Cancer Featured The Brief: Colorectal Cancer Blog

Colorectal cancer knows no age

Dr. Shady Ashamalla

Q: I’ve always thought that colorectal cancer is mostly a problem for older people. Is this true, or can younger people have it too?

I will tell you about Mary*. She had no risk factors or family history of rectal cancer. At 29 years old, this new mom had been bleeding for a few months in small amounts that went largely unnoticed. Cancer was not on her radar. A visit to her doctor eventually led to a colonoscopy that detected the cancer.

Over the course of about a year, Mary received chemotherapy, radiation and surgery. While the cancer was controlled for a short time, it returned.

As a cancer doctor, I have many difficult days sharing in my patients’ sadness. The day I looked Mary in the eyes, her baby in her arms, and told her the cancer had returned was — and still is — the most difficult day of my career. Just when we thought the disease was controlled and Mary would get her life back, we were stopped in our tracks. How brutally I was reminded that day — and each day since — that this disease shows no mercy and knows no boundaries. Mary died just over a year after her diagnosis.

Colorectal cancer is not just a disease of the elderly. It’s a deadly yet preventable — and often treatable — disease that every adult should be aware of, regardless of age.

In fact, Canadian researchers have recently identified an alarming trend in the rates of colorectal cancer in young adults. Looking at data from the Canadian Cancer Registry from 1997 to 2010, the study found that the incidences of colorectal cancer rose by 1 per cent per year in patients in their 40s, 2.5 per cent per year for those in the their 30s, and a shocking 7 per cent for those people in their 20s during that time period.

These increasing trends among younger people are a stark reminder that this disease is definitely not just a disease of the old but rather a growing problem in young adults.

In my own colorectal cancer practice, about 30 per cent of my patients are under the age of 50.

And, sadly, when colorectal cancer strikes in young adults, it is most commonly only diagnosed in its later, more advanced stages. That’s because with no current general screening recommendations in this age group, the diagnosis is only being made once the cancer has advanced enough to cause symptoms like rectal bleeding or weight loss. Even then, younger adults often take longer to have these symptoms checked out by their doctor, leading to an even worse prognosis.

While we don’t yet know why rates among young people are increasing, we need to raise awareness of this disease among that population, and among health-care practitioners who wouldn’t typically suspect colorectal cancer in a young woman with no risk factors.

Awareness is our most powerful tool in identifying and treating this disease early, and ongoing research into whether screening should be started earlier than age 50 is needed. Since Ontario’s colorectal screening program began for patients over age 50, colorectal rates have actually been decreasing (because pre-cancerous polyps can be removed before advancing to cancers).

It’s so important to be vigilant in ensuring that all adults know the signs and symptoms of this disease, as well as the screening guidelines for early detection.

Step 1 is to know your risk. Check out this risk calculator and talk to your family about your family history. Colorectal cancer can strike even those without known risk factors. If you have any changes to your bowel movements, talk to your doctor.

About the author

Dr. Shady Ashamalla

Dr. Shady Ashamalla

Dr. Ashamalla is a colorectal cancer surgeon at Sunnybrook’s Odette Cancer Centre specializing in minimally invasive surgical treatments. He’s also a teacher and researcher in surgical education and simulation, and he's a consultant surgeon to the Toronto Maple Leafs. Read more posts on his blog. Follow @ShadyAshamalla on Twitter.