Could colorectal cancer in people under 50 years old be biologically different and more aggressive than colorectal cancer in older people?
That’s what some researchers have proposed as people in their 20s, 30s, and 40s face a disturbing rise in colorectal cancer — people who are often decades younger than the typical age of patients with the disease.
But important new research from experts at Memorial Sloan Kettering Cancer Center suggests that the biology of colorectal cancer is actually very similar whether a patient is 15 years old or 75. The study was published August 18 in the Journal of the National Cancer Institute.
And that has important implications for how younger people with colorectal cancer should be treated.
Similar Response Across Age Groups
MSK medical oncologist Andrea Cercek led the study with a team of MSK experts. Dr. Cercek says, “Many medical oncologists, with very good intentions, tend to recommend more aggressive therapy when a young person has colorectal cancer, especially cancer that has spread. In chemotherapy that may mean giving three drugs instead of two.”
But the new study found, she says, “that the tumor of a 30-year-old responds the same way to chemotherapy as the tumor of a 70-year-old. Giving a young person more aggressive treatment does not give them a better outcome than they would get with fewer drugs — and extra chemotherapy exposes them to extra toxicity.”
The conclusion, she says, is that “our research suggests that more aggressive treatment of younger patients does not appear to be warranted.”
The Rising Number of Younger People with Colorectal Cancer
These findings are particularly important as a growing number of younger adults are diagnosed with colorectal cancer, for reasons that are not yet clear.
Dr. Cercek explains, “The growing number of younger people with colorectal cancer do not have a family history of it or have conditions like Crohn’s disease. Most of the patients we studied at MSK also do not have known risk factors, such obesity or heavy use of alcohol or tobacco.”
Alarmingly, if current trends continue, cases of colorectal cancer in people under 50 are expected to nearly double by 2030.Back to top
The Largest Study of Its Kind
In their study, MSK researchers compared 759 MSK patients with colorectal cancer who were younger than 50 — including 151 who were younger than 35 years old — with 687 colorectal cancer patients older than 50. Most patients in all age groups had advanced cancer, meaning it had spread to other parts of the body.
Dr. Cercek says, “This study is the largest and most comprehensive comparison of colorectal patients across age groups. We looked at all the clinical features of each patient, the genomics of their tumors, and the outcomes for each patient.”
The study considered differences that previous researchers had identified between younger and older colorectal patients, including the fact that younger patients tend to have more cases of rectal cancer compared to colon cancer — two closely related organs of the digestive system. Younger patients also tend to have more tumors on the left side rather than the right side of the body.
These differences are well known. For the first time, this new research factored in these differences and many other facets of colorectal cancer to find out if a different and more aggressive kind of cancer may be affecting young people.
Dr. Cercek explains, “We even compared the youngest patients to the oldest people in the study. What we found suggests that the basic genetic makeup of colorectal tumors and their response to chemotherapy is very similar across all groups.”Back to top
Treating the Whole Person
While colorectal cancer appears to be biologically similar in people of different ages, caring for the whole person demands a different perspective.
Dr. Cercek explains, “We’ve learned that our younger patients have needs that are very specific to their stage of life, involving fertility and sexuality, long-term survivorship, raising young children, and a host of other needs. We know it requires a different approach than people facing colorectal cancer later in life.”
To help, in 2018 MSK founded the first and largest facility in the world devoted to these younger patients — the Center for Young Onset Colorectal and Gastrointestinal Cancer. Dr. Cercek is its co-director, along with MSK gastroenterologist Robin Mendelsohn.Back to top
The Center for Young Onset Colorectal and Gastrointestinal Cancer
The center’s aim is to help people like Damien Scogin. He came to MSK in 2019 after he was diagnosed with stage IV colon cancer in his mid-40s. Because he is under 50, the center was notified as soon as he made an appointment at MSK, and behind the scenes, a team swung into action.
Before his first appointment, Damien was sent a welcome letter from the center. A week after his appointment, he began meeting with Hadley Maya, the center’s dedicated social worker.
She says the people she counsels often are facing concerns specific to their stage of life. “Many are balancing jobs and careers, caring for children and teenagers as well as aging parents, and many are navigating robust social lives.”
Damien faced one of the most common, and heartbreaking, challenges for younger adults with cancer: how to talk about their diagnosis with their young children. Damien says, “Telling my elementary school-age daughter that I might be dying is the worst thing I’ve ever experienced in my life. Seeing the look in her eyes was just gutting.”
Ms. Maya says, “At the center, we have developed a real expertise in counseling parents with cancer about how they can talk to their young children. The people I work with say they find our support really helpful.”Back to top
The Next Step in Research
Of course, the great big question in this field is why more young adults are developing colorectal cancer — especially those with no obvious risk factors.
“The answer is beyond the scope of this current study,” Dr. Cercek explains. “But it’s an urgent question for MSK and the Center for Young Onset Colorectal and Gastrointestinal Cancer.”
She continues, “We’re looking at this from many angles, including trying to figure out what changes might be happening prior to the tumor forming in the intestinal lining of a 20-year-old that we would expect to see in someone in their sixth decade of life.”
Another avenue of research for the center is expanding research into the genetics of tumors to get an even deeper and broader picture of possible targets for therapies.
MSK researchers are also pioneers in research into the microbiome — the complex community of bacteria, fungi, and other microbes that live in our bodies and help us digest our food and regulate our immune system. MSK investigator Melissa Lumish will be looking at whether something in the microbes in the guts of some young people is putting them at risk.
For Dr. Cercek and her colleagues, the urgency is clear: “This cancer is still relatively rare for younger people, and research is needed into many more patients, including patients from many different backgrounds. But the trendline is clear — the incidence is rising quite quickly and there is a population of people at risk. We need to figure out what’s happening and help.”
- MSK research among patients of different age groups suggests that colorectal cancer is not a distinct, more aggressive cancer when it develops in people younger than 50.
- The new MSK research finds that more aggressive treatment of younger colorectal patients because of their age is not warranted, since their tumors and outcomes are very similar to older patients.
- The research by MSK experts is the largest and most comprehensive look to date at colorectal cancer across different age groups.
- Colorectal cancer is on the rise among people in their 20s, 30s, and 40s, who are much younger than the average age of people who face this disease —typically in their 50s, 60s, and older.