Colorectal Cancer: Why Younger Patients Face More Aggressive Disease and Higher Recurrence Rates

Colorectal cancer (CRC) is a cancer of the colon or rectum, traditionally diagnosed in patients above 50 years of age. In recent times, there has been a significant shift towards younger age groups (between 30-40 years old) compared to the previously typical older demographic, primarily attributed to lifestyle factors like unhealthy diet, increased alcohol consumption, and lack of physical activity; this trend is highlighted by research from the Delhi State Cancer Institute (DSCI).

It has been also observed that early-onset colorectal cancer (EOCRC), which refers to CRC occurring in people less than 50 years of age, is aggressive and has greater recurrence rates in comparison to the elderly population, following therapy, making long-term survival more difficult. The trend calls for increased awareness, early screening, and prompt interventions among the Indian population.

Increase in prevalence of early-onset colorectal cancer

The rising prevalence of early-onset colorectal cancer (EOCRC) in India is alarming, as it is often diagnosed at advanced stages due to delayed detection. Factors contributing to this increase include dietary changes, such as high consumption of processed foods and low-fiber diets, along with sedentary lifestyles, obesity, genetic predisposition, gut microbiome alterations, environmental exposures, and metabolic disorders like diabetes. Additionally, many young patients neglect early symptoms or are misdiagnosed, leading to late-stage detection, higher mortality, and increased recurrence rates. Addressing this growing concern requires better awareness, targeted screening for high-risk individuals, and improved early detection efforts in India.

Why younger patients have more aggressive forms

Genetic and Biological Factors: EOCRC is usually characterized by unique genetic mutations than cancers of older individuals. For example, mutations in the KRAS and BRAF genes are more common in younger patients, resulting in more aggressive tumour behaviour.

Delayed symptom presentation and diagnosis:

Younger patients tend to ignore symptoms or blame them on less severe conditions, leading to delayed diagnosis. At the time of diagnosis, the cancer is usually advanced, making treatment and prognosis difficult.

Challenges in diagnosis and treatment

1. Delayed diagnosis:

Symptoms of CRC in young adults are often confused with benign gastrointestinal problems, resulting in misdiagnosis and delay in treatment.

2. Treatment difficulty:

Furthermore, insufficient routine screenings and checkups in this age bracket also contribute to delayed diagnoses.

3. Increased recurrence rates:

Patients who are younger have a greater chance of experiencing cancer recurrence after treatment. This could be as a result of the aggressive character of their tumors and the presence of residual microscopic disease that might escape initial therapy.

4. Treatment response:

Younger patients tend to handle intensive treatments well, but the distinctive biology of EOCRC may make general treatments less efficient, which translates to increased recurrence.

Need for early diagnosis and awareness

Early screening is essential, particularly for individuals who have a familial history or hereditary predisposition, as the disease can then be detected early in its treatable phase. EOCRC is more insidious and tends to recur in greater frequency and severity because of genetic, biologic, and treatment-related parameters. To help combat this developing problem, deep research, awareness campaigns and better means of screening in high-risk younger populations are necessary.

(Dr Amanjeet Singh, Senior Director -Head of Colorectal Surgery, GI Surgery, GI Oncology and Bariatric Surgery, Medanta Gurugram)

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