At 35, Nikki Lawson experienced the shock of her lifetime.
She noticed her stomach felt irritable and would feel the urge to go to the bathroom. Sometimes, there was blood in her stool. She said that her stomach symptoms became so severe that she went to the hospital. Before being sent home, she was informed it could be a stomach ulcer.
"That was about the time Chadwick Boseman, actor, died. Lawson spoke of the "Black Panther" star, who was 43 years old when he died from colon cancer in August 2020.
"But at that moment, I wasn't thinking, 'This is something that I'm experiencing,'" she stated.
Lawson decided to change her diet instead. Lawson decided to eat fewer red meats and more fruits and veggies. She noticed a significant weight loss, which she believed was due to her new diet.
Lawson replied, "But then I went to a physical."
Because she was low in iron, her primary care physician suggested that she immediately see a gastroenterologist.
"When I went to see my gastro, she said that she had bad news. We have something. It was sent to us for testing. It appears to be cancer. Lawson stated that his entire world was "just kind of blanked out." Lawson said, "I was 35 years old, healthy, going about my daily life, raising my daughter and when I got a diagnosis like this, it was so shocking."
Lawson was diagnosed with stage III rectal carcinoma at the age of 23.
Since the 1990s, colorectal cancer has been increasing in adults under 55 years of age in the United States. No one knows why.
"Crying through chemotherapy"
Researchers from Dana-Farber Cancer Institute call for more research to better understand, treat and prevent colorectal carcinoma at a younger age.
The researchers Dr. Marios Giannakis, and Dr. Kimmie Nag published a paper last week in Science. They proposed a way scientists could accelerate their research into the mysterious rise in colorectal carcinoma among younger people. This included establishing more specialized research centers that can focus on young patients and allowing for inclusion of diverse populations in studies on early-onset colorectal disease.
They hope that their work will improve the outcomes of young patients with colorectal cancer like Lawson.
Colorectal cancer will be the most common cause of death in America among younger adults between the ages of 20 and 49 by 2030.
Lawson, now 36, lives in Palm Bay, Florida with her 5-year old daughter. She is currently in remission.
She was a former middle school teacher and had multiple surgeries. She also received chemotherapy and radiation therapy to treat her cancer. Her doctors are now closely following her.
"My words of hope for young people with colorectal carcinoma would be to keep going strong." Find the courage to tell yourself, "You know what? I'm going out to fight this." Lawson stated, "I just looked inside myself."
"I have a supportive family system so they were there for me. She said that her treatment for cancer was difficult.
She said that she cried through chemotherapy sessions, when the medicine made her weaker, and that my daughter was 4. "My advice to young people: If you notice symptoms, or you feel that something is not right, and you are losing weight but not trying to lose it off, see a doctor.
Colorectal cancer symptoms include changes in bowel habits, blood in the stool, constipation, weight loss, weakening, fatigue, and rectal bleeding.
The American Cancer Society released a report this month showing that colorectal cancer rates among people younger than 55 years old increased from 11% to 20% between 1995 and 2019. The reasons for this increase are still unknown.
Lawson's surgeon Dr. Steven LeeKong, chief for colorectal surgery at Hackensack Medical Center in New Jersey, stated that there could be more than one cause.
In his own practice, he has seen an increase in colorectal patients in their 40s as well as in their 30s. Rectal cancer was discovered in his youngest patient, who was 21 years old at the time.
Lee-Kong stated that there is a trend of decreasing colorectal cancer rates across the country. This could be due to increased screening, especially for older adults. "But this doesn't account for the overall rise in patients younger than 50 or 45 who are developing cancer.
"There's more going on"
There are several factors that can increase the risk of developing colorectal carcinoma. These include having a family history, being overweight, smoking cigarettes, and having a certain genetic mutation.
"They were identified as risk factors in older patients, but they also seem to be associated with early-onset diseases, and those are things such as excess body weight, lack physical activity, high intake of processed meats and red meats, and very high alcohol consumption," said Rebecca Siegel, an American Cancer Society senior scientific director of surveillance research and a cancer epidemiologist. She was the lead author of this month’s report.
She said that the data didn't support the specific factors driving the trend. Excessive body weight can increase your risk of developing colorectal carcinoma in your 40s. It is true. However, the risk of an excess is very small. This is yet another reason to believe that something else may be happening.
Many people are being diagnosed earlier than expected. This includes some high-profile cases like Quentin Oliver Lee (Broadway actor) who was 34 when he was diagnosed with stage IV colon carcinoma.
"Anecdotally," I have heard at conferences that many of these patients are healthy. Siegel stated that they aren't obese and that they are very active which adds to the mystery.
She stated that the risk of developing cancer from excess weight is well-known. "And that is contributing more cancer to a lot cancers, as well as colorectal cancer. This trend, however, does not explain the steep rise in cancer. It doesn't.
Scientists are still divided on the role that obesity and other risk factors play in colorectal cancer growth among people younger than 55.
Scientists debate the role obesity plays in our lives
Although the causes of colorectal carcinoma in young adults are not fully understood, Dr. Subhankar Chakraborty suggests that lifestyle and dietary factors may be more important than many people think.
