Dr. Anna Serur, chief of colon and rectal surgery and Dr. Minaxi Jhawer, chief of medical oncology discuss risk factors, prevention efforts, and new trends
For decades, colorectal cancer has predominately affected older adults, but according to a new study published in the Journal of the National Cancer Institute, colorectal cancer is on the rise in adults younger than 55, with a particularly sharp increase in those in their 20s, 30s, and 40s. Researchers at the American Cancer Society and National Cancer Institute noted that those born in 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared with someone born around 1950.
Often called a silent disease because of its lack of initial symptoms, colorectal cancer will be diagnosed in more than 95,000 people this year, according to the American Cancer Society. It is the third most common cancer diagnosed in both men and women in the United States. In recognition of Colorectal Cancer Awareness Month, Dr. Anna Serur, chief of colon and rectal surgery at Englewood Hospital and Medical Center and Dr. Minaxi Jhawer, chief of hematology/medical oncology at Englewood Hospital and Medical Center, who specializes in gastrointestinal cancers, shed light on the complexities of this cancer.
Q: What are the suspected causes of colorectal cancer?
Dr. Jhawer: Research has linked colorectal cancer to family history and particular inherited conditions as well as a variety of environmental and lifestyle factors, including physical inactivity, certain types of diets such as western diets, which are high in processed foods and meats, obesity, heavy alcohol use, and smoking. There’s also evidence that conditions such as inflammatory bowel disease – Crohn’s disease and ulcerative colitis – may contribute to a higher risk of colon or rectal cancer.
Q: What are some reasons why we’re seeing higher colorectal cancer rates in young people?
Dr. Serur: The only leads we have are that an increase in these rates in young people parallel the increase in rates of obesity and diabetes, which are often correlated with dietary patterns and sedentary lifestyles. As a society, we’re not as active as we used to be and today’s diets often include high saturated fat, high-glycemic carbohydrates, carbonated drinks and processed foods.
Q: What are a few ways people can reduce their risk?
Dr. Jhawer: Adopting a healthy lifestyle is always a great recommendation. Some general guidelines include:
- Get plenty of physical activity
- Maintain a normal weight
- Actively manage stress
- Avoid tobacco products
- Limit consumption of processed foods and red meat
- Eat a diet of varied and whole grains, lean proteins, and colorful fresh fruits and vegetables daily
I also encourage people to not just take steps to prevent illness but to engage in activities that promote relaxation, stress reduction, and overall wellness. Our Graf Center for Integrative Medicine, for example, offers medically supervised therapies including yoga, massage, nutritional counseling, guided meditation, and stress management. Screening colonoscopies, starting at age 45 for those with average risk, may help detect precancerous polyps – growths on the lining of the colon and rectum – that can then be removed. Those with a family history and/or predisposition for colorectal cancer may be eligible for genetic counseling to assess risk and be considered for earlier screening tests.
Q: What are some symptoms that may be missed as signs of colorectal cancer?
Dr. Serur: In its early stages, colorectal cancer may not have any symptoms. But as colorectal cancer progresses, people may experience rectal bleeding, a change in bowel habits, abdominal pain, blood in the stool, and unintended weight loss. Those are patients that shouldn’t ignore their symptoms. I always tell my patients, “Listen to your body, if something feels wrong, get checked out.”
Q: What should people know about the rates of colorectal cancer?
Dr. Serur: The rates of colorectal cancer are declining in older people. Young people still represent a small number of those diagnosed with colorectal cancer, but a majority of this population is diagnosed at a later stage, which impacts prognosis and survival. We may be missing these younger people because they are not routinely screened and there may be a belief that the symptoms are something minor like hemorrhoids instead of a more serious illness. Our recommendation as GI and colorectal surgeons is to have practitioners appropriately send patients to us or to a gastroenterologist to make sure they don’t have colorectal cancer. In order for us to identify young people at risk, though, we need to raise awareness and educate about this disease.
Q: Is colorectal cancer treatable?
Dr. Serur: In general, patients with early colorectal cancer have excellent prognosis if treated appropriately by an experienced team. Whether early or advanced stage, treatment has advanced significantly; it’s no longer a one-size-fits-all approach. At Englewood Hospital, we use a team approach, with input from other surgeons, oncologists, radiologists, radiation oncologists, nutritionists, pathologists, nurses and nurse practitioners, integrative medicine experts, and social workers to provide a tailored and personalized plan of care. Using state-of-the-art technology, we can offer treatments that are oncologically sound, tailored to a particular individual and lead to great outcomes. In my specialty, I use minimally invasive techniques using robotic and laparoscopic surgery, which allow patients to return to pre-surgery functions quicker, results in a more acceptable cosmetic appearance, and leads to better patient satisfaction without compromising cancer-free prognosis.
Q: What emerging treatment areas are available for people diagnosed with colorectal cancer?
Dr. Jhawer: Over the past few decades, there has been tremendous evolution in treating patients with colorectal cancer. In the earlier stages the cancer is treated with surgery followed by chemotherapy. As cancer progresses, not all patients benefit from chemotherapy. We are able to use precise molecular testing on the tumor sample to assess which patients would benefit from chemotherapy and for whom we can limit the use of the drugs and limit toxicity as they have a better prognosis.
In advanced stages, surgery might still be an option if the disease is localized to a single area. But for the most part in advance stages, chemotherapy, biologic therapy and immunotherapies are used. We are able to send off a full molecular panel of their tumor sample to target and use agents which might work best for their tumor type i.e., personalizing the medicine.
Updated February 2023
Dr. Anna Serur, chief of colon and rectal surgery and Dr. Minaxi Jhawer, chief of medical oncology discuss risk factors, prevention efforts, and new trends