In recent years, due to the promotion of colonoscopy and routine stool screening, the incidence of colorectal cancer in people over the age of 50 has been declining, but the incidence of colorectal cancer in people under the age of 50 in the United States and other developed countries is increasing at an alarming rate.
A 36-year-old father with two children undergoing dialysis, a 25-year-old woman with suspected pelvic inflammatory disease, and a 31-year-old woman with a history of Crohn’s disease have one characteristic in common-they are all patients with colorectal cancer.
This kind of disease that once favored the elderly is now becoming younger and younger. In recent years, due to the promotion of colonoscopy and routine stool screening, the incidence of colorectal cancer in people over the age of 50 has been declining, but the incidence of colorectal cancer in people under the age of 50 in the United States and other developed countries is increasing at an alarming rate.
According to the statistics of the Epidemiological Surveillance and Final Results Database (SEER): From 1992 to 2005, the incidence of colorectal cancer per 100,000 young men and women in the United States increased by 1.5% and 1.6% annual growth rates, respectively. Going forward, from 1973 to 1999, the incidence of colon cancer and rectal cancer in young people increased by 17% and 75%, respectively. At present, there are about 13,000 new cases of colorectal cancer in people under 50 each year.
The younger the patient with colorectal cancer, the greater the possibility of high-grade malignant transformation. When diagnosed, it is often in the middle and advanced stages, and the mortality rate is very high. Statistics from a single center show that most patients with primary colorectal cancer under the age of 50 have symptoms when they are diagnosed. Some patients under the age of 20 have been diagnosed and died within half a year.
The neglect of doctors and parents has caused delays in the diagnosis of colorectal cancer. Young patients often do not understand the symptoms and signs of colorectal cancer, which may also delay the time for him or her to see a doctor. Due to the neglect of doctors, 15%-50% of young patients with colorectal cancer are misdiagnosed at first diagnosis.
Why does the incidence of colorectal cancer increase among young people?
From historical data, doctors often attribute colorectal cancer in young people to genetic factors, especially Lynch syndrome. But 75% of young people with colorectal cancer have no family history and no other genetic factors. In addition, most of the colorectal cancer caused by Lynch syndrome is located in the right colon, while the non-hereditary, early-onset colorectal cancer is mostly located in the left colon and rectum. Therefore, although they are all colorectal cancers, there must be differences in biological characteristics.
The biological characteristics of each colorectal cancer patient are not the same. Even if cancer originates in the same organ, it has its own unique genetic characteristics. In order to explore the complexity of colorectal cancer, some researchers are conducting retrospective genetic profile testing on about 5000 patients, mainly to compare the differences in the genetic profiles of young and elderly people. The relevant results will be reported in the American Society of Clinical Oncology Gastrointestinal Tumor ( Announced at ASCO GI) seminar.
Others focus on the epidemiological characteristics and risk factors of early colorectal cancer. Colorectal cancer in young people is more common in inflammatory bowel disease and African descent, indicating that it may be related to genetic susceptibility and family history. But apart from these known risk factors, what else we don't know?
In the past three decades, with the increase in the incidence of obesity and diabetes among young people, the incidence of colorectal cancer has also increased. Whether there is a causal relationship between the two is currently unknown, but it should not be ignored. Similarly, the consumption of sugar-sweetened beverages increased during this period, while milk (calcium has a protective effect on colorectal cancer) decreased, which may also be a factor in the increase in the incidence of colorectal cancer among young people. Effective diet, nutrition and obesity management for young people can not only reduce the incidence of diabetes, but also reduce the incidence of colorectal cancer.
Other factors that increase the incidence of colorectal cancer in the elderly include lack of exercise, high-protein and high-calorie, high-fat diet, and alcohol consumption. However, whether these factors can cause colorectal cancer in young people is still unclear, and the data are still limited. Other studies are also exploring changes in young people's colorectal cancer and intestinal microbes, exposure to environmental toxins, and the use of statins and antibiotics in the past few decades.
Early prevention, early diagnosis
Most of the young people's colorectal cancer is already at an advanced stage when it is discovered. It is a challenge for treatment and long-term survival. So how to make an early diagnosis? The most important point is to pay attention to it. A major feature of colorectal cancer is that it is highly concealed. Many people have bowel cancer. Since colorectal cancer has no symptoms or symptoms in the early stage, it is also mistaken for chronic colitis, hemorrhoids, dysentery, adhesive intestinal obstruction, intestinal polyps and ulcerative colitis.
Another point is to popularize science, especially doctor education, to young people, tell them which risk factors can cause colorectal cancer, and what are the early symptoms of colorectal cancer, and change their diet and lifestyle as soon as possible. Once symptoms appear See a doctor early.
To prevent colorectal cancer, it is also recommended to do colonoscopy earlier. Colorectal cancer is the best preventable cancer in the digestive system because it has a relatively clear precancerous lesion-polyps, and polyps can be found by colonoscopy and most of them can be removed under colonoscopy. It is recommended that people who have a family history of colorectal cancer and who often have abdominal pain, diarrhea, blood in the stool and other symptoms have a colonoscopy.
Colonoscopy is not as painful and scary as most people think, especially with the improvement of endoscopy equipment and inspection methods, most of them can be completed in a relatively relaxed situation, and with the popularity of anesthesia endoscopy, more and more The more patients can complete the examination in their sleep.