Colorectal cancer is increasingly becoming a bigger problem for younger people, even children and teens. Research out today shows that these latter 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 usually had no family history of cancer, they found, and commonly had aggressive, advanced tumors. Though the overall risk of colorectal cancer remains small among adolescents, doctors should suspect it more often in those with potential symptoms that have no other explanation, the researchers say.
Early and advanced
Scientists have noticed an unusual pattern in colorectal cancer as of late. While the incidence and mortality of this cancer has been steadily shrinking for people over 65, it’s instead been rising for people ages 50 and younger.
According to the American Cancer Society, the incidence of colorectal cancer increased by 2.9% annually from 2013 to 2022 among people under 50. Other research has shown this rise is also apparent among children and teens. Though it still occurs more frequently in older people (true of cancer generally), early-onset colorectal cancer has become a growing public health concern.
To get a better sense of the situation in kids, the study authors analyzed data from the Pediatric Surgical Oncology Research Collaborative, a network of centers across North America tracking children with cancer. They specifically focused on children and teens with sporadic cases, meaning they didn’t have genetic or other health conditions known to predispose them to cancer.
They looked at 84 people ages 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.
Only about 20% of these cases had a family history of colorectal cancer, the researchers found. A majority already had advanced cancer, either stage III (51%) or IV (29%). These cancers also tended to be especially aggressive.
The cost of delay
The team’s findings are set to be presented this weekend at the American Academy of Pediatrics’ national conference. That means this research has yet to undergo the typical peer review process, an important part of confirming any scientific research.
Assuming these results are valid, however, it suggests that children and teens with colorectal cancer routinely aren’t diagnosed until after their tumors have started to spread beyond the original site. And this delay, coupled with the more aggressive nature of these tumors, often enacts a deadly cost.
About 37% of younger people experienced a relapse of their cancer after treatment. And, by the end of the study period, nearly half (45%) had died. For comparison’s sake, the overall five-year survival rate for colorectal cancer today is 63%.
Pediatric cancer in general is still rare, which is one reason why we can miss spotting the earliest signs of it. In this study, the most common symptoms presented by children and teens prior to their diagnosis were back or abdominal pain, a change in bowel habits, weight loss, and rectal bleeding. While there are many different potential causes for these symptoms, doctors should be more mindful about the possibility of cancer when seeing young patients with certain health problems that have no clear explanation, the researchers say.
“Given the increasing incidence of adolescent [colorectal cancer], 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.
Roughly 150,000 Americans are expected to be diagnosed with colorectal cancer annually. And though scientists have posited several different hypotheses as to why rates are rising in younger people, including processed foods, higher obesity rates, and certain infections, this trend doesn’t appear to be ending anytime soon.
