care provider if they have any potential symptoms or changes in bowel habits.

Very important: For colon cancer, screening is actually a preventive tool. A colonoscopy allows your doctor to not only check for cancer, but also identify and remove polyps before they develop into cancer.

Read: Colon Cancer Screening Test Guide >>

Are there any additional considerations regarding treatment side effects and outcomes for colorectal cancer in young adults?

Colon cancer is different in younger people because it occurs at different stages of life before the age of 50. If a patient wishes to become pregnant, fertility issues may need to be taken into consideration during treatment, especially if radiation therapy is required. If you have young children, you may have additional stressful parenting issues to deal with while undergoing cancer treatment.

Relationship issues may be different for younger people. For example, if you need a permanent ostomy bag, it can be very emotional to deal with it while you’re dating, early in a relationship, or early in a marriage. Cancer can interfere with school and work, and can have a major financial impact. Treating colon cancer at a young age can be very challenging emotionally, physically, and financially. Of course we try to help and support people through this.

Treatments are also improving. Colon cancer is not easy, but the sooner it is diagnosed, the more options you have and the better your chances of cure.