What you should know about colorectal cancer if you are under 50

You may think you don’t have to worry about colorectal cancer until you’re 50.  That’s the age doctors recommend most patients get a colorectal cancer screening.

But colorectal cancer in those under age 35 is on the rise.

By 2030, colon cancer cases are expected to increase by 90%. And rectal cancer cases are expected to increase by 124% in patients age 35 and younger.

Here’s what you should know about colorectal cancer if you’re younger than 50.

More than one-third of colorectal cancers diagnosed in patients under age 35 are hereditary

Most cancer cases, including colorectal cancer, aren’t related to family history. But colorectal cancer in patients under 35 is more likely to be genetic. In other words, it’s more likely to be passed down from a family member, says Eduardo Vilar-Sanchez, M.D., Ph.D., assistant professor of Clinical Cancer Prevention at MD Anderson.

Find out if any of your relatives have had cancer and how old they were when they were diagnosed. Ask them about other cancer types as well as colorectal cancer. In some cases, other types of cancer, including uterine, stomach, ovarian, prostate and liver, can be clues to a family history of colorectal cancer.  

About 5% of colorectal cancer cases are related to hereditary syndromes, like Lynch syndrome or familial adenomatous polyposis (FAP). Patients with Lynch syndrome have a 50 to 80% chance of getting the disease. Patients with FAP have a 100% chance of getting colorectal cancer.

“For some of them, it’s not a matter of if it will happen, it’s when,” says Vilar-Sanchez.

Genetic testing can help determine if you’re at risk for colorectal cancer

How do you find out if you have Lynch syndrome or FAP? That’s where genetic counseling comes in.

If you have colorectal cancer in your family, you may need genetic counseling. During genetic counseling, a genetic counselor may review your family history. Then, he or she will perform a hereditary cancer risk assessment. This will cover your chances of having a genetic mutation and your personal cancer risk. 

Then, the genetic counselor may recommend that you or another relative have genetic testing. Typically, it’s reserved for cancer patients and survivors, especially younger patients.   

“Patients under the age of 35 need to be evaluated by a genetic counselor. Period,” Vilar-Sanchez says. “There are tremendous benefits from being able to share genetic risk with their parents, siblings and many other family members.”

Genetic testing for colorectal cancer is administered through a blood test. This test will show if you have a hereditary syndrome like Lynch syndrome. Patients typically receive results in four to six weeks.

If you do have FAP or Lynch syndrome, your doctor can help you decide what next step is best for you. Many at risk patients undergo annual colorectal cancer screening. Those diagnosed with Lynch syndrome may also get a urinary analysis every two to three years. In some cases, patients may have their colons removed to prevent colorectal cancer.

Changes in bowel movements are the most telling colorectal cancer symptoms

Regardless of family history, anyone at any age can develop colon cancer. That’s why it’s important to know the signs. Colorectal cancer symptoms can be mistaken for signs of less serious conditions, like irritable bowel syndrome. Any changes in your bowel movements, sudden changes in weight or abdominal pain should be taken seriously, says Vilar-Sanchez.

“Changes in bowel movements, blood in stool or very dark stool can be red flags for colorectal cancer,” Vilar-Sanchez says.

Talk to your health care provider if you notice any of these symptoms.

Colonoscopies are the gold standard of colorectal cancer screening

“No one likes colonoscopies, but they’re the best proven way to find colorectal cancer and polyps, growths that could turn into cancer,” Vilar-Sanchez says.

Men and women at average risk for colorectal cancer should begin colorectal cancer screening beginning at age 50. African American men and women should begin screening exams at age 45.

Your health care provider will recommend when to get tested again based on the results.

Healthy diet and exercise can lower your colorectal cancer risk. 

There’s still more research needed in this area, but experts suspect a link between growing colorectal cancer rates and an increase in obesity and inactive lifestyles.

Try taking the following steps to help lower your colorectal cancer risk:

• Aim for at leaset 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week.
• Opt for plant-based protein and limit your consumption of red meat.
• At each meal, fill at least two-thirds of your plate with plant-based foods, including fruits, vegetables, nuts, seeds, beans and whole grains. The other one-third or less can be animal based.
• Talk to your health care provider about taking aspirin to reduce inflammation and your cancer risk.
• Find ways to manage your stress, like yoga and meditation.

 “The best way to end cancer is to not develop it to begin with,” says Vilar-Sanchez.