Dr. Einat Shacham-Shmueli. Photo courtesy of Dr. Einat Shacham-Shmueli
With more and more people below the age of 50 being diagnosed with the illness, the medical community is urgently trying to determine a cause.
The recent revelation by Kate Middleton, Princess of Wales, that she was battling cancer was a shock to many around the world. Middleton, who is only 42, has always appeared to be in the best of shape and in good health.
Her diagnosis, however, only highlights the disturbing rise in the number of young people diagnosed with various forms of cancer, especially colon or colorectal cancer.
Middleton is rumored to have been diagnosed with colorectal cancer, but her exact diagnosis has not been revealed by the Buckingham Palace officials.
20 percent increase
Many studies in recent years have tried to explain why more adults under age 50 are getting this type of cancer, but there’s no definitive answer.
“When the medical community can’t pinpoint a cause, it’s believed there are a number of factors or causes involved,” Dr. Einat Shacham-Shmueli, who heads The Gastrointestinal Cancer Department at Sheba Medical Center, tells ISRAEL21c.
“There has been a 20 percent increase in the number of young patients diagnosed with colorectal cancer in the past five to 10 years,” adds Dr. Idan Levy, the head of innovative endoscopy at Sheba Medical Center.
Levy says that although the terms “colon cancer” and “colorectal cancer” are often used interchangeably, colorectal cancer also includes cancers of the bowel and rectum.
The studies and statistics that refer to colon cancer normally address not just the colon, but the entire colorectal system.
The most comprehensive studies on colorectal cancer are conducted in the United States, and Israel often relies on the US-based studies in practice since the conditions and variables appear to be very similar.
Under 40
Shacham-Shmueli says that some 3,000 Israelis are diagnosed each year with colorectal cancer, around 10 percent of them aged 40 and younger.
“I see young people who come to me, some in their 20s, including soldiers and pregnant women,” she says.
“It’s more difficult to treat them, not because their cancer is different, but because they are at different stages in their lives compared to older patients.”
The increasing number of young cancer patients in recent years has prompted Sheba Medical Center to open a special department to treat them — not only medically, but emotionally and bureaucratically as well, providing psychologists and social workers.
Screening tests
Shacham-Shmueli says that while only a third of all new patients are diagnosed at a late stage of the disease, this number appears to be higher when it comes to younger patients, although there are no definitive statistics.
“There is less awareness when it comes to the younger demographic. They may experience abdominal pain or even see blood in their stool, but they may brush it aside as hemorrhoids or lactose intolerance issues,” she explains.
“The doctors also often dismiss the symptoms as something non-life-threatening when it comes to young and healthy patients,” she explains.
“On average, it takes up to six months for a young patient to undergo a colonoscopy from the moment they first start experiencing symptoms [associated with colorectal cancer]. This delay often results in late-stage diagnosis.”
According to the American Cancer Society, patients with late-stage colorectal cancer that has metastasized (spread to other organs) have a survival rate of only 13%.
Levy adds that doctors are hesitant to issue referrals to screening tests for younger patients. And some people are afraid of undergoing colonoscopy due to the stigma associated with the test, as well as potential pain, even though it is done under general anesthesia. It also requires a rigorous diet in the days leading up to the test.
Some medical centers have recently started experimenting with “virtual” colonoscopies that do not involve the insertion of an endoscope into the colon.
A silver lining
Shacham-Shmueli says the increase in young patients with colorectal cancer is surprising. There has been a decline in the number of new cases in people aged 50 and over thanks to advanced screening tests and awareness campaigns.
Unlike younger patients, older people usually get to a colonoscopy screening within a month of first experiencing symptoms. Furthermore, annual colorectal cancer screening tests are recommended for people aged 50 and over, and in the US, the recommended age was updated to 45 two years ago.
“If you’re 50 [or over] and you tell your doctor you’ve been experiencing symptoms, you immediately get a referral and an appointment for colonoscopy. Even if you’re 45, I don’t believe you’ll be denied,” says Levy.
If you are over 50 and you don’t experience any symptoms, it is still recommended to annually undergo a fecal occult blood test once a year to reveal the presence of a potential problem.
10 years a polyp
If there is one thing about colorectal cancer that could be described as “positive,” it is that the malignancy takes years to develop.
It all starts with a polyp, a small clump of cells on the lining of the colon. Most people are unaware that they have polyps, which allows them to grow in size.
As polyps grow, they develop cellular and nuclear changes. The more abnormal they become, the more likely it is that they will become cancerous at some point.
“It can take up to 10 years for a polyp of a few millimeters to develop into a cancerous growth. It’s actually a fantastic window of opportunity to catch it at an early stage,” says Levy.
He adds that small polyps at an early stage of development almost never cause physical symptoms and even fecal occult blood tests don’t always detect their presence until they begin to grow.
Risk factors
The development of cancerous polyps is often linked to genetic predisposition and family history of colorectal cancer.
Other risk factors include obesity; excessive consumption of processed meat, tobacco and alcohol; and a lack of exercise.
“But,” says Shacham-Shmueli, “most of the patients that I encounter are not overweight. They eat a healthy diet, they exercise, they often don’t even smoke.
“The bottom line is you need to keep your finger on the pulse if you experience symptoms or you’re over the age of 50.”
