The disturbing rise of colorectal cancer among the youth

When 37-year-old Michael Oloo began experiencing intermittent stomach upsets, acid refluxes and heart burns, he shrugged it off as a side effect of the back therapy he was undergoing. He was not worried about it. He had fallen off a six-metre high roof and that had left him with a lingering back pain that he was seeking treatment for.  

“I took antacids for my troubles but the pain did not seem to abate. That is when I went to see a specialist. He recommended a change of diet and prescribed some medicines,” says Mr Oloo.

The symptoms persisted, and worsened over time. In fact, the medicines seemed to aggravate the condition. He had also detected bloodstains in his stool.

Unbeknownst to Oloo, his body was in the throes of battling a cancer that was eating away his gut; specifically the colon and rectum.

While colorectal cancer has always been quite rare, and classed as a disease for older people - above 55 -, it is steadily rising among the younger population. About a month ago, the world was rocked off its feet by the death of the prolific actor Chadwick Boseman. At age 43, Chadwick lost the battle after four years battling the disease.

Just like Oloo, Chadwick was in his late 30s when the disease reared its ugly head and was diagnosed with Stage III colon cancer in 2016.

A study on colorectal cancer carried out in 2017 and published in the Journal of the National Cancer Institute showed that while the incidence of colorectal cancer was declining among the older generation, it was increasing among young adults.

While the study does not expound much on the exact reason why this is so, it notes that some of the increased colorectal cancer cases may be because of the rise of better developed diagnostic and screening tools.

A separate study published in the peer-reviewed BMC Cancer journal five months ago confirmed that there was indeed a growing trend of young people being diagnosed with colorectal cancer. Some of the major findings of the report indicate that the risk of young-onset colorectal cancer in adults less than 50 years of age has increased in the past two decades.

Changing diet in Africa

In a bid to explain the rising numbers, medics have increasingly cited changes in dietary habits and a sedentary lifestyle as some of the glaring factors fueling the rise of colorectal cancer cases among the younger generation.

Primus Ochieng’, an oncologist who specialises in colorectal cancer at the Kenyatta National Hospital, says historically, colorectal cancers were rare in sub-Saharan Africa due to the staple high fibre diet in the region. Sub-Saharan Africa comprises of countries south of the Sahara desert.

“But, our dietary habits have gradually changed to adopt the western world kind of diet that is very refined. Other risks associated with colorectal cancer in the young population include inheriting from family,” Dr Ochieng’ points out.

The specialist says the resulting obesity from the poor diet and lack of physical activity, coupled with consumption of alcohol and smoking, is contributing to the rising cases of cancer among the youth.

“Many of the patients have had a history of overindulging in animal fats, red and processed meats and not eating nearly enough fruits and vegetables,” he explains. 

While the treatment for colorectal cancer is quite straightforward, a late diagnosis complicates the process.

Oloo had five years pass as he went through prescriptions to deal with his stomach upsets and acid refluxes; symptoms that worsened over time.

“I was okay for as long as I took these medicines, but as soon as I was done with the dosage, the symptoms would be back and stronger,” he recalls.

Even when a gastroentologist recommended further tests; a colonoscopy and an endoscopy, it would take Oloo another year to go back to see the doctor.

He would, however, be spurred into action when one day chunks of blood came out as he passed stool. That got him extremely worried and a quick visit to the doctor showed that he had Stage III colorectal cancer. So in April 2015, Oloo was wheeled into the theatre and underwent a surgery, which entailed taking out part of the rectum as it had been badly damaged by cancer.

“They also had to drill a hole in my stomach and fit it with a stoma bag, in which the stool would be emptied,” he explains, describing a procedure referred to as a colostomy.

It has not been easy for Oloo walking around with the special bag supposed to collect his stool. “There are many adjustments I have had to make in my life to accommodate the bag. I even joined a support group called the Stoma World Kenya.

The stoma bags cost a pretty penny too. A bag goes for Sh1,300.

“Through the group, I got to learn how to maximise the use of the bags and have one last me up to five days,” says the 47-year-old.

Late treatment and poor outcome

The late diagnosis for Oloo is not a unique case. Majority of the cancer’s diagnosis happens late because it is often mistaken for other stomach issues.

“That is what makes the major difference between the outcomes of colorectal cancer in young people and the older ones because among the young it is often misdiagnosed and when finally discovered, it is at its final stages; stages III and IV. Then it also quickly spreads to other parts of the body,” says Ochieng’.

An analysis by the US National Library of Medicine National Institutes of Health shows some of the symptoms of the cancer such as fatigue, constipation and rectal bleeding could often be caused by many noncancerous conditions that are much more common in younger adults.

“These symptoms can also point to other conditions like haemorrhoids. And cancer would not be high on the list of issues for the young generation.”

Development of the cancer

According to Ochieng’, almost all colorectal cancers arise from polyps, which are abnormal tissue growths that most often look like small, flat bumps or tiny mushroom-like stalks.

“However, not all polyps become cancerous. About 10 per cent to 15 per cent of polyps develop into colorectal cancer. It takes about five to 10 years for a polyp to develop into a colon cancer.”

To detect cancerous cells in the colon, a patient is expected to undergo a colonoscopy or a faecal occult blood testing. Genetic testing is also recommended for those with positive family history.

For early stages of cancer, most doctors recommend removal of polyps in a minimally invasive approach. However for more advanced colorectal cancer cases, surgeons often recommend a procedure known as partial colectomy. This is the removal of a section of the colon that contains the cancer along with a margin of normal tissue on either side of the cancer.  It is after this procedure then that a stoma bag is fitted to enable the patient recover while performing normal digestive system processes.

Often when a patient presents themselves with stage II of the cancer and some with stage III they may have chemotherapy after surgery to increase the chance of eliminating the disease.

Stage IV cases are however often not curable due to the likelihood of having spread to other organs. That said, the growth of the cancer and the symptoms of the disease can be managed.

Oloo, who began cancer treatment at stage III, did not go through chemotherapy and now has to go for check-ups often to ensure that his recovery is progressive.

 Warning signs

During the early stages of the cancer, stage I for instance, there are no obvious symptoms for this condition, but as the cancer progresses, it often causes major changes in the stomach, which come with symptoms like

·  Acid reflux

·  Rectal bleeding

·  Persistent abdominal pains and diarrhea

·  A change in your bowel habits, including diarrhoea or constipation

·  Also a change in the consistency of the stool should also be a warning sign