In Greek mythology, there were three “sisters” or fates who decided what would happen to mortals during their lives. The Greeks believed that people were connected to the source of life by a divine thread. Clotho, the eldest of the three sisters, spun this thread while her younger sisters, Lachesis and Atropos, determined how much thread (longevity) a person had. Atropos, sometimes portrayed with a pair of shears, cut the thread at death. As one of the ancient philosophers in Greece described them, “The Fates lead those who are willing and drag those who are unwilling . . .” to their death.
Who was their father, and who bore them? Different sources provide contradictory accounts. The general consensus is that they were created around the time that the world and all living things came into existence. Their roles were to ensure that every mortal had the opportunity to meet their destiny. The thread Clotho wove contained both joys and sorrows, as well as hopes and fears. Taken in the context of thousands, perhaps millions, of other threads representing other people, they were all included in the fabric of life—one grand tapestry documenting human history on this planet.
Woven perhaps as early as the 12th century AD, this tapestry is almost as long as a football field! Think of each of the
threads as representing a particular human life from birth to death. One thread is perhaps a single foot soldier who
died in battle while another thread one who reached old age. Yet another thread a knight, a groom or an armorer.
When their lives are collated and woven together by Clotho and her sisters, they represent this particular event in
human history. Credit Creative Commons.
Disease
Disease is often predictable. If you have certain risk factors, you are prone for heart disease or stroke. This could happen almost anytime after your diagnosis is confirmed. However, many diseases, particularly the chronic ones take time to become a problem. Prepubescent boys rarely have prostate problems. For men in their seventies, it is rare if they don’t have genitourinary issues. To go through menopause, you must first have encountered menarche.
The problem
Today, many millennials (1981-1996) and early Zoomers (1997-2012) are finding themselves afflicted with potentially deadly diseases that, in the past, were almost exclusively associated with people sixty-five and older. In this sense, these young people are being dragged unwillingly to what we perceive as premature deaths, leaving small children, shattered dreams, massive debt and grieving loved ones in their wake.
The objective of this and subsequent posts is to identify and describe these diseases, offer possible explanations for why this might be happening, and mention treatments that your doctor might or might not consider appropriate for your circumstances. Each of these diseases involves cancer, and I will present the four disorders that are appearing with increasing frequency in people of early middle age, if not sooner.
I want to provide an important caveat. I am not a physician, and I cannot offer medical advice. I am a cancer patient myself and I do blog on cancer among other topics using the professional literature. As a retired educator, I have learned to make difficult concepts easy to understand. However, you should always check with your doctor before modifying, or abandoning any prescribed therapy.
Cuatro enemigos
The fastest-appearing and most surprising cancers for doctors to diagnose in the 18–35 age group include colorectal cancer, breast cancer, lung cancer and pancreatic cancer (in that order). Among colorectal cancers, the incidence between men and women is roughly the same. However, in breast cancer and lung cancer, women are afflicted in greater numbers than men. This is also true of the fourth greatest threat (pancreatic cancer).
How people contract cancer
People develop cancer for many different reasons. Smoking is the most common cause people get cancer and alcohol consumption is not far behind. We all know that smoking causes cancer, but why and how does alcohol? It is because an important chemical compound called Acetaldehyde is produced when alcohol is broken down in the liver. Acetaldehyde can damage a person’s DNA in ways that leads to malignancies. Diets high in red meat and low in fiber as well as processed foods also have been identified as making one suseptible to cancer either directly or indirectly. Also, a sedentary life style that includes exposure to more than the recommended amount of radiation, whether from the sun or from work environments canlead to cancer. Certain chemicals, such as dioxin and the creosote build-up over time in your chimney can also lead to cancer. Additionally, contracting specific viruses, such as the human papillomavirus (HPV), is a risk factor. While men can develop cancer from HPV, women are particularly at risk once again. Fortunately, an effective vaccine against HPV is readily available.
Genes
Hereditary factors also play a significant role in cancer development. Some individuals carry what are known as oncogenes. These arise from proto-oncogenes, which perform useful roles in cell growth. Oncogenes contribute to cancer in at least two ways. First, they can “turn on” a body’s instructions to produce cells, but in a manner that the body cannot “turn off,” leading to uncontrolled growth. Second, oncogenes can suppress the immune system by disrupting signals that would typically mobilize the body’s natural defenses.
