Bob Underwood, M.D. (Host): The incidence of colon cancer is rising among young adults under the age of 50 years before most people are supposed to have their first colonoscopy. So, who's at risk? And what symptoms do you need to know? Hello, I'm Dr. Bob Underwood. Welcome to the Cancerwise podcast from The University of Texas MD Anderson Cancer Center.

Joining us now is colorectal surgical oncologist and Professor of Colon and Rectal Surgery at The University of Texas MD Anderson Cancer Center, Dr. Nancy You, whose research focuses on this unique population. Dr. You, thank you so much for being with us today.

Nancy You, M.D.: Thank you so much for having me.

Host: So, what should young adults know about colon cancer?

Nancy You, M.D.: I think the number one thing to know is that, unfortunately, colorectal cancer, the incidence is rising among the young patients, ages 18 to 50.

Host: Do we know what's causing this increase in the number of cases?

Nancy You, MD: So, we always ask that question for anyone with a cancer diagnosis. Unfortunately, it's very hard to pinpoint exactly why a particular individual got their cancer, but we have some ideas on the population basis. We know some of the risk factors for colorectal cancer is related to lifestyle, things like heavy alcohol consumption, heavy smoking, heavy use of processed meats, and sedentary lifestyle, and obesity. However, there's probably not a smoking gun that we know of just yet that accounts for the rise in the young patients.

Host: These are the factors that put young adults at greater risk for colon cancer. So, this is more important in younger adults?N

Nancy You, M.D.: So, those are the risk factors that we know of for colorectal cancer. Because colorectal cancer, the majority still do occur in people older than 50, so those are risk factors for anyone that are at risk. In particular, for the young patients, that's the million-dollar question. There's so much research going on. We think, though, there is some kind of genetic and environmental interaction that may be putting the younger patients at a little bit higher risk at a little bit earlier age. But exactly what that is, there are so many things that we're looking at. We're looking at how the tumors are different. We're looking at some of the microbiome factors. We're looking at how some of the tumors induce the body's immune reaction. So, there are many things that's under investigation. And it's complicated and we don't exactly know what they are.

Host: Right. What are some of the signs and symptoms of colorectal cancer in young adults?

Nancy You, M.D.: That's also a really important question. So, some of the symptoms are very simple. There are changes in someone's bowel habits. They may be as dramatic as blood in the stool, but they might just be subtle changes in the typical pattern. A little bit more cramping, a little bit more bloating, a little bit more mucusy in the stool. And so, I think knowing what is normal for you and paying attention and being vigilant is the way to go. Some patients, though, actually have no symptoms. It's quite subtle. And they just feel a little bit more tired, which probably all of us do on days. And yet, when they go in for a blood test, they're found to be anemic. Sometimes it can be subtle.

Host: Some of these symptoms that you just talked about sound a lot like symptoms of other common GI issues. So, how does a young person ensure that they're getting the right diagnosis?

Nancy You, M.D.: It's tricky. But I think some of the key things are really know what's normal for yourself and be vigilant. We find some patients are shy about talking about their bowels, so don't be shy and be persistent. There's been a national survey done by the Colon Cancer Alliance where they surveyed a thousand patients. And over two thirds of the patients had to see two to three providers before they arrived at the correct diagnosis. So, don't feel like you're alone. You know, it's unfortunately a common story, but be persistent.

Host: Indeed. So, what are some of the challenges that young adults might face when they're actually going through colorectal treatment?

Nancy You, M.D.: I have so much interest in the special population, because I see the challenges they have across the entire cancer spectrum. And it really ranges from diagnosis, like we just talked about, to kind of all the way through their treatment and their survivorship. So, I think, beyond kind of the delaying diagnosis, some of the patients I run into, there's a very significant, as we all understand, psychological response to the diagnosis. Anyone has to go through some stages when they receive bad news and a difficult diagnosis. And I think that process is sometimes more difficult for a younger adult.

And also, as they go through treatment, I think there's a lot of logistical as well as psychological challenges. Young adults under age 50 are really busy. They may have children of their own. They certainly have a lot of friends. They may have older parents that they are trying to take care of. So, how do you fit cancer treatment into that whole ball of wax is often very challenging. And so, we have a special program for young adults with colorectal cancer, mainly just to let them know you're not alone, and there's others. And we try to provide a community where people can compare notes and potentially find some solutions for each other.

And then lastly, even for the people who are ending their treatment and entering their survivorship, I think there's challenges on how do you reintegrate and how do you get back to normal living and regain some of those things that you had to put aside for a few years.

Host: How would a young adult really start the conversation with their doctor?

Nancy You, M.D.: Again, some of the young patients are very well educated, and there's a lot of resources out there. So, I think doing some preparatory work before you go in to see the physician and making a list of questions, bringing a friend who may be another set of ears to help take notes and ask and answer questions would be great. But I think, you know, mainly just don't be shy, and we're here to help. Unfortunately, there's a lot of young patients going through this.

Host: All right. You already made mention of this, MD Anderson was one of the first to start a clinic focused on youn-onset colorectal patients. So, why is it so important to focus on this population?

Nancy You, M.D.: So, young onset colorectal cancer has some unique characteristics compared to all other colorectal cancers. The vast majority of the young patients have their cancer on the left side of the colon and also in the rectum. And so, the treatment is quite different, the outlook is different. The whole issue with needing a temporary bag or even a permanent bag arises in that population. The impact on fertility, sexual function, bowel function long term is significant. All of those issues, we want dedicated attention to and we want network of support for those patients.

Several years ago, we developed this dedicated program for these patients. And, unfortunately, a third of all of our patients with colorectal cancer are under 50. So, it's a large group. So, we have a dedicated nurse navigator who proactively reaches out and provides an assessment of the various needs. We have a network of support services that we can link the patients to. We have a community of patients going through similar things to support each other and talk to each other about their disease and their journeys.

Host: Wow. Dr. You, thank you so much for sharing your great knowledge with us today.

Nancy You, MD: Thank you. Thank you for having me. It's an important issue.

Host: It's a very important issue. For more information or to request an appointment at MD Anderson, call 1-877-632-6789, or visit MDAnderson.org. I'm Dr. Bob Underwood. Thanks for listening to the Cancerwise podcast from MD Anderson Cancer Center.