April 18, 2017 - Matt Wixon is not the typical colon cancer patient. He has none of the risk factors sometimes associated with the cancer — he is active and fit, eats healthy and smoked only for a very short time. But, most unusual of all, Wixon is young — he was 39 when he was diagnosed with stage 4 colon cancer last December.
However, Wixon and patients like him are the new faces of colon cancer. A study published February 28 in the Journal of the National Cancer Institute found that colorectal cancer rates are rising in people under age 50, who will make up one in ten of the 135,500 new cases of colorectal cancer expected to be diagnosed in 2017.
That means that people born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to people born in 1950.
Of the 1,000 GI cancer patients seen at his clinic last year, nearly half were under age 50, says John L. Marshall, MD, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown Lombardi Comprehensive Cancer Center and chief of hematology and oncology at MedStar Georgetown University Hospital. Many are in their 20s and 30s; one was just 17.
“This has been a trend that has become an alarming issue in the last decade,” he says. “Treatment of colorectal cancer in patients over 50 has improved — there is less cancer and lower mortality — but we seem to be trading that good news for this really disturbing trend that people in the prime of life are getting a diagnosis no one was expecting.”
Finding the silver lining
That was certainly true for Wixon, a patient at the Ruesch Center, who owns a moving company. When he received his news, he and his wife were anticipating the birth of their first child.
“This is a grave diagnosis that came as a shock, an existential threat,” says Wixon. “This was two weeks before Christmas and my wife was seven months pregnant with a boy. All the plans I had for our son— the books I would read to him, the vacations we would take, the joy we would have — just vanished.”
Wixon had noticed some changes in his bowel habits, but they weren’t severe and hadn’t been going on for long. Still, when he met with his gastroenterologist, who suggested he might have hemorrhoids, Wixon insisted on a colonoscopy. Knowing that the test would not be covered by insurance, he was concerned enough that he was ready to pay for the test out of pocket.
Now he is on three different drugs, several of which require infusions every two weeks. Wixon makes the most of these events. “I bring friends, read books, joke around a lot with the really extraordinary nurses and staff at Georgetown.”
Wixon tries to find the silver lining in the cloud hanging over his head. He knows his youth is a benefit and sometimes he finds it hard to believe he is as sick as he is. He is active on “Colontown,” a Facebook group that Marshall told him about, where he has found “hope and solace.” He is planning for the day when he is healthy enough to have surgery that can remove the tumors that have metastasized in his liver.
Lots of theories
Marshall doesn’t know why this trend is happening, nor do other colorectal experts. “I did not sign up to be a cancer doctor for young people,” he says. “Most of my young patients are marathon running, cardboard eating people.”
But he suspects one player may be an altered microbiome, the galaxy of symbiotic bacteria that live in the human gut to aid digestion. “There is a beautiful coral reef of bacteria in the colon, but the reef may be dying or altered in some people due to modern habits — too much use of antibiotics and antibacterial hand wash, for example, that could reduce the known effectiveness of bacteria in protecting against cancer,” he says. But Marshall is the first to say there are many theories.
Mohamed Salem, MD, a gastrointestinal oncologist and researcher at Georgetown Lombardi, is among a team of investigators studying the foundations of young onset colon cancer. He is exploring whether colon cancer in these patients is more aggressive, and, if so, why, and where it occurs, whether on the left side or right, which matters in terms of outcome and drug treatment.
Then there is the question of diagnosis. No one imagines giving every person younger than 50 a colonoscopy, Marshall says. And for those with some symptoms, there are less invasive and cheaper screening tools than a colonoscopy. But it is important that frontline health care providers, such as primary care doctors, know about the real risk of colon cancer in young people, and “that they take it seriously,” he says.
“All I can say is that people really need to pay attention to their bodies, and if there is something real going on, they should not hesitate to be assertive with their doctors,” Wixon says. “So many people are afraid of bad news. But it will only get worse if you wait.”