Why is colon cancer rising in young? There is mounting evidence linking an unhealthy diet, one high in processed meat and fat, and low in fruits and vegetables to early-onset colorectal cancer. Other scientists have turned their focus to bacteria that live in the gut, also called the gut microbiome adults. Colon cancer risk is vastly lowered by following a healthy diet and daily exercise, avoiding processed food, and screening for those with genetic risks of colon cancer. Significantly, a healthy diet and exercise help prevent most non-communicable diseases.

Incidence of Cancers:

Excluding skin cancer, colon cancer is the  3rd most common cancer in USA.In the western world its 8 times more common than in India.

The commonest cancers in the Western world are:Lung, colon and rectum, and prostate in men and breast in women.

In India: the leading cancers in men –oropharynx, stomach and esophagus.Uterine cervix, breast, and oropharynx in women.[2]

CRC is Rising in those below 50. It is now the sixth most common cancer in India.

The incidence of CRC in India is approximately 4.7/100,000 among males and 3.2/100,000 amongst females.[Source]

Relatively higher Incidence of Colon cancer less than 40 years of age, is found in Kolkata than in other cities, according to  Pal.[source]

Why is there a rising incidence of CRC?

Altered gut bacteria die from ultra-processed food and antibiotic use, obesity, and even lack of exercise.

Obesity, insulin resistance,  drugs, and alter the gut microbiome and increase colon cancer risk.

Known risk factors include hereditary syndromes, ulcerative colitis, and Crohn’s disease.

Symptoms of colorectal cancer may include:

• Changes in bowel habits or stool character that last longer than a few days, such as constipation and diarrhea.
• Rectal bleeding (bright red blood)
• The feeling of incomplete bowel emptying and sudden urge to visit the loo.
• Abdominal pain or cramping
• Unintentional significant weight loss
• Fatigue and weakness
• Persistent feeling that you need to have a bowel movement, even after using the restroom.
• But colon cancer can also present without signs of obstruction, even in advanced cases.

The reason behind lower CRC in India is our diet low in fats, and rich in fruits and vegetables and spices like curcumin.

Case Studies:

When I was studying MBBS, I didn’t know anyone personally who had colon cancer,in fact, the C word was not a regular except in the cancer wards. But over the years I have known people (personally not patients) affected by breast cancer, thyroid cancer, colon cancer, and in one case three different cancers in one person over 3 years.

One of the people with Colon cancer was a male with a family history of colon cancer and another solid organ tumor, a history of smoking, and obesity. Diagnosed in his mid-fifties. In his case, the first symptom was abdominal discomfort, with no obvious obstructive symptom, but clinically pallor was present but no significant weight loss. The other person with colon cancer had no family history, and no symptoms except sudden spells of weakness. The latter had liver metastases and the colon cancer was inoperable. But good chemotherapy is giving her a fighting chance. In both cases, the indomitable spirit of the people affected made me realize how important our mindset is.

The first case was followed up six monthly to yearly. However, the screening was CEA and CT scan of which the CT scan for the abdomen was never done by the patient after the first year. Somehow a repeat colonoscopy was done only one time at one year post surgery. There was a recurrence involving the proximal jejunum after 4 years and this time it was T4N2M0

That’s why I am writing about colon cancer. To build awareness about a highly preventable cancer.

Screening in colon cancer

When to get started?

How frequent?

With what tool?

Based on current guidelines, it is important to know your family history when it comes to screening for certain types of cancer. Ideally, screening should begin about ten years before the diagnosis of the cancer in the last known family member who had it. If you are above the age of 45, it may be necessary to undergo routine screening.

Risk factors requiring to personalize screening schedule include:

• polyps
• history of abdominal radiation for cancer
• hereditary syndromes
• Family history of colorectal cancer or certain polyps
• Inflammatory bowel disease (IBD)
• Ulcerative colitis is a mixed bag where CRC is not reported in a disease duration of less than 10 years. It is also not as frequent as in the West [source].

Screening tests include:

• Occult blood test in the stool: The advantage is its low-cost, easily available screening test. It is cheap, easily available, and has been extensively studied and proven to reduce CRC mortality. The problem lies in low sensitivity and false positives. Fecal immunochemical test (FIT) detects the human globin. and has better sensitivity, but it costs more and is not widely available in India.

• Colonoscopy-which is an endoscopic test to check the colon for these growths. Most CRC follows a typical adenoma-carcinoma path. With colonoscopy, the adenoma can be easily removed and is an excellent method to prevent it from developing into cancer which may take from 10 to 15 years.The advantage of diagnosis and taking a biopsy in the same sitting makes this a very important tool in the arsenal to fight CRC.

Types of polyps include: There are different types of growths in our colon, such as adenomatous, hyperplastic, inflammatory, or hamartomatous. Not all adenomas, which are a type of growth, turn into cancer. Adenomatous polyps, which are a specific type of growth larger than 10 mm, have the highest risk of becoming cancerous. Because of the discomfort, cost, and unknown reasons, many people in the Western world don’t get a colonoscopy, let alone India. Plus the cost has to be kept in mind for all such invasive procedures.

• CECT whole abdomen:

• CEA Carcinoembryonic antigen (CEA) is expressed in the majority of colorectal, gastric, and pancreatic cancers, some breast cancer and non-small-cell lung cancer (NSCLC) Higher levels of CEA at diagnosis indicate a poorer prognosis

In the case of the male patient, I mentioned he didn’t have significantly elevated CEA and even on recurrence, the CEA was within normal limits. Monitoring of CEA at intervals of 3 to 6 months is the single most effective method of detecting early relapses. The benefit of monitoring, however, decreases after 2 years[source].

