Jo Henderson was 17 when she was diagnosed with advanced colorectal cancer. This came after months of symptoms – stomach pain, bloating, constipation – and months of tests.
“I was expecting a gluten allergy and lactose intolerance,” said Henderson, now 18, of Seekonk, Massachusetts. “Literally everything except cancer. »
Colorectal cancer in people under 20 is exceptionally rare: People like Henderson are about one in a million and account for fewer than 100 cases per year in the United States. But a new study has found that most cases of colorectal cancer in children and adolescents are aggressive and often diagnosed at an advanced stage.
The results show that “adolescents and younger adults are at particular risk for poor outcomes and are a unique and vulnerable population, even compared to people in their 30s and 40s,” said Dr. Danielle Cameron, director of pediatric surgical oncology at Mass General Brigham Cancer Institute in Boston, who worked on the study.
“They are at higher risk of developing more aggressive types of colorectal cancer and have more opportunities for diagnostic delays,” she said.
Cameron stressed that cases in adolescents and very young adults are “still very, very rare.” But anecdotally, experts say rates are starting to rise.
Worldwide, rates of colorectal cancer are increasing in people between the ages of 20 and 30. A person born in the 1990s is four times more likely to be diagnosed with colorectal cancer before age 50 than someone born in the 1960s.
Previous research has focused on colorectal cancer in adults younger than 50 years old. Cameron and her team have gone younger, focusing on people under 21.
The team identified 84 adolescents, with a median age of 16, in the United States who had been diagnosed with colorectal cancer between 2012 and 2023. (Henderson was not part of the study and Cameron was not his doctor.) The research will be presented at the American Academy of Pediatrics national conference in San Diego. SATURDAY. It has not yet been published in a peer-reviewed journal.
Most of the young people in the study, 80%, were not diagnosed until their cancer reached stage 3 or 4, meaning the cancer had spread. This fits with Henderson’s diagnosis: By the time her cancer was discovered, it had spread to her ovaries.
Once a cancer has spread, it is much more difficult to treat: In the study, about 37% of patients recurred and 45% of patients died.
Diagnosing colorectal cancer in adolescents can be difficult. They are decades away from having colonoscopies to screen for the disease and, according to Cameron, “the symptoms they present with are vague.”
In the study, about 74% of people reported back or abdominal pain, and about 45% reported changes in their bowel habits. A similar proportion of people reported unexplained weight loss and around 32% had rectal bleeding.
“There are much more common things that cause these symptoms,” said Dr. Tara Henderson, chair of the department of pediatrics at the Yale School of Medicine, who was not involved in the research. (Tara and Jo Henderson are not related.)
Dr. Christopher Lieu, co-director of gastrointestinal medical oncology at the University of Colorado Anschutz in Aurora, Colo., said not every child or adolescent who is losing weight or experiencing abdominal pain should have a colonoscopy, “but it’s important to take the symptoms seriously.”
If a doctor has ruled out more common problems such as irritable bowel syndrome and things don’t improve in the short term, doctors should consider ruling out colorectal cancer, said Lieu, who was not involved in the research.
“If it’s colorectal cancer, the earlier we can detect these cases in the disease, the better the outcome will be,” he said.
And then there’s “the million-dollar question,” as Cameron calls it: What’s causing the increase in colorectal cancer among young people?
She suspects this is likely due to DNA changes caused by environmental exposures during childhood.
Dr. Kimmie Ng, director of the Young-Onset Colorectal Cancer Center at the Dana-Farber Cancer Institute in Boston, said the increase in consumption of ultra-processed foods could play a role. Ng, who is Jo Henderson’s oncologist, noted that her previous research found that women who ate more ultra-processed foods had a higher risk of colon polyps that can be precursors to cancer. Studies to determine whether microplastics could play a role are underway, she said.
A common risk factor for colorectal cancer is having a first- or second-degree relative – a parent, sibling, grandparent, aunt or uncle – who has had the disease. But this was only the case for 20% of those surveyed.
However, “even if there is no family history, they may still have a genetic predisposition,” explained Tara Henderson.
About half of the patients in the study underwent genetic testing, which revealed a handful of genetic mutations that may increase cancer risk. These mutations are not necessarily inherited; instead, they may be caused by certain exposures, or simply by chance.
“It really suggests that some of the exposures that occur early in life play a role in the early onset of colorectal cancer,” Lieu said.
After her diagnosis, Jo Henderson began treatment. In December, she had part of her colon removed, as well as both ovaries, before undergoing five months of chemotherapy. She is taking hormone replacement therapy and will need annual colonoscopies going forward.
A colonoscopy in August showed no signs of cancer. It was only four days before she left for college. She is now a first-year student at Clemson University’s Powers College of Business.
Gn Health
