Endangered Butts Come in All Shapes, Sizes and Ages!

Endangered Butts Come in All Shapes, Sizes and Ages!

About Colorectal Cancer

Colorectal cancer is a malignant tumour that starts in cells of the colon or rectum.

1 in 14 men and 1 in 16 women are diagnosed with colorectal cancer each year in Canada. Approximately 25,100 Canadians were diagnosed with CRC in 2015. It is the 2nd deadliest cancer, although the disease is more than 90% curable if detected early. Colorectal cancer is Preventable, Treatable and Beatable!

Colorectal cancer most often touches individuals over the age of 50 and over ninety percent (90%) of patients are over 55 years of age. Ten percent (10%) of new colon cancer patients however are under the age of 50. Individuals with certain risk factors such as a family history of polyps, colon cancer or genetic alterations, have an increased risk of developing colon cancer at a younger age. Sixteen percent (16%) of patients under the age of 40 have been reported to have predisposing factors and twenty-three percent (23%) had a family history of the disease.

Table 1: Number of new cases of colorectal cancer diagnoses in 2015 by age group in Canada

chart 1 EN

About the Colorectal Cancer Association of Canada (“CCAC”)

The CCAC is dedicated to colorectal cancer awareness and education, supporting patients and their families, and advocating on their behalf. The CCAC raises awareness and provides important and practical information to colorectal cancer patients, young and old. Together with the Never Too Young (“N2Y”) coalition, we provide support and information to young patients in Canada who have experienced early onset of the disease.

About N2Y

The Never Too Young Coalition is united to take action on young onset of colorectal cancer through action, education, and research. The Coalition includes medical professionals, patient advocacy organizations, cancer survivors and caregivers working to educate the public about this growing issue and to reduce the number of late stage young-onset colorectal cancer cases.

As the leading national colorectal cancer patient advocacy organization in Canada, we’re dedicated to bringing together the brightest minds to increase screening and to promote equal and timely access to effective treatments to improve patient outcomes.

Symptoms of CRC

• Blood in the stool
• Narrower-than-normal stools
• Prolonged diarrhea or constipation
• Feeling that the bowel does not completely feel empty
• Abdominal pain or discomfort
• Loss of appetite, unexplained weight loss
• Constant fatigue, anemia
• Nausea, vomiting

Risk Factors

Family History of Colon Cancer or polyps

About 10% of the population has a first degree relative with colon or rectal cancer.

First and second degree relatives (children, siblings, grandchildren, nieces, nephews) of a person with a history of colon cancer are more likely to develop CRC themselves, especially if their relative had the cancer at a young age. If several close relatives have a history of colon cancer, there is an increased risk. In view of this increased risk, both the U.S. Preventative Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care (CTFPHC) recommend screening as of the age 40 for these high-risk individuals or ten years earlier than the youngest age of colorectal cancer diagnosis for any affected relative.

Genetic Alterations

Changes in certain genes increase your risk of colon cancer.

Hereditary nonpolyposis colon cancer (HNPCC or Lynch Syndrome) is the most common type of inherited colon cancer, accounting for about 2% of all colon cancer cases. It is caused by changes in a HNPCC gene. If not closely monitored, most individuals with this altered gene will develop colon cancer, with the average age at diagnosis being 42-45, and 35-40% being diagnosed before the age of 40. General screening guidelines recommend colonoscopy every 1-2 years, beginning between the ages of 20-25, or five years younger than the earliest age at diagnosis in the family, whichever is sooner.

Much rarer is familial adenomatous polyposis (FAP) an inherited condition in which hundreds of polyps form in the colon and rectum. It is caused by a change in a specific gene called APC. Unless FAP is treated, it usually leads to colon cancer by age 40. FAP accounts for less than 1% of all colon cancer cases.

Family members of individuals who have HNPCC or FAP can have genetic testing to check for specific genetic changes. For those who have changes in their genes, healthcare providers may suggest ways to try to reduce the risk of colon cancer or to improve the detection of this disease. For adults with FAP, the doctor may recommend the removal of all or part of the colon and rectum.

Ulcerative Colitis or Crohn’s Disease

A person who has had a condition that causes inflammation of the colon (such as ulcerative colitis or Crohn’s disease) for many years is at an increased risk of developing colon cancer. Patients should therefore be screened regularly.

Other Factors

Other factors contributing to young-onset of colon cancer have not been definitely identified, but we do know they occur with an increased prevalence of obesity and diabetes. Factors that may increase your risk of colon cancer include:

• There is approximately two times higher risk of developing colorectal cancer later life if you are overweight or obese during adolescence.
• A diet high in red or processed meat and low in fiber, vegetables and fruits.
• Inactivity: 12-14% of colorectal cancer could be attributed to lack in physical activity
• Smoking
• Increase consumption of alcohol
• Racial and ethnic background

Statistics and Data

• Colon cancer incidence and mortality rates are increasing in the young-onset population while decreasing in those over 50.
• About 30% of young-onset colorectal cancer cases develop in those with a family history of the disease or genetic disposition.
• Young-onset rectal cancer incidence has increased at nearly twice the rate of young-onset colon cancer.
• About 72% of cases of colorectal cancer in young people arise in the colon and about 28% in the rectum.
• Younger adults were more likely than older adults to be diagnosed with late-stage cancers.
• Rates have been increasing in all younger age groups with the highest increases for the 15-29 years old, followed by the 30-39 years old and then 40-49.
• The increase is more rapid in males compared to females.
• Diabetes has been associated with up to a 38% increase in colon cancer risk and 20% increase in rectal cancer risk.

