Why Do Young People Get Colon Cancer?

Dr. Lenz explains that colon cancer doesn’t just affect those in middle age and beyond.

colon cancerIt’s no secret that many younger people take risks with their health and believe that diseases like colon cancer won’t occur until they are safely into middle age. While this may be true for some, for many young people colon cancer is a reality that they did not ask for.

Dr. Heinz-Josef Lenz explains that the risk of colon cancer is not only environmental or related to age, that many people are unknowingly genetically predisposed to colon cancer. For more, watch Dr. Lenz in the video below:

Dr. Lenz:  There is always a question when I have a patient who is may be early 20s or early 30s, why do I get colon cancer because in patients in that young age, we cannot really relate the development of colon cancer to lifestyle or diet, so what is the reason that young patients develop this disease?  Well, we have learnt over many years that there are familial forms of colon cancer.

We have genetic predispositions which lead to development of colon cancer as early as teenage years, so there is a genetic predisposition called familial adenomatous polyposis.  This means these patients develop thousands of polyps in their colon and all of these patients would develop colon cancer.  Now, how can we deal with that?  Well, there is now a surveillance, we can screen for that, it’s very easy to identify them and what we usually recommend that these young patients with 16, 17 undergo a removal of their colon and that prevents the development of colon cancer.  Now, this is not the only form of genetic predisposition, there is another familial form which is called HNPCC standing for hereditary nonpolyposis colorectal cancer.

Now, this is a mutation in DNA mismatch repair genes and how do we identify these patients in our clinics.  Now, these patients can develop colon cancer in their 30s and 40s.  Now, usually these tumors are located on the right side of the colon, under the microscope, they usually look poorly differentiated and there seems to be more females than males, but an easy clue that there may be a genetic predisposition of the family is of course your family history.  Now, it’s very important to know a genetic predisposition for colon cancer does not mean it’s only colon cancer, it can travel with other cancers.

Any cancer in your family, of course colon cancer, is important to discuss with your physician, but ovarian cancer, endometrial cancer, gastric cancers, and many others belong to this genetic predisposition, so it’s very important to really discuss your family history with your physician.  Any patient under the age of 50, right-sided colon cancers, family histories of these cancers mentioned, need to be evaluated by a genetic counselor or geneticist to make sure you undergo genetic testing to understand if you have a predisposition.

Why is that important?  Two reasons, one the patients with genetic predisposition do overall much better.  They have very different clinical causes.  They have a different metastatic pattern.  They usually do not travel to liver and lung, so certain treatment options may be look differently and second if we can screen your family identifying the patients who carry the predisposition, we can 100% prevent colon cancer in these families, so I think it is very important to be aware of your family situation and discuss that with your oncologist and possibly with a genetic counselor or geneticist.

Heinz-Josef Lenz
Heinz-Josef Lenz, M.D., FACP, is the Associate Director for Clinical Research and Co-Leader of the Gastrointestinal Cancers Program at the USC Norris Comprehensive Cancer Center. Dr. Lenz is Professor of Medicine and Preventive Medicine, Section Head of GI Oncology in the Division of Medical Oncology and Co-Director of the Colorectal Center at the Keck School of Medicine of the University of Southern California.


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