Early-Onset Colorectal Cancer From Harlem To Hollywood

Everyday Health writes that early-onset colorectal cancer refers to colon and rectal cancers that develop in people before age 50.

While colorectal cancer mostly occurs among people 50 and older, the number of younger people getting the illness has dramatically climbed over the past few decades.

Researchers now estimate that 10 percent of all new colorectal cancer diagnoses are in young adults.

As more people in their prime get this illness, scientists are searching for the reasons why.

Read on to learn more about what makes early-onset colorectal cancer unique and how to recognize, treat, and prevent this potentially life-threatening disease.

Overview

What Is Early-Onset Colorectal Cancer?

With early-onset colorectal cancer, a person below the age of 50 experiences uncontrollable growth of cells in their colon (the bowel or large intestine) or rectum (the final section of the large intestine connecting to the anus). These malfunctioning cells may spread to other parts of the body.

Normally, the body eliminates cells with damaged DNA (genetic code) before they can turn cancerous. As we age, however, the body’s ability to get rid of these cells decreases, which partially explains why the risk of cancer is higher later in life.

That’s why a spike in early-onset colorectal cancer is unusual and troubling.

Signs and Symptoms of Early-Onset Colorectal Cancer

Because young people don’t expect to get colorectal cancer, they may ignore symptoms early on when the cancer is most treatable, says John Marshall, MD, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University in Washington, DC.

“We all need to be more aware of the symptoms so we take them seriously right away,” says Dr. Marshall, who also serves as chief medical consultant for the Colorectal Cancer Alliance.

An analysis of data published in 2023 from more than 5,000 people diagnosed with colorectal cancer before age 50 found that the four most common signs reported prior to diagnosis were:

Rectal Bleeding There may be very bright or dark red spots in the stool.
Abdominal Pain Gas pains, bloating, fullness, or cramps may occur.
Bowel Movement Changes Diarrhea or constipation can be a sign of colorectal cancer. Stool may be narrower or have a different shape than usual.
Iron-Deficiency Anemia This condition, defined as a lack of healthy red blood cells due to inadequate iron, may be due in part to blood loss and poor nutrient absorption.

The researchers noted that having a single one of the symptoms almost doubled the risk of getting an early-onset colorectal cancer diagnosis, having two symptoms increased risk by more than 3.5 times, and having three or more boosted the risk by more than 6.5 times.

In a separate review of 81 studies representing more than 24.9 million patients, scientists identified the most common red flags for early-onset colorectal cancer as:

Fresh blood in stool (hematochezia)
Abdominal pain
Altered bowel habits
Unexplained weight loss
Loss of appetite

Extreme fatigue and muscle weakness may also be indicators of the disease.

Causes and Risk Factors of Early-Onset Colorectal Cancer

Some factors that put a person at risk of colorectal cancer cannot be changed, such as:

Genetic Conditions Inherited physical problems such as Lynch syndrome and familial adenomatous polyposis (which can produce hundreds of polyps in the colon) increase the chances of developing colorectal cancer, especially at a young age.

“Younger adults with colon cancer are more likely to have an inherited syndrome,” says Kelley Chan, MD, a clinical scholar with ACS Cancer Programs, and resident at Loyola University Medical Center in Chicago.

The Global Colon Cancer Association estimates that 16 to 25 percent of early-onset cases are related to a genetic syndrome, whereas only up to 10 percent of regular colorectal cases are related to genetics.

Racial and Ethnic Background American Indian and Alaska Native people have the highest rates of colorectal cancer in the United States, followed by African American men and women. Jews of Eastern European descent (Ashkenazi Jews) also have a high risk compared to other ethnic groups; about 6 to 8 percent carry a specific gene mutation that increases their risk of developing colorectal cancer by 1.5 to 2 times.

Other Health-Related Issues Certain health-related conditions may contribute to colorectal cancer risk, including a family history of the disease, a personal history of radiation to the abdomen or pelvis area, a personal history of inflammatory bowel disease (Crohn’s or ulcerative colitis), and having had the gallbladder removed (cholecystectomy).

Toxins in the Environment Researchers are studying whether exposure to chemicals may play a role in colorectal cancer. Chemical exposures (from air and water pollution, chemicals in soil and food, and pesticide use) may damage the DNA of intestinal cells leading to cancer-causing mutations.

Modifiable Risk Factors

According to one study, one-third to one-half of all early-onset colorectal cancer cases are attributable to modifiable risk factors, including:

Obesity A review of more than 100 scientific papers found that half of younger adults with colorectal cancer were overweight and 17 percent were obese.

Excess fat has been linked to inflammation, which may raise the likelihood of developing cancer. Obesity is also connected to insulin resistance and diabetes, increased production of the hormone leptin, and gut hormone imbalance — all factors tied to greater cancer risk.