As a result, oncogenes behave erratically, producing cells that the body cannot stop from reproducing, with some cancerous cells surviving longer than normal cells, sometimes indefinitely. Over time, generations of new cells are produced with errors in their DNA. For instance, one might think that an abnormal growth of normal cells on the thyroid gland could be resolved simply by removing it. This approach can be effective for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) skin cancers if detected early enough. However, in other cancers, surgeons cannot guarantee that they have removed every single cancerous cell; it only takes one of these cells to migrate to another organ in the body and work its mischief there. Some cancers can be effectively managed with chemotherapy—like my bladder cancer was—but what worked the first time will likely not be as effective the second time, as chemotherapy treatments using the same medication typically become less effective over time with the particular cancer.
The BRCA genes
For our purposes here, the human body has 20,000 to 25,000 genes that reside on the 23 pairs of chromosomes that we have. Genes determine our eye color, our blood type, the shape of our nose, and thousands of other things. These genes include the BRCA1 and BRCA2 genes which you may have heard of. While the BRCA prefix to these gene stands for breast cancer, these two genes are capable of causing other types of cancers as well, such as ovarian cancer in a woman. Many women ask their oncologist whether they have the BRCA gene. In fact, almost every single woman and every man have these two genes in pairs (one from each parent).
These two genes start out to be “good genes”. BRCA1 looks for damaged genes and selects them for repair while BRCA assembles proteins need to repair the damaged DNA. However, sometimes the genetic damage is to the BRCA genes, themselves. A damaged BRCA1 gene can lead to ‘triple negative breast tumors1
Read more on the BRCA genes here.
One more note: As a rule, I document sources whenever possible, but many of the sources here are found behind a elaborate network of paywalls. I personally either pay for access or have institutional access to these articles; otherwise, they would be difficult (i.e., costly) to obtain. If there is a specific point that I mention that piques your curiosity, please contact me, and I’ll gladly provide some original source citations with the journal article(s) intact.
Colorectal cancer
In the early history of medicine, cancers of the colon and rectum were often referred to as “occult” cancer. The word “occult” means “hidden” and therefore not observable in the same way as skin cancer or cancer of breast is. There is a comment in an ancient document (1,500 B.C.) called the Ebers Papyrus that men tions cancer. (particularly rectal cancer), which may have been discovered while embalming the patient. The Egyptians understood cancer to be incurable and perhaps a curse from the gods.
Hippocrates, the “Father of Medicine,” was certain that the colon (i.e., your large intestine), like any other organ, was susceptible to cancer. He wrote, “It is better not to treat hidden cancers; such patients die sooner when treated but live longer untreated.” Had there not been religious restrictions “back in the day” against exploratory surgery, and had the sorts of diagnostic tools we have today been available, no doubt Hippocrates would have spent more time on the subject.
It was only around the end of the eighteenth century that surgery was being attempted—with and without anesthesia. By that time, surgery on the colon was being performed to remove bowel obstructions. Patients who survived lived between a month and a year, dying from infection, ascites (the abnormal accumulation of fluid), or mercury poisoning (which was commonly used for bowel obstructions). While serving as a medic in the U.S. Air Force, we used mercury for that exact same reason, though the procedure was obviously different.
Over the past two centuries, surgical procedures cancerous colons became more sophisticated. Portions of the colon were removed, colostomies (where an artificial opening with a bag for feces was constructed) were performed and perfected, and the two separated ends of the colon were successfully rejoined. It is also worth noting that the development of anesthesia and much better aseptic (sterile) techniques became available and helped raise the survival rate.
The anatomy of the colon.
The colon is somewhere between four and almost five feet in length. It begins at the cecum and extends to the rectum. There are five parts to the colon: the cecum, the ascending colon, the transverse colon, the descending colon, and the sigmoid colon. It is not unusual for small “pouches” to appear in the colon, and these are typical places for infection—and cancer—to develop. These pouches can be polyps or diverticula. Polyps can progress to cancer, but diverticula, as a rule, do not (though infected diverticula can produce signs and symptoms consistent with cancer and mask an underlying malignancy). Cancer can occur in any part of the colon.
The colon has several functions, perhaps the most important of which is water and electrolyte absorption. Storage of feces, preparation for evacuation, and isolation of certain bacteria from other body systems (such as the urinary tract) are also important. Our appreciation of the colon’s responsibility to maintain a healthy microbiota community is becoming increasingly significant as we learn more about immunity. The need for a healthy microbiota helps prevent cancer in young adults.
