New research has identified two “red flag” symptoms that appear in nearly half of all cases of early-onset colorectal cancer: abdominal pain and hematochezia, or blood in the stool.
In the United States, colorectal cancer is more common among older people: the average diagnosis is made at 66 years old. However, the incidence of early-onset colorectal cancer, which involves cases diagnosed in people under the age of 50, is increasing and has doubled since the 1990s.
The review, published in Open JAMA Network on May 24, reviewed 81 studies including data from more than 24 million people under the age of 50. They found that, in the United States and around the world, people with early colorectal cancer most often had blood in their stools, abdominal pain, and altered bowel habits.
“The challenge is always: what types of symptoms may be associated with potential cancer risk? » Kishore Guda, PhD, DVM, associate professor at the Comprehensive Cancer Center at Case Western Reserve University, said Health. “What this document emphasizes at a minimum is that if you find anything abnormal, go get it checked out.”
Here’s what experts said about the study and how identifying signs of colorectal cancer can protect your health.
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With the incidence of colorectal cancer increasing among young people, researchers wanted to identify any common symptoms in this age group that might otherwise be missed or ignored.
To do this, reviewers looked at 81 studies conducted in various regions around the world. Together, these studies included data from nearly 25 million people.
The authors found that 45% of people with early-onset colorectal cancer had hematochezia, also known as rectal bleeding or bloody stools, and about 40% of patients reported abdominal pain. The third most common early symptom of colorectal cancer (affecting 27% of people) was altered bowel habits, which the study defined as constipation, diarrhea, alternating bowel habits, or alternating diarrhea and of constipation.
Rectal bleeding and abdominal pain were also associated with a greater likelihood of having colorectal cancer than not having it, the review found.
In 34 studies, reviewers found that it took about four to six months after the onset of symptoms for patients to receive a diagnosis of early-onset colorectal cancer.
These findings aren’t necessarily new: A study published just over a year ago studied 5,075 cases of early-onset colorectal cancer and identified four “warning” symptoms. These included abdominal pain, rectal bleeding, diarrhea and iron deficiency anemia. But the new research pooled data from thousands of other people and further highlights how important it is for younger people to recognize the warning signs of the disease.
The study did not explicitly examine why it took so many months for people to be diagnosed with colorectal cancer, even after experiencing symptoms. However, the authors noted that the problem could concern both young people and doctors.
The average person under 50 may not think about seeking care when they start experiencing these symptoms, or may be deterred by logistical issues such as finding daycare or accessing health care, Yi-Qian Nancy You , MD, professor of surgery and director of the Young-Onset Colorectal Cancer Program at the University of Texas MD Anderson Cancer Center, said Health.
“Younger people don’t even think about cancer,” Guda said. “They think, ‘I’m only 35 or 40, why would I have cancer?’ I don’t have any family members with cancer. Why should I suspect this? I’ll just wait.’
On the other hand, doctors might also be contributing to the problem: Health care providers may assume that symptoms are a sign of something less serious.
“It’s very difficult to fault front-line providers, whether emergency physicians or primary care physicians, for not immediately initiating a cancer screening workup,” You said. Health. “Sometimes it takes a second visit or a repeat symptom before a review is triggered. »
The good news is that most of the time, skeptical patients and doctors are right: abdominal pain and blood in the stool are often a sign of other conditions, such as diverticulitis of the colon, hemorrhoids, or disease. inflammatory bowel disease, Guda explained.
But assuming these symptoms aren’t serious or delaying treatment can put your health at risk.
Generally speaking, all people, regardless of age, should know to watch out for the following symptoms of colorectal cancer:
- Blood in your stool
- Changes in bowel habits, including constipation and diarrhea
- Stomach cramps, bloating or discomfort
- Unexplained weight loss
- Vomiting
- Fatigue
Again, because these symptoms are fairly nonspecific, they are not a sure sign that a person has colorectal cancer. But if something is wrong, Guda says, it’s best to talk to a doctor.
This is especially important because by the time a person has symptoms of colorectal cancer, the case might be a little more serious.
“Younger patients present at a little later stage, so two-thirds of them are already stage three or stage four by the time they’re diagnosed,” You said. “That may or may not result in a tumor that’s a little more symptomatic.”
The U.S. Preventive Services Task Force recommends that people start getting screened for colorectal cancer at age 45. People with a high genetic risk for colorectal cancer can start having regular colonoscopies even earlier. But in general, “there are no specific guidelines” for detecting asymptomatic colorectal cancer in young people, Guda said.
“How can we identify people who are at higher risk of developing early colorectal cancer? There are no easy answers,” he said.
If someone has any of these symptoms, there’s no need to panic, experts emphasize.
“It’s really difficult to consider one symptom as a red flag on its own to trigger a massive cancer screening,” You said. “We can’t go 100% to the other end of the spectrum.”
However, if stomach pain, intestinal changes, or other problems persist, especially if you experience more than one, you shouldn’t ignore them, you explained.
If someone has some of these symptoms, they can try performing a home stool test to check for colorectal cancer, Guda suggested. But again, having a doctor evaluate your symptoms is the best solution. If necessary, they can help screen you for colorectal cancer via a colonoscopy or other test.
In general, a person is more likely to recover from cancer when it is detected and treated early.
“You know your body well,” Guda said. “If you have anything like (these symptoms), just go get it checked out. Get a checkup, do a colonoscopy, try to rule things in or out, and do it quickly too.