Unhealthy Diet Colorectal cancer has been linked to the consumption of red meats (such as beef, pork, lamb, or liver) and processed meats (like hot dogs and some lunch meats). Research has also found that sugar-sweetened drinks may be a culprit.

Lack of Exercise Research has shown that physical inactivity and sedentary behavior are well-established risk factors for colorectal cancer. Insufficient exercise may contribute to weight gain, insulin resistance, and inflammation.

Smoking A study involving more than 700 adults under the age of 55 with colorectal cancer found that former smokers had a 139 percent higher risk of developing colorectal cancer compared with nonsmokers in the same age group. For current smokers, that risk was 150 percent greater.

Alcohol Use Moderate to heavy alcohol consumption is a known risk factor for colorectal cancer. Alcohol consumption can damage the intestinal lining, allowing bacteria and toxins to enter other tissue in the body. A scientific investigation looking at more than 8,000 colorectal cancer patients between ages 20 and 49 found that the risk increased in relation to how much a person drank. Compared with nondrinkers, those who had one to two drinks weekly had a 7 percent higher risk. For those having three to four drinks per week, the risk was 14 percent higher, while five drinks or more equaled a 27 percent greater risk.

How Is Early-Onset Colorectal Cancer Diagnosed?

In addition to looking for symptoms, a doctor will identify early-onset colorectal cancer through screening and diagnostic tests.

For people at average risk of colorectal cancer, the American Cancer Society recommends regular screenings beginning at age 45 (lowered from age 50 in 2021). If someone younger than 45 is exhibiting symptoms, however, a colonoscopy may be warranted.

Screenings that can detect early-onset colorectal cancer include:

Colonoscopy and Other Visual Exams

A colonoscopy is the most common method of screening for colon cancer, and for people at average risk it should be performed once every 10 years. This is an examination of the colon, rectum, and anus using an endoscope (a flexible tube with a tiny lighted camera on the end that’s inserted through the anus). A colonoscopy can reveal if a person has any suspicious swollen or irritated tissue, internal bleeding, or polyps that may be indicative of cancer. (Early-onset colorectal cancer is more commonly found in the rectum or the left side of the colon.)

Getting a colonoscopy is associated with a lower risk of dying from colorectal cancer. An analysis of medical records from more than 5,200 adults revealed that a screening for colorectal cancer may reduce the risk of dying by 67 percent.

Other visual screening methods include flexible sigmoidoscopy (which uses a flexible scope to see inside the lower colon and rectum) and virtual colonoscopy (an X-ray exam).

Stool Exams

Fecal Immunochemical Test (FIT) This screening detects blood in feces that may not be visible. This test is done once a year.
Guaiac-Based Fecal Occult Blood Test (gFOBT) Like the FIT, this test looks for blood in feces that may be hidden and should be done annually.
Fecal DNA Test This test looks for signs of genetic mutations and blood in feces. It should be performed every three years.

Blood Tests

Shield Blood Test Approved by the FDA in the summer of 2024 for use in people 45 and older, this test looks for the presence of specific changes to DNA floating freely in the blood, which indicate the presence of a tumor or precancerous growths in the colon.

Diagnostic tests to confirm the presence of cancer include:

Complete blood count
Comprehensive metabolic panel, a routine test to assess 14 substances in the blood, including electrolytes, blood sugar, cholesterol, and liver enzymes
Carcinoembryonic antigen (CEA) assay, a test that measures CEA, a protein found in the blood that may be elevated in people with cancer
X-rays
Computed tomography (CT) scan
Magnetic resonance imaging (MRI) scan
Positron emission tomography (PET) scan
Ultrasound
Biopsy

Treatment for Early-Onset Colorectal Cancer

Diagnostic tests help clinicians determine what stage of cancer a patient may have. Younger people tend to be diagnosed when the cancer is at an advanced stage.

Depending on stage, a doctor will determine the appropriate treatment, which may include one or more of the following:

Surgery Removal of cancerous tissue and possibly reconstructing the bowel
Chemotherapy Drugs that travel through the bloodstream and destroy cancer cells
Immunotherapy Drugs that help the body’s immune system recognize and kill cancer cells
Targeted Therapies Treatment that targets the genetic changes or mutations that turn healthy cells into cancer cells
Radiation Therapy High-energy rays (such as X-rays) that shrink or eliminate tumors

Prevention of Early-Onset Colorectal Cancer

The Centers for Disease Control and Prevention (CDC) recommend that people at average risk of colorectal cancer get a colonoscopy every 10 years starting at age 45.

Screening tests like colonoscopy may identify precancerous polyps, which a doctor can remove to reduce cancer risk.

