Colorectal cancer: know symptoms of the disease in the intestine – 03/24/2023 – Equilíbrio

In a study published in March by the American Cancer Association, researchers estimated that the number of colorectal cancer diagnoses in the United States in 2023 will reach 153,000. About 13% of these cases will be in people under 50, which represents a 9% increase in cases in this age group since 2020.

[Segundo o Inca (Instituto Nacional do Câncer), a expectativa é que o Brasil tenha cerca de 46 mil casos de câncer de cólon e reto no triênio 2023-2025. A expectativa do órgão é que o número de mortes precoces pela doença cresça cerca de 10% entre 2026 e 2030 no país em relação ao período entre 2011 e 2015. Um levantamento feito pelo A.C Camargo Cancer Center mostra que de 1.167 pacientes que receberam o diagnóstico entre 2008 e 2015, 20% tinha menos de 50 anos.]

Since they peaked in 1985, new diagnoses of colorectal cancer have been dropping in people over 50, but the trend for younger people is going in the wrong direction, says Steven Itzkowitz, professor of medicine and oncology sciences at Icahn School of Medicine at Mount Sinai in New York.

Not only that, report the authors of the new study: cancers diagnosed in people under 50 tend to be more aggressive.

“We are living in a time when younger people, in the prime of life, are getting colorectal cancer,” points out Itskowitz. “If we don’t discuss this in depth, we may not have the opportunity to make the greatest possible impact on this disease.”

What is colorectal cancer and who is most at risk?

The disease is the third most common cancer diagnosed in the United States. [e no Brasil, se dispensados os tumores de pele não melanoma, segundo o Inca]. It starts with a polyp, or abnormal growth, in the large intestine, which over time can become cancerous and potentially spread to other parts of the body.

Men and women are at similar risk of developing the condition, and these risks increase with age. Only five out of every 100,000 people ages 30 to 34 in the United States develop colorectal cancer, for example, with 61 out of every 100,000 people ages 50 to 54 developing it and 136 out of every 100,000 people ages 70 to 74. Blacks, American Indians and Alaskan Indians are at higher risk, something many studies attribute to social inequalities and barriers to health care.

Certain health conditions, such as obesity, or the incorporation of certain foods and beverages in the diet (such as alcohol and processed meats such as sausage, salami or sausage) are known to increase the risk, in addition to sedentary lifestyle having the same effect.

Should I be concerned if I’m under 45?

For starters, points out Nancy Baxter, a colorectal surgeon and director of the Melbourne School of Population and Global Health at the University of Melbourne, the rising incidence of early-onset colorectal cancer is worrying, but the risk of someone under 50 developing this cancer it is still minimal.

“I don’t want people to panic,” says Baxter. Between 1998 and 2019, less than 15 out of 100,000 people aged 20 to 49 were diagnosed with the condition. “Age is still the factor that most influences the risk of colorectal cancer”, she ponders.

That said, you should still be on the lookout for early warning signs, which could include rectal bleeding, anemia, changes in bowel habits (such as new, sudden constipation) or any type of abdominal pain. Younger people often develop rectal bleeding as the first symptom. Doctors believe this may be because their cancers tend to grow near the colon.

Baxter says that if you’re under 45 and have worrisome symptoms, see a doctor right away.

Why are cases increasing among younger people?

Researchers don’t know for sure and are looking for answers, points out Itzkowitz, but some changes in risk factors suggest clues.

According to Itskowitz, rising rates of obesity in children and adults may be a contributing factor. A large study published in 2022 concluded that obesity at age 20 or 30 may more than double the risk of early-onset colorectal cancer.

Binge drinking—usually defined as five or more drinks in two hours for men and four or more for women—has also been suggested as a possible contributing factor. The practice has been steadily increasing for decades among adults up to age 30.

But, according to Baxter, there is likely to be much more to it than that. Researchers still don’t understand how childhood risk factors — such as having a cesarean delivery, childhood antibiotic use or exposure to certain environmental substances — might influence the risk of early-onset colorectal cancer, or what role they might play. by the microbiome.

Consumption of sugary drinks, for example, which increased among teenagers in the 1980s and 1990s, has been linked to an increased risk of early occurrences of colorectal cancer. But it’s not clear whether this is due to the sugary drinks themselves or related factors such as diabetes, or any changes that the sugary drinks may have caused in the gut bacteria.

