Often silent until advanced, colorectal cancer is increasingly affecting younger adults – but early screening can make a critical difference.
Most people rarely think about their colon – until something goes wrong. Colorectal cancer (CRC) develops in this muscular tube of the digestive system, which measures about 1.5 metres in length. Each year, around 500,000 people across Europe are diagnosed with CRC, while in the United States roughly 160,000 new cases are expected in 2026. In Malaysia, CRC is the second most common cancer after breast cancer.
WHAT ARE THE SYMPTOMS OF CRC?
Fatigue, abdominal pain or discomfort, changes in bowel habits, unexplained weight loss, loss of appetite, and blood in the stool can all be possible warning signs of colorectal cancer. While there are many possible causes for these symptoms, a comprehensive evaluation should be carried out to determine the underlying issue. It is important to note that by the time symptoms appear, CRC is often already at an advanced stage. Studies consistently show that 75% of CRC patients are diagnosed at stage III or IV.
There has also been a rising trend in people below the age of 50 being diagnosed with CRC. This is referred to as Early Onset Colorectal Cancer (EOCRC), with the increase most pronounced among adults aged 20–29. Colorectal cancer is now the leading cause of cancer-related death in people under 50.
WHAT INCREASES THE RISK OF COLORECTAL CANCER?
Several factors are believed to contribute to EOCRC, including increased consumption of red meat and ultra-processed foods, rising obesity rates, and sedentary lifestyles. Psychosocial factors such as high stress levels, poor sleep quality, and socio-economic pressures have also been suggested as possible contributors.
There is also emerging evidence that EOCRC may present with more aggressive tumour biology and distinct molecular characteristics compared to CRC in older adults. At the same time, systemic challenges – including lower awareness among healthcare providers and delays in referrals for diagnostic testing – can contribute to poorer outcomes. Younger patients are often more significantly impacted by a CRC diagnosis, as it can disrupt early careers and the responsibilities of raising young families.
HOW CAN CRC RISK BE REDUCED?
To reduce risk, maintaining a healthy body weight, limiting the intake of red meat and ultra-processed foods, increasing fibre consumption, and exercising regularly are all important. Screening is another key component. Colorectal cancer screening is widely available and supported by strong scientific evidence. Polyps in the colon are recognized as precursor lesions that can develop into cancer, so the goal of screening is to detect and remove these early.
Screening for CRC is typically based on two methods: stool tests that check for the presence of blood, and colonoscopy. A colonoscopy involves inserting a flexible tube with a camera through the anus to examine the entire colon lining. During the procedure, doctors can identify and remove polyps immediately. It is a painless procedure performed under sedation, usually taking about 30 minutes, and is commonly done as a day-case procedure, allowing patients to return home the same day.
In summary, CRC remains one of the most common cancers and a significant cause of cancer-related deaths. Of increasing concern is the rise in cases among younger individuals, driven by a range of lifestyle and systemic factors. The encouraging reality, however, is that CRC is largely preventable through risk reduction and regular screening.
This article contributed by Dr. Muhammad Ilham Abdul Hafidz, Consultant Gastroenterologist, Hepatologist and Physician, Sunway Medical Centre Damansara
Sunway Medical Centre Damansara, located in Kota Damansara, opened in December 2024. More information is available at sunwaymedicaldamansara.com.