The colon has four layers. The outer layer is the serosa, which anchors the colon and helps protect it from injury. The next layer inward is the muscularis propria (muscle layer). Among other functions, this layer provides for peristalsis, which is the contracting motion that moves food slowly through the gastrointestinal tract. The next innermost layer is the submucosa, made of connective tissue, and it is the conduit where blood vessels and lymphatic vessels are found. Finally, there is the mucosa, which is the innermost layer. There are actually three sub-layers to the mucosa. One sub-layer absorbs water and electrolytes as well as secreting mucus.
The next layer is home to lymphocytes and macrophages, which play a role in fighting infection.
The last sub-layer assists with mucosal movement. Cancer of the colon generally originates in the innermost layer of the mucosa and spreads outward into the adjoining layers.
The artistic illustration to the left is a side-by-side representation of the different layers, including the various muscle cells, mucosal cells, lymphatic cells, stem cells, and other cells, plus the cilia, which are hairlike projections. In the colon, the cilia are involved in sensory and signaling activities in the colon.
Early-onset colorectal cancer (EOCRC)
This is the heart of my post as far as colorectal cancer in young adults is concerned.
Early onset colorectal cancer (EOCRC) is usually advanced by the time a doctor becomes aware of it. This explains why many who have EOCRC die from the disease; had it been investigated and treated at an earlier stage, their prognosis might have been more promising.
At present, more young men develop EOCRC than young women, but as the percentage of young men with colon cancer climbs, the rate among infected women increases even more rapidly. Currently, EOCRC accounts for eleven percent of colorectal cancer, but by 2030, that figure is expected to grow to about one in four new patients.
In many cases, the patient is physically fit, often a competitive athlete in a high-impact or particularly straining sport such as distance running or weightlifting. There seems to be considerable disagreement in the medical community regarding the cancer risk factors as they apply to EOCRC. One perspective cites “poor diet, obesity, inactivity, smoking, and alcohol,” but many young men and women take their health seriously. Personally, I’m not sure how many people who run marathons are obese or how many who spend hours each week in a gym lifting weights smoke cigarettes. It’s counterintuitive (at least to me). Moreover, in the majority of people with EOCRC, hereditary factors are not involved. The minority of young adults with cancer also have a first-degree relative who has (or had) it. The opposing viewpoint seeks variables that have changed over the last forty years that may be contributing factors. These doctors focus on the overuse of antibiotics, which can disturb the microbiome, and the consumption of drinks packaged in plastic containers, which can shed microplastics. Environmental pollutants also attract attention, but they don’t seem to be particularly culpable so far.
One interesting observation comes from a famous Swedish study that noted a “modest” increase in EOCRC among women born via C-section as opposed to vaginal delivery. I’ve seen half a dozen journal articles suggesting that children delivered surgically may miss out on some yet-to-be-discovered advantage that would help immunize them against EOCRC; however, I did not find anything persuasive. Furthermore, the Swedish study had fewer than 1,000 participants and was not repeated. Still, an article in Pediatrics magazine noted:
“Children delivered by cesarean delivery had significantly increased risk of asthma, systemic connective tissue disorders, juvenile arthritis, inflammatory bowel disease, immune deficiencies, and leukemia…”
So, there may be something going on, and it may involve the microbiome of the colon.
In EOCRC, tumors are generally located in the rectum or in the immediate vicinity. This differs from where a physician might find tumors in the colon in older patients. There are also several types of bacteria (Fusobacterium nucleatum, Bacteroides fragilis, and Escherichia coli) that can produce an inflammatory response at least in the colon.
The microbiome of the colon
There does not seem to be nearly enough discussion in popular journals such as Healthy Aging or Senior Living, as well as in newsletters and pamphlets, on the need for a healthy microbiome in the colon, as far as I can tell. Therefore, I want to explain it a bit here because an abnormal distribution of bacteria can actually lead to cancer of the colon or rectum. And it’s not just bacteria in your colon. There are all sorts of other cells as well.
If you could see the inside of your colon, it would resemble the diversity of a coral reef, filled with all sorts of interesting life forms, though perhaps not in the same vivid colors as a reef.
