According to a report by the American Cancer Society released in January, colorectal cancer is now the primary cause of cancer-related deaths among young men under 50 and the second leading cause among women in the same age group.
The rise in younger men and women developing colon cancer is a trend Alicia Logue, MD, has observed over the last 10 years. She is a fellowship-trained colorectal surgery specialist at the Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center.
“If I were asked the average age of a patient when I finished residency 16 years ago, my answer would be different,” she said. “Now, at least 1/3 of my patients are under 50.”
Colon and rectal cancers are tumors of the large intestine. Risk factors for developing the disease, according to the Centers for Disease Control and Prevention, include inflammatory bowel disease, family history and in rare cases an inherited trait.
Certain lifestyle choices can heighten the risk of developing the disease. These include a lack of regular exercise and a diet lacking in fruits and vegetables, as well as one low in fiber and high in fat and processed meats. Being overweight or obese, along with the use of alcohol and tobacco, can also elevate the risk for developing the disease.
Colorectal cancer symptoms
Colorectal cancer can start as a polyp or small, abnormal grouping of cells in the colon’s lining. Logue said polyps can develop and mutate into cancer slowly, and symptoms are common enough that patients ignore them.
“The symptoms are oftentimes subtle and attributed to common life circumstances, such as fatigue, stress or difficulty maintaining a healthy lifestyle,” she said. “It’s not unusual for most of us to have symptoms such as occasional stomach discomfort, fatigue, constipation or seeing small amounts of blood in the stool. They are symptoms that can easily be dismissed or attributed to less serious conditions.”
Jeff Kubes, a 43-year-old father of three, said the initial abdominal pain and constipation he experienced five years ago was worrisome but not alarming enough to seek medical attention. However, the pain became so intense he went to the emergency room twice in one month.
“I’m naturally skinny, but I lost 20 pounds in one month. I hardly ate,” he said.
At the recommendation of his doctor, Kubes underwent a colonoscopy. A tumor was found in his colon, and he was scheduled for surgery to have it removed.
“I was worried because you hear the word cancer, and you think bad things,” he said “But I knew we would get through it.”
At the time of his diagnosis, Kubes was 38, much younger than the age recommended by the U.S. Preventive Services Task Force in 2021 for an annual colorectal screening. The task force has since revised its recommendation, advising that screenings should begin annually at 45 instead of 50, citing the increasing trend of cases in younger patients.
Logue said occasional constipation or abdominal pain may not sound the alarm for most. However, she noted that if a patient is not undergoing regular screenings, the following symptoms should prompt a visit to the doctor: change in bowel habits from normal, rectal bleeding, persistent fatigue and unexplained anemia.
“Rectal bleeding can be from harmless sources such as hemorrhoids, but it can be one of the more common initial signs,” she said.
According to Logue, colon tumors bleed slowly, resulting in blood in the stool over time and the development of anemia.
“I see a fair number of young patients who get diagnosed with colorectal cancer as a result from developing symptoms of anemia,” she said.
She said a small amount of blood loss can be tolerated over time. However, as blood loss continues, the heart has to work harder to bring oxygen to the body’s tissues. This can lead to faster heart rate and becoming tired easier than normal.
Logue encourages patients to see a doctor for what might seem like minor symptoms. When diagnosed at an early stage, treatment is much easier to recover from and survival from colorectal cancer is near 90%.
Treatment plans
After his surgery, Kubes was diagnosed as Stage 2 and underwent a resection where part of his colon was removed. Typically, the remaining sections of the colon are reattached.
In Kubes’ case, he required an ostomy bag to facilitate the passage of stool from his body. The bag was connected to an opening in his abdominal wall, allowing his colon to heal from the surgery. He also underwent chemotherapy.
Logue said treatment plans for patients are as individual as the patient. Following a patient’s diagnosis and tumor removal surgery, a multidisciplinary team of doctors convenes to devise a personalized treatment strategy that could include surgery, chemotherapy, radiation and other therapies.
Kubes’ ostomy bag was removed after 11 months and he is now cancer free. Sukeshi Patel Arora, MD, who treated Kubes, said the likelihood of patients developing the cancer again after five years is less than 1%.
Cancer treatments and family planning
Arora suggested that young patients who have not completed their family planning may need to consult with a fertility specialist, especially if they will undergo chemotherapy or radiation therapy.
“I don’t think people think about it, but as clinicians, we should be talking to our patients about the role for fertility preservation,” she said.
Arora said the Mays Cancer Center can facilitate a meeting with a fertility specialist.
Screening options and cancer prevention
Logue said that regular screenings are the best way to prevent developing the disease. She said the gold standard for screening is a colonoscopy. If polyps are found during the screening, they can be removed before they progress into cancer.
However, she acknowledged that the preparation for and the procedure itself can deter some individuals. She mentioned that alternative screenings, such as stool sample tests, can be up to 95% effective in detecting cancer.
“I agree with the saying that the best screening test for colon cancer is the one that patients are actually willing to do,” she said.
To help prevent developing the disease, Logue recommends regular exercise, hydration, a diet high in vegetables, fruits and fiber, and to minimize consumption of highly processed foods, red meats, alcohol and sweets.
“I don’t think many people realize that most of us eat 10 grams or less of fiber daily when we need 30. Fiber may be beneficial because we believe it binds to some of the toxins in our diet that cause stress to the lining of the colon wall,” she said. “So by eating fiber, you are protecting the lining of the colon and may, in turn, lessen the chance of developing any cancer.”
Clinical trials and studies
If diagnosed with colorectal cancer, Arora suggests that eligible individuals consider participating in a clinical trial or study.
“It’s important to remember that every drug and treatment started in a clinical trial and [they] helped many people,” she said.
Patients participating in clinical trials or studies have an additional layer of care through the research team, according to Arora.
“Another big reason to be part of a clinical trial or a study is that it gives patients access to a therapy that may otherwise not be available,” she said. “Also, we know patients who participate do better, live longer and have a better quality of life.”
A clinical trial opening soon will investigate the potential of immunotherapy as a treatment for colon cancer. Immunotherapy harnesses the body’s immune system to fight cancer, either by stimulating or boosting it naturally or by using lab-created substances to restore or improve the immune function.
“Immunotherapy has done so much for so many different tumor types,” she said. “But for colon cancer, in general, we haven’t really found that.”
To schedule an appointment at the Mays Cancer Center, call 210-450-1000 or request an appointment online at MaysCancerCenter.org/Appointments. To learn more about clinical trials and eligibility requirements, click here.