“You have to squeak.”
In other words: speak up and advocate for yourself. That’s the advice Ursina Teitelbaum, MD, who is section chief of Gastrointestinal Oncology at Penn Medicine’s Perelman Center for Advanced Medicine, offers to young adults who notice any change in their bowel habits.
“You must be willing to talk about poop. Yes, it’s embarrassing, and we avoid it. But if something doesn’t feel right and persists after a week or two, you need to pursue care,” she said.
Teitelbaum wants young adults—and their physicians—to be aware of the steady increase in colorectal cancers being diagnosed at a younger age. “We’ve been seeing it in our cancer population databases since the 1990s,” she said.
Colon and rectal cancer, or colorectal cancer, is the third-leading cause of cancer deaths in the United States. Though it’s still mostly diagnosed in older patients, higher percentages of younger people are getting the disease. “And it’s predominantly rectal cancer over colon cancer,” said Noah Goldman, MD, who is medical director of cancer programs at Penn Medicine Princeton Health.
The reason for the rise in early colorectal cancer is not well known. “Only about 20 percent of cases are inherited,” said Anish Sheth, MD, who is the chief of Gastroenterology and co-director of the Center for Digestive Health at Penn Medicine Princeton Medical Center. “There’s this concept of ‘inflammaging’ where cells age more rapidly due to poor diets and sedentary lifestyle. Diets high in processed foods and sugars may contribute to this heightened risk by leading to gut inflammation,” he said.
Goldman said researchers are investigating whether there’s a link between early onset colorectal cancer, the immune system, and the gut microbiome (bacteria[AS1] [AS2] ).
Awareness can save lives
Under a microscope, early onset colorectal cancer appears the same as colorectal cancer in older adults; however, in younger patients the cancer often presents on the left side of the body. One potential upside is that when the cancer is on the left side, there are usually more symptoms—such as changes in bowel habits, thinner stools, or blood in the stool.
Without noticeable symptoms, cancer may continue to grow unchecked until it’s reached an advanced stage, making treatment more complex and outcomes poorer.
“Because they’re candidates for screening colonoscopies, colorectal cancer is often caught earlier and is therefore much more controlled in older patients,” Goldman said. Screening colonoscopies both detect cancer and help prevent it. “If you find a polyp and remove it, it doesn’t have the chance to turn into a cancer,” he added.
The criteria for screening colonoscopies has expanded in recent years to adults age 45 and older who are at average risk (previously, age 50). Still, that means younger adults could have polyps and/or cancer that remains undetected until it has sprea
It’s vitally important to educate young adults to recognize symptoms and seek timely answers from a medical provider. Patients also need to familiarize themselves with their family history. If they have a first-degree relative who had a gastrointestinal (GI) cancer, they need to let their doctor know, because it might put them at a higher risk.
In turn, providers (including pediatricians and family physicians) need to consider CRC as a possibility within a demographic that’s not traditionally associated with it. Colorectal cancer is no longer just a cancer of aging.
“The youngest patient I’ve seen with this diagnosis was 18, with no family history and no risk factors,” Teitelbaum said. “Now that we know that this is something affecting younger people, we have to think about it sooner.”
How Penn Medicine is addressing young adult onset colorectal cancers
The Perelman Center for Advanced Medicine is preparing to launch a young adult-onset GI cancer program. While based in Philadelphia, the program will leverage the resources and expertise at all of the health system’s locations, from diagnostics to treatments to services such as cancer genetics and fertility preservation.
“There are special considerations for younger adults,” Teitelbaum said. For example, “If you’re going to treat someone with chemotherapy or radiation, you want to make sure that a young person’s ability to plan a family in the future is left intact.” She added that while planning therapy (which usually begins within a few weeks of diagnosis), you also need to plan for fertility preservation, which is straightforward for men but can be complicated and time-consuming for women.
The program will also address the unique psychosocial challenges of being a young adult with colorectal cancer, including:
· Treatments that require a temporary or permanent ostomy bag (for collecting stool outside the body)
· Side effects of chemotherapy that can make work, school, or caring for young children more difficult
· The financial, emotional, and logistical impact of dealing with an unexpected illness while juggling responsibilities
A dedicated nurse navigator will manage the program and coordinate care across the Penn Medicine system, enabling patients who live in the Philadelphia suburbs, Lancaster, PA, or central New Jersey to receive the specialized care they need, close to home.
Proton therapy
Penn Medicine offers advanced proton therapy at three locations, including Roberts Proton Therapy Center at Penn Medicine’s Abramson Cancer Center. Not every patient will need radiation therapy, but for those with rectal cancer who do, proton therapy is highly targeted, sparing the areas surrounding the cancer, such as the spine/pelvis bones or bowels.
“You don’t want to be at risk for fractures or cancers in 10 or 20 years, which is particularly relevant for somebody who’s 20, 30, or 40,” said Teitelbaum.
Screening and treatment
Penn Medicine is continually improving cancer detection and treatment. Sheth said this includes the use of artificial intelligence (AI) technology to enhance polyp detection during colonoscopy.
At Princeton Medical Center’s Center for Digestive Health, the Direct Access Colonoscopy program helps fast-track the scheduling of routine screening colonoscopies. Patients also have ready access to other advanced endoscopic procedures as well as an experienced team of gastroenterologists.
“Princeton has incredible GI capabilities both for screening and for therapeutic intervention,” said Teitelbaum.
Goldman said when it comes to any type of cancer, it’s essential to listen to your body. “Nobody knows you better than you,” he said.