Colorectal cancer is on the rise among children and adolescents, and it is not the same disease that adults get

Colorectal cancer is becoming an increasingly serious problem among young people, even children and adolescents. Research carried out today shows that these latest cases are stranger than the cancers seen in adults.

Researchers studied the medical records of people under the age of 21 who were diagnosed with colorectal cancer. Younger people generally did not have a family history of cancer, they found, and usually had aggressive, advanced tumors. Although the overall risk of colorectal cancer remains low among adolescents, doctors should suspect it more often in those with potential symptoms without other explanation, researchers say.

Early and advanced

Scientists have recently noticed an unusual trend in colorectal cancer. While the incidence and mortality of this cancer are steadily decreasing among people over 65 years of age, they are increasing among people aged 50 and younger.

According to the American Cancer Society, the incidence of colorectal cancer increased by 2.9% per year between 2013 and 2022 in people under 50 years old. Other research has shown that this increase is also apparent in children and adolescents. Although it occurs more frequently in older people (as with cancer in general), early-onset colorectal cancer has become a growing public health problem.

To get a better idea of ​​the situation in children, the study authors analyzed data from the Pediatric Surgical Oncology Research Collaborative, a network of centers across North America that track children with cancer. They specifically focused on children and adolescents with sporadic cases, meaning they did not have genetic or other health problems known to predispose them to cancer.

They looked at 84 people aged 21 and younger who were diagnosed with colorectal cancer between 2012 and 2023. The median age of patients was 16.5 years, and the median duration of symptoms before diagnosis was 12 weeks.

According to the researchers, only about 20% of these cases had a family history of colorectal cancer. A majority already suffered from advanced cancer, either stage III (51%) or stage IV (29%). These cancers also tended to be particularly aggressive.

The cost of delay

The team’s results are expected to be presented this weekend at the American Academy of Pediatrics national conference. This means that this research has not yet gone through the typical peer review process, an important part of confirming any scientific research.

Assuming these findings are valid, this suggests that children and adolescents with colorectal cancer are typically only diagnosed after their tumors begin to spread beyond the original site. And this delay, coupled with the more aggressive nature of these tumors, often comes with a deadly cost.

Around 37% of young people experienced a relapse of their cancer after treatment. And, by the end of the study period, almost half (45%) had died. For comparison, the overall five-year survival rate for colorectal cancer today is 63%.

Pediatric cancer in general is still rare, which is part of the reason why we may miss the early signs. In this study, the most common symptoms experienced by children and adolescents before their diagnosis were back or abdominal pain, change in bowel habits, weight loss and rectal bleeding. Although there are many potential causes for these symptoms, doctors should be more alert to the possibility of cancer when seeing young patients with certain health problems that don’t have a clear explanation, researchers say.

“Given the increasing incidence of colorectal cancer in adolescents, practitioners should include colorectal cancer in their differential for symptoms such as abdominal pain and rectal bleeding in adolescents without an alternative diagnosis,” the authors wrote in their study abstract.

About 150,000 Americans are expected to be diagnosed with colorectal cancer each year. And although scientists have come up with several different hypotheses as to why rates are increasing among young people, including processed foods, higher obesity rates and certain infections, this trend doesn’t appear to be stopping any time soon.