Latest / Talking FACS / Cancer Conversations: Early-Onset Colorectal Cancer

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Cancer Conversations: Early-Onset Colorectal Cancer · Talking FACS

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  Welcome to Talking FACs, and thank you for tuning in to Cancer Conversations
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  on Talking FACS, a podcast collaboration between the University of Kentucky
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  Markey Cancer Center and the UK Martin Gatton College of Agriculture,
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  Food and Environments Cooperative Extension Service.
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  We will share with you the latest developments in cancer prevention,
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  diagnosis, treatment and research from the experts at Markey Cancer Center,
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  Kentucky's only National Cancer Institute designated Comprehensive Cancer Center.
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  Talking FACS is hosted by the UK Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  Hello and welcome to Cancer Conversations on Talking FACS.
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  In partnership with the Markey Cancer Center, we bring the latest research news
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  to Kentuckians so that we can all improve our quality of life.
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  I am your host, Mindy McCulley, Extension Specialist for Instructional Support
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  with Family and Consumer Sciences.
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  Cancer is a problem across the state that many of us have faced in a lot of different ways.
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  My guest today is Dr. Erin Wolf-Horrell, who is an Assistant Professor of Colorectal Surgery.
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  Welcome, Dr. Wofl- Horrell.
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  Thank you so much for having me today. We are going to talk about this important
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  issue that is facing so many people across Kentucky, but before we get started,
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  would you just share with me a little bit about what your role is here at the
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  University of Kentucky Market Cancer Center?
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  Absolutely. So I have actually two roles at the Cancer Center.
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  So I'm a colorectal surgeon. So I see patients who are diagnosed with cancers
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  involving the colon, the rectum, and the anus.
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  And I treat these patients both clinically and surgically.
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  And then I also have a research role where I look at specifically early onset colorectal cancer.
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  So that's cancer diagnosed in patients under the age of 50.
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  And I look at both the epidemiology of these patients as well as basic science
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  component trying to identify the mechanism of why this cancer is occurring in
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  patients who are so young.
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  Let's talk about those younger patients. Why are we seeing morecolorectal cancers
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  coming up in younger patients?
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  So we actually don't have a great explanation for that. This is a phenomenon
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  that we've been seeing since about the early 1990s.
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  And we think it's related to this big environmental shift that started in the
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  1950s where we have more processed foods,
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  more sedentary lifestyle, and we think that all of these environmental effects
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  are affecting individuals across the country and across the world,
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  but we don't have a great idea of the mechanism of how this is happening.
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  So when you see these colorectal cancers in younger patients,
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  are they different than the cancers that are in patients of more advanced ages?
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  Yes. So younger patients tend to present with what we call left-sided colon
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  cancers or rectal cancers.
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  So when we think about the colon, it sits like a picture frame around the abdomen.
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  And so it starts on the right side, goes across the middle, and then goes down
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  the left, transitions to the rectum, and then exits through the bottom.
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  And younger patients are more likely to have cancers, like I said,
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  on the left side or in the rectum than they are on the right side.
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  And they also tend to present more advanced than patients who are older.
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  And there are kind of several different reasons why we think that is.
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  One of them is a delay in diagnosis. When these patients are presenting with
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  symptoms, the symptoms are often attributed to other disease processes rather
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  than cancer. And these patients are before the screening age for colon cancer.
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  And so they are only diagnosed after they present symptomatically.
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  And we also know that these patients have, they actually have different molecular
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  markers when we are looking at the cancers compared to older patients.
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  So they have different mutation profiles.
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  And so we do think it is a distinct disease process. How are the diseases presenting
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  for your patients? Yeah, so most patients who are younger present with symptoms.
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  So they either present with bleeding, with bowel movements, or with fatigue
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  and tiredness that's associated with bleeding that we can't see.
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  And they often present with abdominal pain or even obstructive symptoms,
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  which is a blockage where the cancer has grown all the way across the colon or the rectum.
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  And so it's very hard to have a bowel movement. And so those patients have a
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  lot of bloating and abdominal pain.
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  Do you see it more in males or females?
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  It's actually in both, both genders.
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  Okay. And are these people who have had bowel issues throughout their whole life or is it new?
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  Oftentimes, it's new. Okay. All right. That is kind of reassuring to know that it's new.
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  So, at least they can know that if something happens that's not familiar,
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  then they really do need to get that checked out, right? Absolutely. Absolutely.
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  But as we talk about screenings, at what age should people start screening?
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  So, people who are at an average risk should start getting screening for colon
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  and rectal cancer at age 45.
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  Anyone who is at an increased risk would start before that.
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  And particularly, those are patients who have a known family history and a first-degree relative.
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  So a parent, a sibling, those patients should start at least 10 years prior or at a minimum at age 40.
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  Okay. Are there other diseases that might lead to colorectal issues?
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  Yeah, so there are definitely diseases that are associated with an increased
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  risk of getting colon and rectal cancer.
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  Patients who have inflammatory bowel disease are at an increased risk and they
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  have screening guidelines that are specific to that disease process.
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  There are also individuals who have a known cancer predisposition syndrome,
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  where they are at a very high risk of getting not only colon and rectal cancer,
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  but other types of cancers as well.
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  But the interesting and really concerning thing about early onset colorectal
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  cancer is that a majority of these cases are sporadic and so are happening in
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  patients who don't have these increased risk factors.
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  Before we wrap up, are there any last thoughts that we need to share with listeners
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  to make sure that they are looking out for symptoms that might lead to colorectal cancer?
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  I think the major thing is to advocate for yourself. We've
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  done a really good job as we've seen this phenomenon of
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  educating the medical community and so
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  educating primary care physicians to bring awareness to this increased incidence
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  so that everyone has a high index of suspicion if you are experiencing any of
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  these symptoms that we don't attribute it to something else and that we make
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  sure patients are getting colonoscopies appropriately.
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  And I think it's particularly important in the state of Kentucky because we
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  are in the top five for incidence rate of colon and rectal cancer.
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  And we're also in the top five for mortality rate in the country because patients
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  are diagnosed late oftentimes.
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  Thank you so much for your time. I know that this is a very important topic.
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  And of course, we want to make sure that we can bring down those numbers a little bit.
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  Absolutely. Thank you so much for having me. It's been an absolute pleasure.
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  Thank you again. If you are just tuning in, you're listening to Cancer Conversations
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  on Talking FACS, and you can find us wherever you listen to your favorite podcast.
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  Thank you for listening to Cancer Conversations on Talking FACS.
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  Our goal is to connect you with the latest advances in cancer research in the Commonwealth.
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  If you enjoyed today's podcast and have a suggestion for a future show topic,
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  Please message us on the UK Markey Cancer Center Facebook page at facebook.com
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  forward slash UK Markey or visit our website at markey.uky.edu for more information.
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  You can find University of Kentucky Family and Consumer Sciences Extension programs
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  at your local Extension office or online at fcs.uky.edu.
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