Dr. Cathy Eng, an oncologist at the Vanderbilt University Medical Center, talks about the rise of colorectal in young people, which means they should tested for it earlier.
Interview conducted by Ivanhoe Broadcast News in 2023.
How does the patient’s health history affect the development of this cancer, and why do these malignant cells form?
Eng: We don’t know the exact etiology for why there is the development of early-onset colorectal cancer. When I say early onset, we’re referring to patients less than 50 years of age. That is because the screening age previously was 50, now it’s been reduced to 45. How history can have an impact is, that we are very interested in learning about family history, and that can result in a familial form of colorectal cancer that can predispose a patient to developing colorectal cancer. But the majority of early-onset patients, unfortunately, are sporadic cases of colorectal cancer.
What are the primary signs of it and how do they progress?
Eng: Great question. Primary signs of colorectal cancer may be simply a change in bowel habits, a change in gas patterns when you’re passing gas, later signs or pain, urgency when you feel like you want to defecate, and maybe you can’t, constipation, blood in the stools, change in the color of the stools, and more later signs also include severe anemia, weight loss, and right upper quadrant pain, because the liver is a common site of disease involvement.
What are the latest treatment techniques for this?
Eng: Depending upon the stage and whether it’s colon cancer versus rectal cancer, the treatments may vary. For our stage four or metastatic colorectal cancer patients, their treatments are still the same as our average age onset patients, at least at this time, unless they have a form they inherited or familial colorectal cancer, which can be associated with something called microsatellite instability. That’s where immunotherapy may have a role for our patients. For earlier-stage patients, especially if it’s in the setting of rectal cancer, that’s when we often consider whether or not there’s a role for radiation therapy, and that is dependent upon where the tumor lies anatomically in the rectum. That also may determine whether or not we decide to take them to surgery or not. If they have an excellent response, sometimes we do what’s called active surveillance for rectal cancer tumors. That doesn’t apply to colon cancer though. It’s very different depending upon colon versus rectum, and what stage.
What’s the difference between rectal, anal, and colorectal?
Eng: The difference between colorectal cancer, so that’s the large bowel. Then the rectum is roughly about 12 centimeters from your anal canal or the anal verge. The anal canal cancers are usually squamous cell cancers, and that’s the lowest part of the digestive tract. But colorectal cancer, for the most part, is adenocarcinoma. It’s a very different cancer, and that’s the majority of patients we see. Anal cancer is treated very differently, and hopefully, with just concurrent chemotherapy and radiation treatment for cure. It’s a little bit different. We try not to do surgery on anal cancer if we can.
What advice do you have for people who are struggling with this?
Eng: I think the most important thing for our early onset patients is to recognize that these patients are different than our average age onset patients. The average age of patients in the United States is 66 years of age, and yet I’m seeing patients in my clinic that are 20 years old, 30 years old. These are young individuals that may have just graduated from college, graduated from grad school, embarking on some other aspect of their life, and you really have to think about their needs. Think about fertility, planning and discussion about fertility which doesn’t happen enough. Discuss the economics of their decision, because this impacts job security, this may impact family planning. Those aspects are extremely important for our patients. I highly encourage individuals to reach out and to get support. There are so many groups that are available, not only through the Internet, but also at your local hospital clinic, Gilbeys club, or national groups as well that form support groups. But the most important thing at the end of the day is to get diagnosed early. Hopefully by being diagnosed early will have an earlier stage of cancer and a better prognosis overall.
Is there anything important that I missed that is important for younger people or any people to know?
Eng: Yeah, I think I really want to highlight how important it is to recognize the symptoms and recognize the fact that your average patient with early-onset colorectal cancer does not look like your average patient that you would think of in the past, that’s 66 years of age. These are healthy-appearing young individuals who may be training for a marathon but aren’t very fit, and they have no idea that a non-cancerous polyp- has now transformed into a cancer. It takes five to 10 years for that non-cancerous polyp to transform. That’s why I really encourage anybody to have symptoms that do not resolve, they need to get screened. The reality is, that there are approximately 49 new cases per day of early-onset colorectal cancer. Approximately, if you look at the really young patients, between 20 and 34 years of age, it is expected by 2030 that for left-sided tumors there will be a 90 percent increase from 2010, and 124 percent increase for rectal cancer tumors versus 2010. It’s going to be the leading cause of cancer mortality in our young individuals less than 50 years old.
What would you say to the people that are in their 20s and 30s and stuff, that are fighting it and living through it?
Eng: Great question. I would kindly remind them there is a whole group of individuals out there to support them. I work very strongly with patient advocates. I respond to a lot of patients with questions. I want them to recognize they’re not alone. I think that’s the most important thing. It’s really important to stay optimistic and positive and be engaged, and involved in the decision-making process, but also to really continue to live their lives. Continue regular physical activity, and continue to work, if they enjoy work. It’s very important that the cancer does not overcome their entire life. It’s really important to understand that you have to sometimes treat this if it’s a late-stage or more advanced tumor, like a chronic illness such as diabetes, so that it needs medications to be treated, but you can live with your cancer. Once again, we really want individuals to be diagnosed much earlier on. That’s the most important thing we can do. There’s a lot of ongoing research as to why this is happening. We just haven’t identified the exact etiology at this time.
Can you tell us about the new guidelines? Can you tell us what you think?
Eng: As of 2020, the new age for colorectal cancer screening is 45 for an average sporadic colorectal cancer patient. Someone that does not have a known family history. We’re encouraging patients to be screened at 45 versus 50. It’s estimated at least by 2020, that there were approximately about 18,000 young early onset patients. The reality is that, if it takes FIVE TO 10 years for a non-cancerous polyp to become cancerous, these patients probably were developing colorectal cancer in their early 20s or even before that or early 30s. theoretically, the age of screening may not be enough at least for the patients I’m seeing. I would love to have screening reduced further. We need a little bit more evidence to support that. I’m very grateful though that we’re able to reduce the age to 45, but I honestly would like to see it be reduced further.
Can you shed any other light on knowing your family history’s importance?
Eng: The majority of patients do have sporadic colorectal cancer, but there is a small group of individuals that often don’t think about learning about their family history because they’re young and healthy. It’s really important to speak to your family members about any history of cancer because a lot of these colorectal cancer syndromes are not just colorectal cancer, they’re associated with other cancers. The most common one is Lynch syndrome, which is associated with uterine cancer, pancreatic cancer, small bowel cancer, bladder cancer, etc. But that places you at risk for colorectal cancers. Learning your family history could really save your life.
END OF INTERVIEW
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