“… reduce their colorectal cancer risk by adopting healthy lifestyle habits.”

In addition to screening, young adults can reduce their colorectal cancer risk by adopting healthy lifestyle habits.

Claire Saxton, executive vice president of insights and impact with the Cancer Support Community, recommends the following lifestyle changes:

Increase physical activity.
Maintain a healthy weight.
Eat a diet low in animal fats and high in fruits, vegetables, and whole grains.
Limit alcohol (two drinks or fewer a day for men, one drink or fewer a day for women).
Avoid tobacco, or get help to quit.
Limit sugar-sweetened drinks.
Limit fast food, processed foods, and foods high in fat, starches, or sugars.

Prognosis of Early-Onset Colorectal Cancer

Colorectal cancer is highly treatable when it hasn’t spread beyond the bowel, according to the National Cancer Institute.

While every case is different, and statistics don’t predict how long you’ll live, some scientists estimate that those with early-stage colorectal cancer generally have a favorable prognosis, with a five-year survival rate of 90 percent. The survival rate is 71 percent for stage 3 colorectal cancer, and 14 percent for advanced disease.

Unfortunately, compared with older adults, people under age 55 are nearly 60 percent more likely to be diagnosed with late-stage disease, according to a study published in 2017.

One large analysis looking at more than 26,000 patients indicated that 29 percent with early-onset had recurrence at five years, versus 21 percent with late-onset.

Research published in 2021 showed that individuals with early-onset colorectal cancer had a lower 10-year survival rate compared with those diagnosed at ages 51 through 55.

Complications of Early-Onset Colorectal Cancer

Possible complications from early-onset colorectal cancer include:

Blockage of the colon: This prevents food, liquid, gas, and stool from passing through the intestines.
Cancer returning in the colon: When cancer comes back, it can be more aggressive.
Cancer spreading to other organs or tissues (metastasis): One study showed that in more than half of patients with early-onset colorectal cancer, the cancer had spread to other parts of the body.
Development of a second primary colorectal cancer: This is development in a new location in the colon, distinct from any recurrence of the original tumor.
Chronic diarrhea: Some cancer survivors have long-lasting bowel issues.
Numbness in fingers or toes: Peripheral neuropathy (a tingling or numbness in fingers or toes) can affect some patients.

Treatments for this cancer, such as chemotherapy and radiation, can have a range of side effects, including fatigue, nausea, diarrhea, constipation, and pain.

Statistics: Early-Onset Colorectal Cancer

Here is a snapshot of some vital facts regarding early onset colorectal cancer:

An estimated 19,550 people younger than 50 years have colorectal cancer.
About 10 percent of colorectal cancers appear in people under the age of 50.
Cases of early-onset colorectal cancer have increased by 51 percent since 1994.
An increase of 90 percent in early onset colon cancer and 124 percent in rectal cancer is expected by 2030.
Delays in diagnosis occur in 15 to 50 percent of young-onset cases.
Rectal cancer is more common than colon cancer in young patients.

Disparities and Inequities in Early-Onset Colorectal Cancer

American Indian and Alaska Native people have the highest rates of colorectal cancer in the United States, followed by African American men and women.

Some research has shown that patients with early‐onset colorectal cancer are more likely to be Black or Hispanic and to have stage 4 cancer. A study in Cancer Medicine noted that these two groups are more likely to experience socioeconomic barriers and health disparities in cancer care.

Evidence indicates that a significant portion of these populations may not have access to adequate healthcare nor adequate health insurance.

The disparity is reflected in the survival rates. A study published in 2023 looking at more than 33,700 patients with early-onset colorectal cancer found that 57.6 percent of Black patients met the five-year survival mark while 69.1 percent of white patients met it.

Support for Early-Onset Colorectal Cancer

For people with early-onset colorectal cancer, the disease can be uniquely challenging. They may struggle with childcare issues, for instance, or find it difficult to work, leading to financial complications. They may also worry about how the cancer and its treatment will affect their fertility.

The following groups offer support and advice:

Colorectal Cancer Alliance

People with early-onset colorectal cancer have their own online communities, patient support hub, and buddy program.

Fight CRC

Find online meetups where those affected by early-onset colorectal cancer can engage in meaningful conversations.

StupidCancer

Connect with adolescent and young adult cancer survivors and gain access to critical information and resources.

The SAM Fund — Expect Miracles Foundation

Grant money from this foundation can help young adult cancer survivors stay afloat.

The Takeaway

The number of early-onset colorectal cancer cases is growing at a concerning rate.
Scientists aren’t sure why this is occurring, but they’ve identified modifiable factors that heighten risk.
Being aware of symptoms can help young adults know when to get screened.

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