When Dr. Ryan Smith began his career as a colorectal surgeon, it was uncommon for him to treat patients under the age of 50 with colorectal cancer. That trend has changed in recent years.
“We are seeing it much more frequently, even in patients in their 30s,” said Dr. Smith, a board-certified colon and rectal surgeon with AdventHealth Medical Group Colorectal Surgery at Castle Rock. He recently treated a 34-year-old patient with the disease.
Data from the past decade shows that while colorectal cancer rates have declined among people over 50, the rate for those under 50 has increased by 2.4% each year. According to the American Cancer Society, one in five newly diagnosed patients is 50 or younger.
Dr. Smith noted that the causes of this rise remain unclear. “Without knowing what’s causing these cases, we can’t identify who is at risk and screen them,” he said.
Because there are no targeted screenings for early onset cases, Dr. Smith stressed the importance of paying attention to symptoms such as abdominal pain, blood in stool, constipation or diarrhea, and unexplained weight loss.
“It’s really easy to write these off as IBD (irritable bowel syndrome), anxiety, nerves or hemorrhoids,” Dr. Smith said. “But don’t gaslight yourself into thinking your symptoms are nothing. Go get checked out.”
He advised that if symptoms persist after treatment, patients should return to their provider. “Be an advocate for yourself,” Dr. Smith said. “Ask whether you should have a colonoscopy; make sure you’re being evaluated completely. Don’t stop until you’re given a definitive answer.”
Treatment for colorectal cancer is tailored to each patient, taking into account factors such as age, genetic characteristics of the tumor, lifestyle, and personal goals. Dr. Smith explained that younger patients may require different surgical approaches due to their longer life expectancy and considerations related to sexual function and fertility.
“For a younger patient with a longer life expectancy, I might remove a larger portion of the colon to reduce the risk of recurrence,” Dr. Smith explained. “But if the cancer is located near critical nerves in the pelvis, I might take a more conservative approach to preserve fertility and reduce long-term side effects.
“There’s no one-size-fits-all answer. It’s a conversation,” Dr. Smith said.
Colonoscopies play a key role in detecting colorectal cancer early and can also prevent cancer by removing polyps before they become malignant. In response to rising early onset cases, national guidelines were updated in 2021 to recommend that average-risk adults begin screening at age 45. Those with normal results typically do not need another colonoscopy for ten years.
Individuals with risk factors—including family history of colorectal cancer, personal history of inflammatory bowel disease or polyps, prior abdominal or pelvic radiation, or certain genetic mutations—should consult their provider about when to begin screening and how often to repeat it.
AdventHealth Orlando, located in Orlando, Florida, was founded in 1908 and is led by President Terry Shaw. The hospital includes a pediatric ward and serves as a training facility.
Dr. Smith encourages anyone aged 45 or older, or those experiencing symptoms associated with colorectal cancer, to schedule a colonoscopy with AdventHealth Medical Group Gastroenterology at Castle Rock.
