I ‘m sure you couldn’t imagine getting a call from your doctor informing you that you have colorectal cancer. I am sure it would be more unbelievable if you were younger than 50, 40, or even 30. Unfortunately colorectal cancer is on the rise in younger patients. As a proctologist I have had the unfortunate task of informing young patients (younger than 50) that they have colon or rectal cancer. I hear more and more stories from patients who tell me of their close friend or relative, in their 30’s or 40’s, diagnosed with colon cancer. Some have metastatic colon cancer. I recently saw a 42 year old male in my office. It was not his first visit. I saw him, for the first time, 3 years ago at the age of 39. When he first came in he complained of bright red rectal bleeding and pain. I diagnosed a fissure-in-ano (anal tear). I saw him a month later in follow up and advised that he have a colonoscopy because he had rectal bleeding. Two and a half years passed and at the young age of 42 he was back in the office. On my desk was a stack of medical records. As I reviewed his records there were reports of colon cancer, surgery to resect a portion of his colon, and x-ray tests showing cancer in his liver. I checked my notes from his first visit and saw that we had a long discussion about a colonoscopy. I went into the exam room and we talked. He told me he remembered our discussion regarding a colonoscopy and stated he knew that if he had it performed he may not have been in this situation.
This story wouldn’t be so sad if it were the only case. Unfortunately it has happened more than once. Twelve years ago, a 42 year old successful woman came to see me for bleeding. I treated her hemorrhoids and requested she come back in 6 weeks for a colon evaluation. She showed up 2 years later, at the age of 44 with more bleeding. I did a short scope in the office and found a large and almost obstructing, rectal cancer. When I gave her the news that she had rectal cancer she was stunned and replied, “you know, you told me to come back to have my colon checked 2 years ago and I didn’t follow up as I should have”. Here was a young patient with rectal cancer. She underwent extensive chemoradiation therapy and then I performed her surgery to remove the tumor, the rectum, part of her colon and put the bowels back together. She required a temporary ileostomy as the colon was sewn close to the anus. She continued with 3 more months of chemotherapy. After the chemotherapy ended I performed the surgery to reverse her ileostomy. The whole process from start to finish took 12 months. Fortunately she is still alive and cancer free. It will be 10 years from her diagnosis this June.
When I see a young patient with bleeding, even if due to hemorrhoids, fissures, or other benign conditions, I always recommend a colonoscopy. It is never a simple decision for a young patient to undergo an invasive test, especially when they consider that they are so young and have such a small risk of cancer. Truth is, we are seeing more colorectal cancer in young patients than in the past because young patients can have polyps which can lead to colorectal cancer. I am not worried the young patient has cancer; I am concerned about colon polyps in young patients because it is polyps which can lead to colorectal cancer. If polyps are found and removed during a colonoscopy, colon cancer is prevented. I find polyps in many of my young patients requiring a colonoscopy. Once removed their risk of cancer is very small and we repeat a colonoscopy in 3 or 5 years depending on the polyp pathology.
For any young patient who is unsure of doing the procedure I tell them, “you can marry the wrong person, buy the wrong house or buy the wrong car. All of these poor choices will only cost you time and money to fix. You can look back at these mistakes and say, ‘gee I wish I would have made a better choice’ and there is still no harm. If you chose not to do a colonoscopy and develop cancer it isn’t just time and money which is wasted. You can’t look back and say, ‘gee I wish I would have made a better choice’, because with a diagnosis of cancer, there is a lot of harm”. Don’t ignore your health, it is the most important commodity you own, without it you have nothing!