Evo Terra (Host): This is Check-Up Chat with EvergreenHealth. I'm Evo Terra. And I'm joined today by Dr. Ehsaan Akhtar, a board-certified internal medicine and gastroenterology physician to help answer a single question: Why are so many young adults getting diagnosed with colorectal cancer? Dr. Akhtar, thanks for joining me.

Dr. Ehsaan Akhtar: Thanks for having me.

Host: So, let's start at the beginning. What do you think is causing such a sharp rise in colorectal cancer diagnoses amongst young people today?

Dr. Ehsaan Akhtar: That's a difficult question, actually. The short answer is that we don't know, unfortunately. What we do know is that there definitely is a rise in colon cancer in younger people. So, about 2% increase per year since the 1990s, we've been tracking. There have been a lot of studies showing possible associations. So, some of those things are "Western diet." So, the rise of ultraprocessed foods, increase in red meat intake, sweetened beverages. Those have all been linked with increased rates in colorectal cancer screening, also, "sedentary lifestyle." So, there have been some studies showing that, with the increase in exercise and activity, there's less risk of getting colon cancer. Same thing with lack of vitamin D in the general population. Lower vitamin D levels have been associated with higher rates of colorectal cancer, too.

Host: Got it. So many different possible causes, and it's complex like most things, as you said. Well, let's talk about some symptoms. What are the symptoms people should be looking for that might indicate some sort of a colorectal issue?

Dr. Ehsaan Akhtar: That's also a little bit of a difficult question. A lot of times, people don't have symptoms until the actual tumor presents. So, I should probably back up just slightly and talk about screening. Generally, a polyp is kind of like a growth that we have in the colon. By the age 45 or 50, a person has, like, a 30% chance of having one of these polyps. They usually don't cause any symptoms, and the thought is that in, five to 10 years, they could turn into cancer. The whole point of colonoscopies is to look to see if you have these polyps and take them out.

That being said, if the tumor develops, probably the number one symptom is rectal bleeding that people will notice. Sometimes if it's a very small amount of blood in the stool, you won't be able to see it. But you may be diagnosed with anemia, so you'll be tired. And then, the doctor will check your blood count and say that it's low. That's another thing.

And then, the last thing is weight loss. These tumors tend to consume a lot of energy. A lot of times, we'll see cancer patients, like, extremely underweight. It's kind of for the same reason. So, unexplained weight loss is a worrisome symptom.

Host: That was two difficult questions to answer. I'm going to give very easy one this time. What's the best way to help prevent colorectal cancer? Kidding, obviously. That's not an easy question, I understand.

Yeah. Getting screened appropriately is probably most important. In terms of things that you can do on your own, it will probably be the opposite of the things we talked about like in the first question. So, trying to have a very healthy diet, eating mostly whole foods. Increasing activity and exercise. Fiber intake is super important. So, there was study showing that, like, per 10 grams increase fiber in your diet, you have, like, 10% less risk of getting colorectal cancer.

And then, you know, spending time outside and getting adequate vitamin D exposure.

Host: All good things we should all be doing anyhow. So, you mentioned screening a moment ago. So, how often should people be getting screened? And what's the new age when we start to get our first screening?

Dr. Ehsaan Akhtar: Yes. Recently, the age got changed according to the National Cancer Guidelines from age 50 to about age 45, and that was also because of this rise that we're seeing of colon cancer in younger people. So, you get screened at age 45 for the average adult, and then every 10 years after that. If you have a family history of colon cancer, or people in your family with polyps, then we usually start at age 40 or 10 years before whenever that person was diagnosed. So, we think it takes 10 years for a polyp to become colon cancer. So, let's say you have a brother who was diagnosed with colon cancer at 41, then you would start screening at 31.

Host: Okay. We're talking a lot about cancer and preventing cancer. But let's talk about treatments for colorectal cancer. What are they, and how's the survival rate?

Dr. Ehsaan Akhtar: The cornerstone of treatment for colorectal cancer is surgery, where they just remove the tumor. And the higher stages, like a stage III or IV, sometimes people will get chemotherapy or, in rectal cancer, chemoradiation. The survival rates tend to be excellent as far as the cancer goes. So, for stage II disease, like higher than 70%. For all-comers, like the five-year survival for colorectal cancern can be greater than 60-65%. Just to contrast that, the other cancer that I see a lot of is pancreas cancer. The five-year survival for pancreas cancer is something like 13%.

Host: That is really tough. And as we're mentioning right here, the earlier you detect these polyps, if that's what's going on inside of you, the greater your chance of not developing any cancer, which we definitely do not want to. But let's talk about remission, right? Colorectal cancer has happened. are there any lingering side effects if they are in fact going into remission?

Dr. Ehsaan Akhtar: Yeah. In my experience with patients, I don't tend to see actually too many side effects, which is great. What some people do mention is generally the treatment is getting part of your colon removed. And then, it gets reattached together. So, having a shortened colon sometimes can lead to like a change in bowel habits. Some people might say that they go, like, two to three times per day compared to like one time per day. So, that's probably the most common thing I hear.

The only caveat or the area where people do sometimes have issues is rectal cancer. So like the rectal area and the muscles there are all important for, like, controlling when we have our bowel movements or sensing that we need to have a bowel movement. So, people who have a surgery for rectal cancer specifically, sometimes they develop something called low anterior resection syndrome. And just what that means is sometimes they will have trouble regulating their bowel movements, or they'll have incontinence or constipation or increased sensitivity. So, that's kind of the only one where we see kind of lasting side effects sometimes.

the last thing I should probably mention is, if you have an advanced stage and you get chemotherapy—I'm not an oncologist, so I'm not as good at speaking at this—but you can have some side effects, long-term side effects from chemotherapy.

Host: Well, this has been a fascinating conversation. I'll end by asking you, what did we miss? Anything else you would like to add?

Dr. Ehsaan Akhtar: I think we've covered pretty much everything. If I had to sum up the two things I would say, one is to pay attention to your symptoms. A lot of people who are younger and were diagnosed of colon cancer had something in their chart, a history of like hemorrhoids, anal fissures or something like that. And their symptoms would be attributable to that for years before they ended up getting the colonoscopy and getting diagnosed. So, if you have a worrisome symptom, I would encourage you instead of just like watching it for a long time, to talk to your doctor about it.

And then, the second thing would just be getting your screening done on time. If you have and advanced polyp, you know, at age 45 when you're first checked, then letting your younger brother or sister know that they should get screened a little bit earlier or something like that.

Host: Yeah. I'd spread the word that colonoscopies are pretty easy as a patient who's been through several of them. I mean, it's not nearly as bad as all my friends made it out to be. But that's what I think, at least. So. Dr. Akhtar, thank you very much for all the information today.

Dr. Ehsaan Akhtar: Sure.

Host: Thank you for having me

Dr. Ehsaan Akhtar: And that wraps up this episode of Check-Up Chat with EvergreenHealth. Head on over to the website at evergreenhealth.com for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. For health tips and updates, follow us on your social channels. I'm Evo Terra. This has been Check-Up Chat with EvergreenHealth. Thanks for watching