Know the symptoms you should never ignore

Colorectal cancer is not typically viewed as a disease of younger people. Yet over the last two decades, its incidence and mortality have increased significantly in younger adults ages 20 to 49.

This uptick is expected to persist over the next two decades. “Of all the new colorectal cancers in young patients, most are found between the ages of 45 and 49,” says colorectal surgeon David Liska, MD.

An unexplained trend

As colorectal cancer rates have fallen overall, researchers are trying to understand why they’re rising in younger adults.

No definitive data explain the increase, especially in the very young. But rising obesity rates and dietary trends may be factors.

“We also know certain diets and environments may increase the risk for colorectal cancer in older adults,” says Dr. Liska. “This may play a role in younger people too, as our diets are constantly changing and evolving from generation to generation.”

What is clear is the need for colorectal cancer prevention. Dr. Liska recommends taking the following steps to protect yourself.

Don’t ignore rectal bleeding with bowel changes

“We see a number of young patients who may have initially ignored symptoms or were told they were too young to have colorectal cancer,” Dr. Liska says. “Many of the advanced cases of colorectal cancer we see are in young people who were misdiagnosed or had a delayed evaluation for this reason.”

Not everyone with colorectal cancer has the same symptoms, but any sort of bowel changes accompanied by rectal bleeding should prompt a visit to your doctor, including:

• Anemia (a low red blood cell count).
• Blood mixed in with bowel movements.
• Belly pain or other symptoms of blockage.

“Don’t just assume you have hemorrhoids if you see blood on the toilet paper or in the toilet,” he says. “There’s no such thing as ‘normal’ bleeding. Tell your physician so he or she can assess you immediately.”

Know your risk and family history

Often, people have no symptoms in the early stages of colorectal cancer, when it’s easier to treat.

That’s why it is critical to identify those at higher risk of developing the disease. Earlier screening may be advised for younger adults at high risk. Your doctor can help assess your risk, as can online risk assessment tools.

“I encourage patients of all ages to know their family history. It’s extremely important that everyone know if a close relative was ever treated for colorectal cancer or colon polyps,” Dr. Liska says.

Don’t be afraid to talk to your doctor — and possibly get screened earlier

Take your health seriously, even if you’re in your 20s when you might feel that nothing can go wrong, Dr. Liska says.

That includes developing a good relationship with a primary care physician with whom you can discuss any unusual symptoms, as well as when you should be screened for colon cancer.

Most U.S. professional societies and task forces recommend that people begin having colonoscopies at age 50. The American Cancer Society recently lowered its recommended starting age to 45, but this is controversial among colon cancer experts.

“We must always balance our desire to screen patients with the risk of complications and cost,” Dr. Liska says.

A procedure called flexible sigmoidoscopy is a less expensive and invasive way to screen and could be used for people under age 50, since most colon cancers found in young people lie in the rectum or sigmoid colon, which are reachable with the sigmoidscope, he says.

“It’s also important to note that there is a difference between a routine screening colonoscopy for people without any symptoms and a diagnostic colonoscopy to evaluate symptoms,” he notes. “People with symptoms might be appropriate for a diagnostic colonoscopy at any age.”

Other screening options, such as highly sensitive stool-based DNA tests for colorectal cancer, are also becoming more effective and will be used increasingly in the future, he adds.

Eat healthier, exercise and stop smoking

Fresh fruits and vegetables and other high-fiber foods, as well as regular exercise, help keep your colon healthy.

Experts still have much to learn about how lifestyle affects colorectal risk, says Dr. Liska. But he advises young adults to reduce their consumption of red meats and overly processed foods.

And if you smoke — now’s the time to quit.

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