Colon cancer rising in young people: a gastroenterologist’s perspective

I am seeing gastrointestinal (GI) cancers (esophageal, pancreatic, liver and colorectal) in people under 40 years old. Often these cancers are not found until they are advanced and show symptoms. If you're under 40, you're probably not thinking about getting screened unless you have a family history of cancer.

Most people don't have symptoms in the early stages, and that's the scary part. You could have something serious, like pancreatic cancer, and not know it. Sometimes your only symptom might be intermittent back pain or an upset stomach, which is easy to dismiss. After all, who doesn't have occasional heartburn?

When to take action against GI cancers

If you have digestive symptoms that are persistent or worsening, you should be evaluated.

Swallowing issues: when to act

I had a 20-year-old patient who had trouble swallowing. Swallowing issues can have many causes, not just cancer. But if you have continuing swallowing problems, you should see your primary care clinician. They might order an X-ray or refer you to a gastroenterologist for an endoscopy.

If symptoms persist or worsen, that's when we get more concerned. If symptoms start occurring most days of the week or last for much of the day, or if they suddenly worsen, it's important to be seen by a healthcare clinician. In the case of my patient, he had esophageal cancer.

Heartburn that won't go away: when to act

Reasons for you to get evaluated for cancer include:

• If you have heartburn that doesn't go away even after taking over-the-counter medications
• If you have symptoms like:
  • Unexplained weight loss
  • Lasting reflux
  • Regurgitation
  • Trouble swallowing

If symptoms are persistent, especially at night or interfering with sleep, I'd strongly encourage an endoscopy, even in younger patients.

Abdominal issues: when to act

Talk to your clinician if you have symptoms like:

• A change in bowel habits that lasts for more than a few days (diarrhea, constipation and change in stool width or thickness)
• Bright red or very dark red blood in your stool
• Constant fatigue
• Ongoing cramping, abdominal pain or bloating
• Unintended weight loss

Any GI symptom: when to act

It will most likely be nothing serious, but it's better to address the symptoms and figure out the cause. Be careful about searching for answers online.

Start with your primary care clinician, who will refer you to a specialist if appropriate.

Having a conversation with someone who can ask the correct questions to potentially lead you toward the right testing is the way to go.

Risk factors and genetics

We don't know exactly why GI cancers are increasing in young people, but many of the usual culprits — diet, smoking, alcohol use and a sedentary lifestyle — likely play a role.

Is colon cancer genetic

There are inherited genetic mutations such as Lynch syndrome that can lead to colorectal cancer. It's important to have conversations with your family about your medical history and share that information with your primary care clinician.

Talk to a genetic counselor, who may recommend genetic testing. Your clinician may suggest early cancer screening based on your family history and genetic testing results. You should have your first colonoscopy 10 years before the age at which a first-degree relative was diagnosed.

Screening recommendations

The best way to prevent colorectal cancer or detect it in its earliest, most treatable stage is through screening. Colonoscopy is the gold standard, as we can remove precancerous polyps during the colonoscopy.

The recommended age for colonoscopy is now 45 (recently lowered from age 50 due to the increase in young people with colorectal cancer). However, family history may warrant earlier screening. Screening should begin 10 years before the age at which a first-degree relative was diagnosed.

To determine when you should start screening, discuss the following with your healthcare clinician:

• Your family history
• Continuing symptoms like:
  • Bleeding with bowel movements
  • Abdominal pain
  • Unexplained weight loss

What happens if you're diagnosed with GI cancer

If screening reveals a cancer diagnosis, gastroenterologists work closely with a treatment team that may include surgical oncologists to help guide treatment decisions. There are many treatment options for young patients with GI cancer, depending on the stage.

Quality of life is very important, especially for younger patients. For colon cancer that hasn't spread, surgery can be curative, and patients need regular follow-up. Some procedures may have lasting effects.

Don't panic about possible GI cancer without first seeing a healthcare clinician who can assess whether you need urgent attention. But do pay attention to your body and seek help when you feel something is off.

Understanding cancer in young people

Main Line Health's clinicians and care team have additional insights on their approaches to diagnosing, treating and supporting young people with cancer.

Explore the full series

Next steps

Learn more about Rasiq Zackria, DO

Learn more about cancer care at Main Line Health

Learn more about the Genetics and Risk Assessment Program

Related posts

Jessica's story: Genetic testing revealed risks for breast and colorectal cancer

How to recognize the silent symptoms of colorectal cancer

Everything you always wanted to know about home colorectal cancer tests but were afraid to ask