For Baxter, to understand why the rate of colorectal cancer is rising among younger people and to prevent this trend from continuing, we need to answer these types of questions.

Why is the disease in young people usually more aggressive?

One prevailing theory is that because young people are less likely to develop colorectal cancer than older people in the first place, they and their doctors may miss early symptoms, leading to later diagnoses.

“I’ve seen young people go from one emergency room to another until someone finally said, ‘Maybe this is something more concerning,'” Baxter said.

For example, a study published in 2017 in the journal Clinical Gastroenterology and Hepatology found that people under 50 tend to wait two months longer than those over 50 to seek medical attention after first noticing their symptoms. turn. Baxter thinks this window of time could give the cancer time to advance. But she noted that when younger people seek medical attention, the time it takes to receive treatment is comparable to that of older adults.

But, according to Baxter, the reason these cancers seem to grow faster may lie in their fundamental biology.

“Cancers that affect younger people tend to be more inherently aggressive,” he says. Scientists have discovered that early-onset colorectal cancers have molecular, epigenetic, and genetic characteristics that are distinct from those that are diagnosed later in life. These differences may contribute to the fact that the disease is more advanced when diagnosed.

What can I do to reduce the risk?

For Itzkowitz, people under 45 should talk frankly with their family members about their family’s medical history.

“People either don’t take the time to find out about their family history, or family members are shy about talking about it, but this is an easy thing that can be done by anyone, at any age.”

If you have a first-degree relative (for example, father, mother or brother) who was diagnosed with colorectal cancer before age 60, or if you have two first-degree relatives diagnosed at any age, your risk is higher.

You can’t change your family history, of course, but there are some lifestyle habits you can adopt to reduce your risk.

Have a healthy diet. It has already been shown that diets rich in processed meats (such as sausages, bacon and some sausages) or red meats (such as beef, pork or lamb) increase the risk of colorectal cancer. Diets rich in fruits, vegetables and whole grains have a protective effect. Even small changes, such as choosing fiber-rich fruits and vegetables as snacks over potato chips, or incorporating “Meatless Mondays” into your weekly eating plan, can make a difference.

Stop smoking. More than 70 chemicals in cigarettes are already known to increase the risk of cancer by damaging the DNA in our cells. Nicotine patches, gum and lozenges can help reduce cravings, according to the US Centers for Disease Control and Prevention. And there are many free smartphone apps that offer tips, motivation and challenges to help you quit smoking.

Do physical activity. A study published in 2018 of nearly 90,000 nurses found that sedentary nurses who spent more than 14 hours a week watching TV were significantly more likely to develop early-onset colorectal cancer than those who watched TV for less than seven hours a week.

Federal guidelines recommend that most adults do at least 150 minutes a week of moderate-intensity physical activity (such as bicycling, swimming, or gardening) and do strength-training activities two days a week (such as push-ups and weight lifting).

Reduce alcohol consumption. Drinking alcohol to excess (14 drinks or more per week, according to a study published in 2012) may increase the risk of developing early-onset colorectal cancer. Federal guidelines recommend that women consume no more than one serving per day and men drink no more than two servings.

Maintain a healthy weight. Body mass index is an imperfect measure of health, but researchers have found that people with a BMI of less than 25 have a lower risk of getting early-onset colorectal cancer. If you have difficulties with your weight, it’s worth talking to your doctor. Several approved weight-loss drugs, such as phentermine or liraglutide, are now recommended for adults with obesity.

Take preventive exams. Experts recommend that most people at age 45 start getting regular screening tests — a colonoscopy or a similar procedure called a flexible sigmoidoscopy.

If you have a family history of colorectal cancer or if you have a genetic predisposition to cancer, such as Lynch syndrome, for example, or if you have an inflammatory bowel disease such as ulcerative colitis, your doctor may recommend that you start testing preventive measures before age 50. In such cases, medical insurance must cover early examinations.

According to a recent study by the American Cancer Association, in 2021, four out of ten Americans aged 45 and over had not taken the necessary preventive exams, and among people aged 45 to 49, only 20% had their exams up to date. . “Some people say that colorectal cancer is the most preventable but least avoided we’ve worked with,” says Itskowitz.

Ultimately, he says, the best screening test for younger people is one that gets done. Talk to your doctor about the pros and cons of each to decide which one is right for you.

Translated by Clara Allain