There are approximately 39 trillion bacterial cells, or at least three pounds of sheer mass if these cells were packed together and placed on a scale. If you’ve ever worked in a hospital or reviewed culture reports on intestinal samples, you may have breathed a sigh of relief upon reading the words “normal flora.” That suggests that everything is okay in some important sense. It might also imply that the bacteria in a person’s colon are plant-like (as opposed to normal-fauna or animal-like). In fact, bacteria are neither plant nor animal. However, the various types of bacteria must not only be present but also must exist in specific proportions relative to one another.
For example, there are five most common flora in the colon. Don’t let the Latin terms confuse you, as we will not go into that.
| Phylum | Genera | What it does | Proper proportion |
|---|---|---|---|
| Bacteroidetes | Bacteroides | Breaks down carbs and reduces inflammation. | 20-30% |
| Firmicutes | Clostridium | Related to “C-diff.” Causes colitis and severe diarrhea. Can lead to life threatening megacolon. | 40-60% |
| Lactobacillus | Produces lactic acid and lowers irritable bowel disorder and colorectal cancer risks. | ||
| Faecalibacterium | Assists in controlling inflammation. | ||
| Actinobacteria | Bifidobacterium | Ferments fiber and is linked to lower irritable bowel and colorectal cancer risks. | 3-5% |
| Proteobacteria | Escherichia | Maintain mucosal barrier function and vitamin K synthesis. However, they can also assist invading cells in attacking us and can scramble DNA in other cells in a way that can lead to colorectal cancer. | 1-3% |
| Fusibacteria | Fusobacterium | Assists in amino acid metabolism, but also promotes the growth of cancerous tumors. | 1-2% |
The problem with antibiotics
When a person has an infection that could be gastrointestinal in nature but could also be a urinary tract infection or an upper respiratory infection, a lab specimen is usually taken (for example, a “clean catch” urine sample). The lab report will explain what, if any, infectious agents were found and which antibiotic is effective in combating them. These results typically take 1 to 3 days to return. Often, and probably all too often, a “broad-spectrum” antibiotic is prescribed, such as Amoxicillin (or Augmentin) or Cephalosporins, in the meantime. The hope is to kill the pathogen causing the illness whatever it might be. But broad-spectrum antibiotics can also destroy important bacteria in the colon. If there is too much carnage, bacteria such as Clostridium difficile (“C. diff”) may start to bloom and run rampant, causing another, and likely worse, problem. It may take months or perhaps years to restore the proper balance in the bacterial environment of the colon.
One solution for continued gut health is to take probiotics, which are over-the-counter supplements. A doctor’s or nutritionist’s guidance will help you choose the best probiotic for your particular colon, as not every probiotic is created equal, and some will help you more than others depending on what you lack and what the probiotic offers.
Stages of colon cancer
Eventually, cancer spreads. This is called metastasis. It most commonly starts when the patient is staged with Stage III (lymph node involvement) and has the highest risk in Stage IV (distant metastasis). There is also at least a slight risk of what is called “occult micrometastasis” even before Stage III is reached.
The National Cancer Institute (NCI) highlights research2 showing that metastatic colorectal cancer (CRC) can spread very early, sometimes when the primary tumor is tiny (smaller than a pencil tip or a poppy seed), with cancer cells breaking off and forming distant tumors before the main cancer is even clinically detected, a process called early metastatic seeding. This early spread, potentially by single cells, explains why some small tumors become advanced quickly, impacting treatment strategies and emphasizing the need for better early detection and prevention.
The most common places for colorectal cancer to wind up are the liver (in ~70%-80% of cases); the lungs (~10%-20%) and the peritoneum in ~10%-15%. Cancer that has spread to the peritoneum carries a particularly poor prognosis. The peritoneum is a thin, serous membrane that lines the abdominal cavity and encloses the intestines, liver and stomach organs. An inflamation or infection of the peritoneum is called peritonitis.
I realize there is much more than can be said about colorectal cancer. I may revise this in the future to provide additional information in the future.
Rather than add three more types of cancers to this post which would increase the size and slow down the loading and scrolling of the post, I will add breast cancer, lung cancer and pancreatic cancer to a following post that I’ll publish in the near future. If you are interested, you may want to bookmark this site.
Footnotes
1Triple negative tumors are those that do not respond to hormone therapies (like tamoxifen). Treatment in these cases focus on radiation, chemotherapy and whatever other new treatments are available. Females who are black and younger than forty represent the three most common Triple negative tumors variables.
2https://www.cancer.gov/news-events/cancer-currents-blog/2019/early-metastasis-colorectal-cancer
#ColorectalCancer
