Colon Cancer
Why colorectal cancer rate is raising among young adults?
What are the symptoms of colorectal cancer?
Are there other screening tests besides colonoscopy for colorectal cancer?
I will answer these questions with a case presentation from my own medical practice. Because in my personal experience, when I organized case related information and knowledge into a narrative, I always learned easier and remembered better:
A 28 year old young girl came to my office, accompanied by her fiancé, complaining of rectal bleeding. She was told by another doctor that bleeding was due to hemorrhoids and given some OTC medications. but bleeding continued and the real diagnosis was delayed.
Hemorrhoidal bleeding is bright red, fresh and almost always occurs with bowel movements. It stains the stool from the outside. Her bleeding was mixed with stool and she will bleed even without bowel movements. Additionally she had a low grade anemia and fatigue. When I asked her, “what makes bleeding worse?” She, after looking at her fiancé, said “anal intercourse”. In her family history there was one member of her close relative with diagnosis of colon cancer at an early age.
Depending on these findings, I told them that this is not hemorrhoidal bleeding and she needs a colonoscopy with biopsy ASAP for a definite diagnosis. Colonoscopy revealed a large tumor mass in the left colon .surgery saved her life , because the tumor was localized to the bowel wall.
This case raises four very important questions which should be discussed openly and I invite my readers to kindly participate
1-This is a very young age to have colon cancer. Why is colorectal cancer rate increasing among young adults?
2- Should colon cancer screening age begin earlier than 50 ?
3-Eventhough a colonoscopy is the gold standard for screening aren’t there some other less invasive and painless screening tests for colon cancer?.
4- Why anal (rectal) intercourse is such a common sexual practice even among heterosexual people?
Since 1970, colorectal cancer rate is increasing about 3% annually among young adults. Colon cancer in these population is more aggressive and usually the diagnosis is delayed because neither patients nor the general public or even doctors think that colon cancer could be seen in young people. For this reason colon cancer signs are ignored and the diagnosis is delayed.
Unfortunately the real cause of increasing colon cancer rate in young adults is not known. Besides hereditary predisposition, several environmental factors such as changing dietary habits, fast food culture, GMO foods, lack of vegetables and fruit consumption, altered guts bacterial flora ( dysbiosis), obesity, sedentary life style could play important roles.
Because of the fact that colon cancer is increasingly being diagnosed among young adults the ACS ( American Cancer Society ) recently changed recommended screening age from 50 to 45 years of age I disagree, if there is a family history of colon cancer, screening should start 15 to 20 years before age 50. If a young patients has symptoms or risk factors, such as chronic ulcerative colitis, Crohn colitis, morbid obesity possibility of colon cancer diagnosis should not be suppressed because of patient’s age.
Colorectal cancer is the second leading cause of cancer related deaths. Fortunately this deadly disease is preventable by screening and early diagnosis, getting tested is the key for prevention, When we see a young patient with colon cancer, we should immediately think of hereditary colon cancer syndromes, such as Lynch syndrome and FAP (familial adenomatous polyposis) and this patients and their family members should be referred for genetic testing and counseling.
There are less invasive and painless screening tests for colon cancer. These tests are: sigmoidoscopy, barium enema, virtual colonoscopy, fecal immunochemical test (FIT) for blood in the stool and, stool DNA test (Cologuard ) .But if any abnormalities detected , colonoscopy still have to be done. These tests are done on patients who needs more frequent screening.
Eventhough I am not a sexologist, I know that rectal intercourse is a common practice even among heterosexual people. To me this is an acquired and aberrant sexual behavior , influenced by increasing availability of pornography and porno culture. Rectum is not a sexual organ. Its function is to collect stool, differentiate between bowel gas and stool, while letting gas to be expelled any time, stool is evacuated only at the most appropriate time and place . For these reasons rectum is very rich of nerve endings. In addition, rectum has very strong , squeezing sphincter muscles. But rectal intercourse may be pleasurable but it is dangerous in the long run. It will cause many sexually transmitted diseases (STD ), rectal ulcers, sphincter muscles disfunction, bowel prolapsus, pelvic floor muscles dysfunctions, constipation and stool incontinence.
