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Colon cancer often misdiagnosed, delayed treatment in many younger patients

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By Linda Carroll

Many younger patients with colon cancer are initially misdiagnosed, which often leads to the discovery of their advanced disease.

The researchers also found that for many younger patients, it required several visits before the correct diagnosis was made, according to the survey results, presented Wednesday at the annual meeting of the American Association. for Cancer Research.

"We need to educate people that colon cancer affects not only the elderly but also the youngest," said Ronit Yarden, director of medical affairs for the Colorectal Cancer Alliance, a patient advocacy organization in Washington, DC. cancer, colon cancer is one of the most preventable cancers and, if misdiagnosed and then discovered at a later stage, one of the deadliest. We need this information to reach both patients and physicians. "

According to Yarden, the biggest problem is that many patients and doctors still believe that colon cancer does not occur in young people.

And this is particularly important since colorectal cancer rates have increased among young adults.

Between 2009 and 2013, colorectal cancer rates decreased by 4.6% per year among people aged 65 and over and by 1.4% among people aged 50 to 64, according to the American Cancer Society . But they increased by 1.6% among the under 50s.

The cancer society estimated that in 2017, there would have been 95,520 new cases of colon cancer and 39,910 cases of rectal cancer diagnosed in the United States. It is the third most commonly diagnosed cancer in Americans, according to the American Cancer Society.

For the new survey, Yarden and her colleagues contacted young patients and survivors through the organization's social media sites to learn more about the difficulties patients face in getting a diagnosis.

Of the 1,195 respondents, 57% reported being diagnosed between 40 and 49 years of age, 33% diagnosed between 30 and 39 years old, and about 10% under 30 years of age.

Why does a youngster even think that his symptoms are related to colon cancer? Colon cancer is often considered a disease in the elderly.

The survey found that at least 63% of patients had waited until the age of one year before consulting a doctor, with a delay of at least a year. And more than two-thirds of patients consulted at least two doctors before obtaining an accurate diagnosis. Some had to consult up to four doctors.

Other key findings:

  • 71% were diagnosed at stage III or IV, unlike patients over 50, most of whom are diagnosed at stage I or stage II.
  • 67% consulted at least two doctors before being properly diagnosed, and some saw up to four.
  • A large number of patients had major risk factors for colon cancer, of which 30% had a family history of the disease and 8% had Lynch syndrome.

Part of the problem, for both doctors and patients, is that the symptoms can be vague and suggest a number of other conditions, Yarden said. Nevertheless, if a person experiences more than one symptom, this should sound the alarm.

Symptoms of early warning

Patients in the survey showed typical symptoms of colon cancer, Yarden said.

  • 50% had constipation
  • Rectal bleeding in 50 percent
  • About 40% had blood in the stool
  • About 40% had swollen stomachs and a lot of abdominal pain
  • 30% were tired while they were young and active

The new survey underscores the need for education about early-onset colon cancer, said Dr. Felice Schnoll-Sussman, a gastroenterologist at New York-Presbyterian Hospital and Weill Cornell Medicine. .

"It is sad but not at all surprising to discover that many patients who develop colon cancer before the age of 50 were initially misdiagnosed," Schnoll-Sussman said in an email. "First of all, why does a young person even think that the symptoms he is experiencing are related to colon cancer? Colon cancer is often considered a disease in the elderly. As a result, they may not consult a doctor until they have had symptoms for some time, and then run the risk of being diagnosed at a later stage, which is less easy to treat. "

Check the blood

Patients are not the only ones who need to understand that young people can develop colon cancer, said Schnoll-Sussman.

"Doctors need to have the possibility of colorectal cancer in younger patients on their radar screen," she told NBC News.

Young people need to be more attentive to their symptoms, especially with the appearance of blood, said Dr. Thomas Imperiale, a gastroenterologist, researcher at the Regenstrief Institute. "People need to look for blood in their stools and toilet paper," he said.

Doctors need to ask more questions when a new patient arrives, said Imperiale. "They have to learn about the symptoms, including whether the patient has ever seen blood on the toilet paper," he added. "The provider must also consider family history for all cancers."

The current recommendations encourage people to begin screening for cancer at the age of 50. The American Cancer Society recommends starting screening for colon cancer starting at age 45.

Imperiale does not support the lowering of colon cancer screening age, as this could result in more invasive colonoscopies in an age group with a lower risk of cancer. The colonoscopies are not completely benign, said Imperiale, noting that the procedure was associated with a number of serious complications, including perforation of the colon in one in every 1,000 patients.

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