Prevention

Research shows that a high fat diet is a risk factor for colon cancer. Some studies have also suggested that a diet high in fiber and a lifestyle that includes moderate exercise are helpful in preventing the disease. Be aware of symptoms and getting recommended screenings are key factors in prevention of the disease.
After speaking to family members and gathering your family health history, speak to your primary care provider about ways to improve your diet and lifestyle to prevent colon cancer and about scheduling preventative screenings when necessary. A healthy lifestyle and healthy body weight is important for prevention of all cancers.

Screening

• Men and women at average risk, screening should be done at least every two years starting at fifty years old with either FOBT (fecal occult blood test) or FIT (fecal immunochemical test). Positive FOBT or FIT tests should be followed up with a colonoscopy.
• Screening has the potential to prevent colorectal cancer because polyps found in the colon (precursors to cancer) can be removed during a colonoscopy screening. Furthermore, being screened at the recommended frequency increases the likelihood that when colorectal cancer is present, it will be detected at an earlier stage and is more likely to be treatable and curable.

Table 2: Canadian Colon Screening Guidelines

chart 2 EN

Genetics

Tests have been developed that look at the activity of many different genes in colon cancer tumors. These tests can be used to help predict which patients have a higher risk that the cancer will spread.

Lynch Syndrome (see also previous section of genetic alterations)

Lynch syndrome is a mutation of a gene that is responsible for fixing errors in your DNA. Lynch Syndrome, also known as hereditary nonpolyposis colon cancer (HNPCC), is an hereditary disorder caused by a genetic mutation in which affected individuals have a higher than normal chance of developing colorectal cancer, endometrial cancer, and various other types of aggressive cancers, often at a young age. To prevent colorectal cancer, people with Lynch Syndrome should undergo a colonoscopy every 1-2 years, starting in their twenties. Doing this will reduce the risk of colorectal cancer by 77%.

People with Lynch syndrome have a mutation of the MMR gene, which means their bodies are less able to fix errors in the DNA. Consequently, a person with Lynch syndrome is more likely to get certain types of cancer. Lynch syndrome increases the risk of getting colorectal cancer by 80 percent and endometrial cancer by 60 percent. Lynch syndrome may also lead to other cancers, such as small bowel and stomach cancer. Lynch syndrome accounts for 2- 4% of all colorectal cancer cases.

Treatments and Effects

1. Newer surgery techniques:

Surgeons are continuing to improve their techniques for operating on colorectal cancers. They now have a better understanding of what makes colorectal surgery more likely to be successful.
Laparoscopic surgery is done through several small incisions in the abdomen instead of one large one, and it’s becoming more widely used for some colon cancers. This approach usually allows patients to recover faster, with less pain after the operation. Laparoscopic surgery is also being studied for treating some rectal cancers, but more research is needed to see if it as effective as standard surgery.

With robotic surgery, a surgeon sits at a control panel and operates very precise robotic arms to perform the surgery. This type of surgery is also being studied.

2. Chemotherapy:

Different approaches are being tested in clinical trials, including:

• Five most common chemotherapy drugs: 5-fluorouracil (Adrucil, 5-fu), capecitabine (Xeloda), oxaliplatin (Eloxatin), and irinotecan (Camptosar).
• Combination of drugs known to be active against colorectal cancer, such as irinotecan and oxaliplatin, improve their effectiveness.
• Combination of chemotherapy with radiation therapy, targeted therapies, and/or immunotherapy.

3. Targeted therapy:

Several targeted therapies are already used to treat colorectal cancer, including bevacizumab (Avastin), cetuximab (Erbitux), and panitumumab (Vectibix). Doctors continue to study the best way to give these drugs to make them more effective.

Targeted therapies are currently used to treat advanced cancers, but newer studies are trying to determine if using them with chemotherapy in earlier stage cancers as part of adjuvant therapy may further reduce the risk of recurrence.

4. Immunotherapy:

Researchers are studying several vaccines to try to treat colorectal cancer or prevent it from coming back after treatment. Unlike vaccines that prevent infectious diseases, these vaccines are meant to boost the patient’s immune reaction to fight colorectal cancer more effectively.

Because cancer treatments may damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. While many effects may be the same, there are some unique challenges those diagnosed and going through treatment under age 50 may encounter, including:

• Relationships with family and friends
• Impact on young children
• Dating issues
• Infertility issues
• Intimacy issues
• Career/workplace issues
• Financial issues
• Psychological issues

References

1. Ahnen et al. (2014). The Increasing Incidence of Young-Onset Colorectal Cancer: A Call to Action. Mayo Clinic.
2. McKay et al. (2014). Does young age influence the prognosis of colorectal cancer: a population-based analysis. World of Surgical Oncology.
3. Patel, P. & De, P. (2016). Trends in colorectal cancer incidence and related lifestyle risk factors in 15-49-year-olds in Canada, 1969-2010. Cancer Epidemiology.
4. Stigliano et al. (2014). Early-Onset Colorectal Cancer: A Sporadic or Inherited Disease? World Journal of Gastroenterology.
5. Alive And Kickn. (2015). http://aliveandkickn.org/
6. Canadian Cancer Society. (2016). http://www.cancer.ca/en/?region=on
7. Colon Cancer Alliance. (2016). http://www.ccalliance.org/
8. Colon Cancer Coalition. (2016). http://coloncancercoalition.org/
9. Colorectal Cancer Association of Canada. (2016). http://www.colorectal-cancer.ca/en/
10. Fight Colorectal Cancer. (2016). http://fightcolorectalcancer.org/
11. Present and Future Directions in Research. (2013). Michael’s Mission. http://www.michaelsmission.org/
12. Stop Colon Cancer Now. (2014). http://stopcoloncancernow.com/
13. What you need to know about your colon. (2013). Colon Cancer Challenge Foundation. http://www.coloncancerchallenge.org/