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 noted that rates of early-onset colorectal cancer are increasing worldwide. Although several risk factors have been identified, they alone do not fully explain this increase. There can be many factors, including lifestyle, nutritional habits, environment, and other factors that can affect your health. We know that lifestyle and nutritional patterns play a role in increasing risk, so it’s important to remember that these risks are within our control. Diets rich in processed and ultra-processed foods and low in fiber, obesity, a sedentary lifestyle, smoking, and drinking alcohol are factors that lead to all types of health problems, including colon cancer.

Are there differences in symptoms and survival rates between early-onset colon cancer and colon cancer that occurs in older people?

Although other symptoms of cancer are not necessarily present, younger people are more likely to have symptoms when diagnosed with colon cancer because they are less likely to be screened for colon cancer. Symptoms such as abdominal pain, weight loss, iron deficiency anemia, and changes in bowel patterns may be signs of colon cancer. Additionally, younger people are more likely to develop cancer in the left side of the rectum or colon. As a result, the stool is more likely to contain bright red blood cells, which are more common in left-sided and rectal tumors.

Survival rates are surprisingly controversial. Patients with early-onset colorectal cancer have a higher mortality rate because they are more likely to develop advanced cancer. About 7 in 10 young people receive a terminal diagnosis, compared with 6 in 10 people diagnosed after the age of 50. Looking specifically at each stage, some recent studies suggest that survival rates for younger people are higher than for those diagnosed at older ages because they receive more intensive treatment. However, other studies have found no difference or worse survival rates. However, we found that clinical outcomes are generally worse in very young patients, <30–35 years of age.

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

Although 10% of colorectal cancers diagnosed after age 50 are the result of inherited genetic mutations (also called “germline mutations”), genes have been found to play a larger role in early-onset colorectal 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 disorders, but there are other genetic syndromes that also contribute to this risk. We are also identifying more novel mutations in the tumors of patients with early-onset colorectal cancer. These mutations, known as “somatic mutations,” are mutations in the tumor itself rather than in the patient’s genes. Patients with early-onset cancer generally have different types of mutations compared to older patients, which may affect clinical outcomes.

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

Treatment usually involves a combination of surgery, chemotherapy, and radiation therapy. Another treatment option, when applied based on diagnosis, is immunotherapy, which fights cancer by specifically targeting genetic mutations.

I mentioned earlier that people who receive this diagnosis at a young age tend to receive more aggressive treatment, but this isn’t always the case. It also depends on the location of the cancer and how aggressive the cancer is. Another factor is how easily the patient tolerates the treatment.

Is there a difference in treatment between the ages of 45 and 68 if you are healthy and independent of this disorder?

no. However, if a patient has another medical condition or cannot tolerate certain treatments, we tailor the treatment to fit the patient’s needs. In general, the younger the patient, the more likely he or she is to tolerate and accept a wider range of treatments.

Is there anything young people can do to prevent colon cancer?

It’s important to remember that while having a healthy lifestyle can help, you can’t really control whether you have cancer or not. We have seen many young patients who are triathletes and are doing everything right. It is recommended to maintain a healthy diet rich in fiber, exercise, quit smoking, and reduce alcohol consumption. I think awareness is also useful.

It is important to know that colon cancer is not a disease that only affects people over 50 years of age. Young people should consult their health care provider if they have any potential symptoms or changes in bowel movements.

Very importantly, for colorectal cancer, screening is actually a preventive tool. A colonoscopy not only detects cancer, but also allows doctors to identify and remove polyps before they develop into cancer.

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Are there any additional considerations regarding treatment side effects and clinical outcomes in young adult patients with colorectal cancer?

Colon cancer is different in younger people because they are at different stages of life before the age of 50. If the patient wishes to become pregnant, fertility issues may need to be considered in treatment, especially if radiation therapy is required. Receiving cancer treatment when you have young children can cause more stressful issues in your family life.

Relationship issues may be different for younger people. For example, many emotions may be involved when you need a permanent ostomy bag, when you start dating someone, or when you enter into a romantic relationship or marriage. Cancer can impact your academic and professional life and have significant financial implications. Dealing with colon cancer when a person is young can be very difficult emotionally, physically, and financially. Of course we try to help people with this and provide support.

Plus, treatments are getting better. Colon cancer is not easy, but the sooner it is diagnosed, the more options and opportunities there are for treatment.