Your doctor will know the best method for follow-up screening. Awareness is crucial. Since the symptoms are often similar to other common conditions like hemorrhoids (piles), fissures, irritable bowel disease, and inflammatory bowel disease the delay in diagnosis is inevitable. Public interest and educational awareness for this highly preventable cancer may help save many lives through timely screening and modifying risk factors.

Cancer treatment as in most cases follows a step-by-step plan

Symptoms-signs-Diagnosis-Imaging-Colonoscopy-Biopsy-Ruling out metastases-Treatment Plan

Treatment depends on Histopathology or type of cancer and stage of cancer whether metastasis is present or not

Surgery

Chemotherapy

Immunotherapy

Downstaging preoperative therapy(radiotherapy and systemic therapy

Therapy for metastatic disease

Palliative therapy

Targeted therapy

In my experience both as a relative/friend of patients and as a doctor Tata Medical Centre in Kolkata Rajarhat and Mumbai both offer excellent comprehensive quality care at affordable rates.The best part is they try to give a overview of the treatment plan so that patient and their relatives are not caught by surprise.

The commonest sites of Cancer of the colon

A tertiary care center in southern  India has a large database of colon cancer showing rectum as the most common site[source]

• rectum (42%)
• rectosigmoid (21%)
• colon (20%)
• anorectum (13%).[3]

 Most present in advance cases and that makes treatment difficult. Early diagnosis through screening makes this a highly treatable cancer with a good prognosis on timely management.

Unfortunately, though, screening has made prevention and mortality lower in the older population. Less than 50% population in UDSA shows a rising trend.63% increase in incidence from  1988 to 2015.

The suspected cause behind younger age of rising incidence

• Processed food (refined sugars, grains, meats, preservatives, additives, colorants, artificial sweeteners)
• Western diet rich in red meat UFSS food(Ultra-processed fatty sugary salty )
• Soft drinks
• Low fibre diet
• Low-level exercise
• Alcohol, smoking, recreational drug use
• Hereditary non-polyposis colon cancer (Lynch syndrome) contributes to <5% in the Western world. Incidence in India 10-15%.

Other hereditary conditions include

familial adenomatous polyposis, MUTYH-associated polyposis, juvenile polyposis, Cowden syndrome, Li–Fraumeni syndrome, and Peutz–Jeghers syndrome.

Relation of these with colorectal cancer requires multicentre trials with large populations to see genetic links in the Indian population.

Prevention of Colon Cancer like all other cancers involves healthy habits, including fresh food covering the nutritional groups to maintaining good health, exercise, avoiding alcohol, tobacco, and sleep. Together with screening of at risk population, we can fight this together.

Healthwealthbridge  Disclaimer health information provided on this blog is for general awareness and doesn’t in any way replace a doctor’s professional medical advice. Kindly consult your doctor in case of any decision regarding your health, and diet.

1. The impact of hereditary colorectal cancer on the Indian population

Maharaj, R; Shukla, PJ; Sakpal, SV; Naraynsingh, V1; Dan, D1; Hariharan, S1

Indian Journal of Cancer 51(4):p 538-541, October–December 2014. | DOI: 10.4103/0019-509X.175307

https://journals.lww.com/indianjcancer/Fulltext/2014/51040/The_impact_of_hereditary_colorectal_cancer_on_the.53.aspx

2. Maharaj, R., Shukla, P. J., Sakpal, S. V., Naraynsingh, V., Dan, D., & Hariharan, S. (2014). The impact of hereditary colorectal cancer on the Indian population. Indian Journal of Cancer, 51(4), 538-541. 

3. https://medicine.yale.edu/news-article/with-colorectal-cancer-rates-rising-among-younger-adults-a-yale-cancer-center-expert-explains-there-may-be-more-factors-behind-this-worrisome-trend/

4. https://m.timesofindia.com/life-style/health-fitness/health-news/colon-cancer-is-rising-among-young-adults-know-the-warning-signs-and-risk-factors/photostory/98738149.cms

5 Curcumin for chemoprevention of colon cancer

Jeremy James Johnson 1, Hasan Mukhtar

https://pubmed.ncbi.nlm.nih.gov/17448598/

6 Rising colorectal cancer in young adults

A warning for all! Let us adopt a healthy lifestyle and colorectal cancer screening

Patel, Amol; Hande, Vivek

https://journals.lww.com/indianjcancer/fulltext/2022/59030/rising_colorectal_cancer_in_young_adults__a.1.aspx

7 Pal M. Proportionate increase in incidence of colorectal cancer at an age below 40 years: An observation J Cancer Res Ther. 2006;2:97–9

http://www.ncbi.nlm.nih.gov/pubmed/17998686

8 Venkataraman S, Mohan V, Ramakrishna BS, Peter S, Chacko A, Chandy G, et al Risk of colorectal cancer in ulcerative colitis in India J Gastroenterol Hepatol. 2005;20:705–9

https://pubmed.ncbi.nlm.nih.gov/15853982/

9 Colorectal cancer

Evelien Dekker 1, Pieter J Tanis 2, Jasper L A Vleugels 3, Pashtoon M Kasi 4, Michael B Wallace 5

https://pubmed.ncbi.nlm.nih.gov/31631858/

10 Colorectal Cancer

Mark Lawler, … Patrick G. Johnston, in Abeloff’s Clinical Oncology (Sixth Edition), 2020

https://www.sciencedirect.com/book/9780323476744/abeloffs-clinical-oncology