Cancer originating in the digestive tract is classified as gastrointestinal (GI) cancer. Statistically, GI cancers have lower survival rates than other cancers, and are more likely to occur later in life. However, the last three decades has seen a dramatic increase in early-onset (<50 years) GI cancers. Confounding this, young people and their medical providers are less likely to suspect GI cancer, so diagnosis often occurs at later stages of disease. Dr. Rob Verhoeven is a senior epidemiologist of GI cancers at Amsterdam UMC and has published several papers on the phenomenon. “The detected trend is worrisome, in addition to the increase of incidence at a young age it suggests that the persons currently in those young age groups might also have a higher incidence of GI cancers when they are older,” notes Dr. Verhoeven.
An untrendy trend
The increase in early-onset GI cancers cannot be explained by either genetic factors or better detection and screening. So, what is driving the increase in early-onset GI cancers?
In a review published this month in the highly regarded journal Cancer Discovery, an international team of collaborators including Professor Hanneke van Laarhoven from Cancer Center Amsterdam scrutinized the data from several large cancer registries to identify probable causes and the unique needs of younger patients.
“The relatively low proportion of hereditary cases among the early-onset GI cancer population indicates a potential key role for environmental and behavioral factors in its pathogenesis,” says Prof. Van Laarhoven.
Defining the trend-setters
Dr. Verhoeven agrees. “The most logical explanation for this increase is in behavioral factors, mainly related to an unhealthy lifestyle.” Indeed, obesity, inactivity, and a Western diet are known risk factors for GI cancer. New research corroborates this, suggesting foods with a high–glycemic load like white bread and pasta can trigger a cascade of detrimental health effects. Furthermore, an unhealthy lifestyle not only derails the finely-tuned epigenetic interconnections but also the complex biochemical interactions between the microbiome and immune system. Young people should heed these health warnings, because despite having better odds of surviving GI cancer, the impacts of treatment are likely to affect their life trajectory.
Cancer impacts unique to young people
For many young people, early-onset cancer occurs during the most productive time of life when body image, finding a partner and having children is the priority. It is a time when career progression is important and family responsibilities are greatest. Relationships are further strained due to lower energy levels and sexual drive caused by illness or treatment side effects. “This emphasizes a more urgent need to avoid surgical interventions that severely affect patients’ body image or carries a risk to impair their sexual and reproductive functions,” note the authors of the review.
Treatment and surgical impacts
“Young patients that survive their cancer can have long-term effects resulting from their diagnosis and treatments,” explains Dr. Verhoeven. For example, rectal cancer patients may suffer from incontinence, frequent bowel motion, urgency, or sexual dysfunction. For gastro-esophageal cancer patients, the longevity of surgical reconstruction is particularly critical and nutrition, weight loss, diarrhea, and reflux are common challenges. Realistically, younger patients should anticipate repeated interventions over their lifetime.
Some treatments can lead to cardiovascular disease and heart failure, while chemotherapy can increase the risk of future cancers. Impacts on fertility vary and, while most chemotherapy drugs only have a very mild toxic effect, certain combinations can cause short-term infertility. Pelvic radiation in females can increase the risk of infertility, sexual dysfunction, or pregnancy complications. The authors note that the effects of newer radiation treatments on the uterus such as intensity modulated radiotherapy (IMRT) urgently requires more research.
Future Research implications
Based on the treatment impacts and the personal priorities of young people, the international collaboration recommends that future research should:
- Focus on early detection through optimal screening.
- Assist healthcare policy makers in developing risk reduction strategies due to the strong link to lifestyle.
- Better understand the role of the microbiome.
- Address the unmet psychosocial needs of young patients.
Going forward, these initiatives should help manage the growing incidence of early-onset GI cancers. But prevention is always the best option. Dr. Verhoeven sums it up perfectly: “A lot of the risk factors are related to an unhealthy lifestyle. Young, but also middle-aged and older Dutch people, should ideally switch to a healthier lifestyle behavior and be sure to participate in colorectal cancer screening.”
For more information contact: Hanneke van Laarhoven.
Read the full article here:
Irit Ben-Aharon, Hanneke W.M. van Laarhoven, Elisa Fontana, Radka Obermannova, Magnus Nilsson, Florian Lordick; Early-Onset Cancer in the Gastrointestinal Tract Is on the Rise—Evidence and Implications. Cancer Discov 13: 538–551. https://doi.org/10.1158/2159-8290.CD-22-1038
Researchers affiliated with Cancer Center Amsterdam
Prof. Hanneke van Laarhoven
Dr. Rob Verhoeven (not involved in the Cancer Discovery review article)
Text by Lynita Howie.
This article was created for Cancer Center Amsterdam.
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