The Troubling Rise in Gastrointestinal Cancers among Younger Adults — How MSK Is Helping

Kellee Strong (left) with her daughter, Karlee Strong

Kellee Strong (left) with her daughter, Karlee Strong

Kellee Strong clearly remembers her first thought when a local doctor broke the news that Kellee had cancer, and it had spread to several organs: “I’m not even going to see my kids graduate from high school.” At age 42, she was enjoying a full life, with a career in the court system, a husband, a daughter in middle school, and a son who had just entered high school.

Kellee wasn’t sure where to turn. But a court officer friend at work was adamant — she needed to go to Memorial Sloan Kettering, as he had. Her friend even insisted on driving Kellee and her husband, Wayne Strong, the three and a half hours from their hometown in upstate New York to MSK in Manhattan.

At MSK, Kellee underwent nine hours of surgery by a team including surgeons Peter Kingham and Yukio Sonoda. Several of Kellee’s organs were either fully or partially removed. And there was a new twist: During the operation, MSK doctors determined that the cancer had begun in her appendix — not her ovaries, as her local doctor thought.

Appendix cancer is a very rare cancer, with 1,500 cases diagnosed each year in America. Even rarer was Kellee’s age at diagnosis, since appendix cancer is usually diagnosed in people at least a decade older than Kellee.

What’s Happening with Younger Adults?

Since Kellee was diagnosed in 2012, researchers at MSK and elsewhere have noticed a troubling trend. A growing number of younger adults are being diagnosed with appendix cancer and other tumors of the gastrointestinal (GI) system. Andrea Cercek, a medical oncologist at MSK who cares for people with GI cancers, explains that “in our clinics at MSK, we’re seeing more and more people under 50 with cancer of the pancreas, the esophagus, stomach cancer (often called gastric cancer), and appendix cancer as well as other cancers of the digestive system.”

These observations are backed by a growing body of research at MSK and elsewhere. And this disturbing trend mirrors a similar rise of the most common GI cancer — colorectal cancer.

Research has proven that the rate of colorectal cancer among people under 50 has reversed course after decades of decline and has been increasing 2% per year for the past several years. In fact, cases of colorectal cancer among younger adults are projected to double by 2030. Deaths from the disease are also rising among younger people. This is happening even as the number of cases and deaths from colorectal cancer is dropping among people over 50.

So far, the rise in pancreatic, esophageal, gastric, appendix, and other GI cancers among people under 50 is not as stark as it is for colorectal cancer. But Dr. Cercek warns that “for younger adults, the rise in cancer isn’t limited to colorectal cancer. The rise appears to be associated with the entire intestinal tract.”

Why this is happening is an open question. Obesity is linked to several types of GI cancer, including colorectal. But Dr. Cercek explains, “the rise in obesity alone does not explain the growth of GI cancers in younger people.” She continues, “We are also looking at other possible factors, including toxins we may be ingesting in our food, like hormones, or changes caused by antibiotics to the microbiome in our bodies, which are bacteria and other microbes that help us digest our food. All of these and more are being investigated.”

A New Way to Help

In March 2018, MSK established the first center in the world devoted to the specific needs of colorectal cancer patients under 50. TThe Center for Young Onset Colorectal Cancer was founded under the leadership of co-directors Dr. Cercek and Robin Mendelsohn, an MSK gastroenterologist. Dr. Cercek explains that “our belief is that early intervention with support services, including fertility, sexual health, counseling services, and more is especially important to patients under 50.”

Our belief is that early intervention with support services, including fertility, sexual health, counseling services, and more is especially important to patients under 50.
Andrea Cercek Medical Oncologist

To accomplish that, the center’s staff is notified as soon as a patient under 50 with colorectal cancer contacts MSK. Before the person’s first appointment, they receive a welcome letter from the center highlighting the support services and resources available to them, including social worknutritionfertilitysexual healthpsychiatrygenetics, and integrative medicine.

Within a week of their first visit with an MSK doctor, patients are contacted directly by the center’s dedicated social worker, Hadley Maya. She explains that “patients under 50 often face concerns that are specific to their stage of life. ‘How do I talk to my young children about cancer?’ ‘How do I balance treatment and work?’ ‘How do I navigate dating and intimacy or starting a family?’ We can help.”

After three years and caring for hundreds of patients, the center has expanded its focus. Renamed the Center for Young Onset Colorectal and Gastrointestinal Cancer, the center’s compassionate, hands-on approach of providing intensive support from the very beginning of treatment will now be used with every patient under 50 who has a GI cancer of any type.

Dr. Cercek explains that “for my younger patients who have cancers of the appendix and other GI cancers, it was obvious they would benefit from our services just as much as colorectal cancer patients.” She continues, “It’s not the tumor type that dictates how much support a person needs. It’s the fact that they’re young and facing a very difficult illness.”

Back to Living Life 

Kellee says that kind of personalized attention at the start of treatment can make a world of difference. She recalls, “When I first came to MSK, my extensive surgery meant I had to stay in the hospital for several days. My husband wanted to stay nearby, but we’re not used to the city — we’re from the country and we didn’t know what to do.” She says that “an MSK social worker stepped in and told us about nearby hotels that had special rates for MSK families. It was so comforting to have access to that kind of help.”

Today, Kellee works full-time as the coordinator of a drug court, which seeks to rehabilitate people convicted of felonies who have drug and alcohol addictions as an alternative to prison. She required another surgery in the fall of 2020, after a cancer recurrence. But she and her MSK doctors are confident about her outlook — and she’s looking forward to resuming weight training as part of her rigorous Cross-Fit training.

As for the children she feared she would never see graduate high school, her son is now a pharmacist, and her daughter is in college. “I am so grateful to MSK,” Kellee says. “I don’t know if the outcome would have turned out as well as it did if I didn’t have such great care.”