Young Colorectal Cancers: A Sudden Bolt of Lightning!

Introduction to Colorectal Cancer

People normally associate colorectal cancers with older people. This is true to a certain degree. Eighty percent of newly diagnosed colorectal cancers are in the above 70 age group, and these are what surgeons call sporadic cancers.

Of the remaining 20%, about two thirds affect young people below the age of 50, and the remaining 1/3 affect people with chronic inflammatory bowel diseases like Ulcerative Colitis and Crohn’s Disease.

For young people in their thirties and forties, getting struck with colorectal cancer is simply shocking. At the prime of their lives and at the peak of their careers they are diagnosed with a potentially fatal disease.

This article aims to shed some light on colorectal cancers in young people, the cause and characteristics, and what can be done to detect the cancer early.

Colon cancer in a 38 year old man. He complained of persistent bloating and vague abdominal discomfort.

Characteristics of Hereditary Non-Polyposis Colorectal Cancer (HNPCC)

Young people affected with colorectal cancer have a genetic defect which makes them prone to such cancers. The typical features are:

  • Multiple members of the same family affected across generations
  • Affected before age of 50
  • Affects right side of the colon
  • Multiple colon tumors

Some genetic defects not only expose the person to higher risk of colorectal cancers, they also cause increase risk for certain gynecological cancers.

The signs and symptoms are the same as regular colorectal cancers. However, as young people frequently dismiss their symptoms to something benign like hemorrhoids or indigestion and not seek medical attention, the cancer often presents late and at an advance stage.

Following Recommendations regarding this rare but potentially fatal condition

  • Have a high index of suspicion. Both patient and doctor should not dismiss seemingly innocuous symptoms if they persist in spite of treatment.
  • Once there is such a cancer history in the family, the entire family should go for genetic counselling as well as early colonoscopy screening.
  • Patients with family history of young colorectal cancers should go for colonoscopy 10 years earlier than age of the affected case. For example, if one family member is diagnosed at the age of 55, family members should be screened at age 45 instead of waiting till the recommended age of 50.

Familial Adenomatous Polyposis (FAP)

Familial Adenomatous Polyposis: Entire colon carpeted by pre-cancerous polyps

This is another genetic condition that puts the patient at great risk of developing colorectal cancer at a young age. It affects one child out of every 10,000. In this condition, the entire colon is literally carpeted with hundreds of polyps by the time the patient is a teenager. Without surgery, the chance of getting colon cancer is nearly 100% in such patients.

Patients typically complain of bleeding during defecation. Frequent diarrhoea, abdominal pain and mucus discharge are also present. In late stages, there will be loss of weight, anemia as well as intestinal obstruction as cancer grows bigger from the polyps.

Patients with family history of FAP begin screening at the age of 10. If no polyps are found, they are continually screened every year for life.

Once FAP is diagnosed, total removal of the colon and rectum (pan proctocolectomy) is advised as the chance of developing fatal colorectal is a near certainty.

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