Colorectal cancer: Alarming increase in people under 50

When Ryan Smith, MD, began his career as a surgeon treating colorectal cancer, it was rare for him to see a patient under 50. That’s no longer the case.

“We are seeing it much more frequently, even in patients in their 30s,” says Dr. Smith, a board-certified colon and rectal surgeon with AdventHealth Medical Group Colorectal Surgery at Castle Rock. Recently, he treated a 34-year-old patient with colorectal cancer.

Over the past decade, the rate of colorectal cancer for people over 50 has been declining. But during that same period, the rate for people under 50 has been rising by 2.4%each year.

One in five newly diagnosed patients is 50 or younger, according to the American Cancer Society.

Experts don’t know what is driving the increase. Normal risk factors — family history, certain genetic conditions, and lifestyle factors (like diet and smoking) — don’t explain the rise in early onset cases, Dr. Smith says. “Without knowing what’s causing these cases, we can’t identify who is at risk and screen them,” he says.

Don’t shrug off symptoms

Without screenings to catch cancer at its earliest stages, it’s crucial for people to pay attention to symptoms and see their provider for a diagnosis. Symptoms include:

• Abdominal pain
• Blood in stool
• Constipation or diarrhea
• Unexplained weight loss

“It’s really easy to write these off as IBD (irritable bowel syndrome), anxiety, nerves or hemorrhoids,” Dr. Smith says. “But don’t gaslight yourself into thinking your symptoms are nothing. Go get checked out.”

In most cases, symptoms will be due to these more common conditions. But if symptoms persist after treatment, patients need to go back to their provider.

“Be an advocate for yourself,” he says. “Ask whether you should have a colonoscopy; make sure you’re being evaluated completely. Don’t stop until you’re given a definitive answer.”

Personalized treatment

While most patients with colorectal cancer require surgery, each person’s surgery is customized based on a number of factors, including age, genetic make-up of the tumor, lifestyle and personal goals. Dr. Smith factors in quality of life and risk of recurrence for all patients. But for younger patients, he must consider those over the decades — not just years — they may live as survivors. Sexual function and fertility also are considerations that differ by age.

“For a younger patient with a longer life expectancy, I might remove a larger portion of the colon to reduce the risk of recurrence,” Dr. Smith explains. “But if the cancer is located near critical nerves in the pelvis, I might take a more conservative approach to preserve fertility and reduce long-term side effects.

"There’s no one-size-fits-all answer. It’s a conversation,” Dr. Smith says.

Colonoscopy: Screening and prevention

Colonoscopies are tests to examine the inside of the colon and rectum to find colorectal cancer at its earliest, most treatable stage. Doctors also use the test to find and remove growths, called polyps, before they develop into cancer — making colonoscopy the only cancer screening that also prevents cancer.

To address the rise in early onset cases, national screening guidelines were updated in 2021 to recommend a first colonoscopy at age 45 for average-risk adults. People without any known risk factors who have a normal test result won’t have to repeat the test for another 10 years.

Adults with risk factors should talk to their provider about when to start screening and how often to repeat. Risk factors include:

• Family history of colorectal cancer
• Personal history of inflammatory bowel syndrome, colorectal cancer or polyps, or radiation to the abdomen or pelvic area for a prior cancer
• Confirmed or suspected genetic mutation, such as Lynch syndrome

Get screened

If you are 45 or older, or you are experiencing symptoms associated with colorectal cancer, schedule a colonoscopy today with AdventHealth Medical Group Gastroenterology at Castle Rock at Call720-455-3879.