"We know that smoking, alcohol and lack of physical activity are all factors that contribute to obesity and other health problems.
He said that there are other factors such as an increase in inflammatory bowel diseases, which may also play a role. However, I believe the most important factors are the diet, lifestyle, and environmental factors.
He says it has been difficult to identify the causes of rising cases in younger age groups because, for example, a polyp in the colon can take between 10 and 15 years to become cancerous.
"During that time, from a polyp to cancer stage, the person is exposed and exposed to many things in their lives. To really determine what is happening, Chakraborty stated that it would be necessary to track specific people over time in order to understand their diet patterns, medication and weight changes. It is difficult because cancer takes so long to develop.
Researchers have looked into how the increase in colorectal and other cancers among young adults could be linked to the US's rise in childhood obesity.
Dr. William Karnes, a California gastroenterologist and director for high-risk colorectal carcinoma services at UCI Health Digestive Health Institute, stated in an email that the rise in young-onset colorectal disease correlates with a doubling in childhood obesity rates over the past 30 years.
He said that there may be other factors, but he also stated that he has been seeing a rise in the number of patients who have colorectal cancer.
According to Dr. Shane Dormady from El Camino Health, California, who treats colorectal patients, there could be a correlation between obesity in young adults and the foods they eat.
Dormady stated that younger people eat less healthy food than older ones - processed foods, fast food, and snacks - and that these foods have higher levels of carcinogens as well as being very fattening.
He stated that obesity in children, adolescents, and young adults is well-known. It is when a person's weight is low, particularly at young ages, that the cells are more susceptible to DNA damage. This really sets the ball in the wrong direction.
However, the Center for Young Onset Colorectal and Gastrointestinal Cancers, Memorial Sloan Kettering Cancer Center, is not seeing any correlation between colorectal and obesity in their patients. Dr. Robin Mendelsohn (gastroenterologist and codirector of the center), said that doctors and researchers continue to work round the clock to unravel this mystery.
She said that although most of our patients were more likely than others to be obese and overweight, when they are compared to a national group without cancer, they are actually less likely to be obese and overweight. Anecdotally, many of our patients are young and healthy and don't fit the obesity profile.
Many oncologists are left scratching their heads.
There is growing doubt about genetics being involved
Scientists are still investigating whether genetic mutations that increase the risk of colorectal cancer in younger people have contributed to the rise in cases. However, the majority of these patients don't have them.
UCI Health's Karnes stated that it is unlikely that there has been an increase of genetic mutations that increase the risk of developing colorectal carcinoma. However, Lynch syndrome is more common among people who have young-onset colorectal disease.
Lynch syndrome is the leading cause of hereditary colon cancer. It causes approximately 4,200 cases per year in the US. Lynch syndrome patients are more likely than others to develop cancers before they reach 50 years of age.
El Camino Health's Dormady stated that 'in my practice, as well as in the medical community and the oncologic community I don't believe there's any evidence that genetic syndromes or gene mutations that patients have become more common'. "I don't believe that the inherent frequency of these mutations is increasing."
According to Mendelsohn, Memorial Sloan Kettering Cancer Center, the tumors of young colorectal cancer patients look very similar to older patients.
"So, then, the question is: If they're biologically identical, why are we seeing it more in younger people?" She said. "About 20% of patients may have a genetic mutation. The majority of patients don't have a family history or genetic predisposition."
Mendelsohn stated that it is likely that some type of exposure (e.g., diet, medication, or changing microbiome) has been responsible for the increase in colorectal carcinomas in younger people.
Mendelsohn stated that this rise "has been something we have been watching, and it has been increasing ever since the 1990s." "And although it is growing, the numbers are still very small. It's still a small country.
More accurate testing and diagnosis
El Camino Health's Dormady said that he sees more colorectal patients in their mid-50s and early 50s than he did 20 year ago. He wonders if this is due to colorectal screening being more accessible and more accurate at detecting the disease.
He said that'some of our diagnostic modalities have improved', particularly with the availability of at-home colorectal testing kits. The US Preventive Services Task Force also decreased the age at which you should start screening for rectal and colon cancers to 50 in 2021.
"I believe you have a subset who are being screened with colonoscopies earlier; we have advanced technology that can detect tumor cell DNA from stool samples, which is leading us to earlier diagnosis. Sometimes that can skew statistics, making it appear that the incidence is actually on the rise. But deeper analysis shows that some of that is due earlier detection and increased screening. "So that could be just one aspect of the equation.
According to Ohio State University's Chakraborty, identifying the cause of this rise in colorectal cancer diagnosis among younger people will help scientists better understand the disease and help doctors create personalized risk assessments for younger patients.
He explained that most people who develop colorectal carcinoma are unaware of their risk.
"Having a personalized risk assessment tool which will take into consideration their lifestyle, environmental factors, and genetic factors - I believe that if that is possible, it would allow us to make personalized recommendations about when someone should be screened for colon cancer and what screening method should be used based on their risk," he stated. "Colon cancer is more common in younger adults than it is in older people. However, the risk of developing colon cancer increases as we age. There is a slight difference between older adults and younger adults when it comes to screening.