Emergency Cases

Too young for this: Facing Colorectal Cancer at a much younger age

"I have repeated rectal bleeding (blood in stool) in the past few weeks. I had occasional constipation, but was never serious. This is the first time that I found blood in my stool. My grandfather died 10 years ago of colorectal cancer, my uncle was diagnosed with the same cancer last year and is currently under treatment. I remember my grandfather also had blood in stool and later confirmed of colorectal cancer. Isn’t colorectal cancer more common in older population, say 50 or older? I have always been healthy; I do not smoke nor drink. Exactly what extent the risk of colorectal cancer was caused by heritable genetic factors?”

Recently, a food supplier of a North America fast-food chain was suspected of using expired inferior meat and the incident caused a huge uproar in Hong Kong. Globalisation and urbanisation around the globe in the past two decades has caused rapid disappearing of traditional diet habits. The “more-grain-less-meat” home cooked meals are gradually being replaced by restaurant food and fast food. Fast food both embodies and symbolises speed and instant gratification has found its way into many homes in Hong Kong. Many Hongkongers have therefore fallen into the fast food diet habits of relying heavily on meat and less on grains and vegetables.

In the past decade, new colorectal cancer cases in Hong Kong continue to rise, and are increasing among the young population. Colorectal cancer is the second leading cause of cancer deaths in Hong Kong, with more than 1,900 deaths per year. In 2011, colorectal cancer (4,450 new cases, 16.5% of all new cancer cases) has overtaken lung cancer (4,401 cases) for the first time to become the most common cancer in Hong Kong, with 2,534 and 1,916 males and females cases respectively, and the male to female ratio was 1.3 to 1. The risk of colorectal cancer increases with age, more than 90% of colorectal cancer cases occur after the age of 50, and the average age of onset is 72 years old. Thus, colorectal cancer is often overlooked or delayed in diagnosis in young patients.

Mr Chan is a 32 years old heavy-set gentleman with a bulging belly, who works in the banking and finance industry. Mr Chan’s department underwent restructure six months ago. After the restructure, his team has to shoulder more responsibilities with much reduced head counts. Working till 8 or 9pm at night is common for him. In order to maintain a close relationship with his clients, frequent business dinners are inevitable, and as a result, Mr Chan has gained more than 10 kg in the past six months alone. “Personally, I am not a picky eater, nor a diehard carnivore. But when I dine out with friends, I prefer hotpot to any other types of food because I enjoy the warmth atmosphere and the pleasant comfort of being surrounded by close friends and good food. We chat, laugh, and have beer, and it helps relieving the pressure from work."

There is a strong association between dietary pattern and risk of colorectal cancer, which may very likely be linked to a high-fat, low-fiber diet. According to the Department of Health, colorectal cancer patients in Hong Kong are becoming younger, especially among the mid-30s’ age group. It is expected that colorectal cancer will soon surpass lung cancer and become the number one cancer killer in Hong Kong. Fortunately, colorectal cancer development takes time and regular screening can effectively prevent it.

As the clinical manifestations of colorectal cancer are similar to that of common intestinal diseases, patients are prone to neglect these signs. Change of bowel habits, for example, diarrhea or constipation with unknown cause, rectal bleeding or blood and mucus in stools could be warning signs of colorectal cancer. And if you have other symptoms such as tenesmus (a feeling of incomplete defecation), abdominal pain, unknown cause of distension or tangible abdominal mass, fatigue and loss of weight, you should seek medical advices as soon as possible to seize the golden opportunity for treatment.

The Cancer Expert Working Group on Cancer Prevention and Screening (CEWG) of the Hong Kong SAR Government recommends anyone aged between 50 and 75 should discuss with their doctors and consider screening for colorectal cancer. Routine colorectal cancer screening methods include: fecal occult blood test, flexible sigmoidoscopy and colonoscopy. However, there is no sufficient data as yet to confirm which screening method is the best among all in preventing colorectal cancer.

Colorectal cancer screening methods:
1. Fecal occult blood test, repeat every one to two years if the result is negative;
2. Flexible sigmoidoscopy, repeat every 5 years if the result is negative;
3. undergo colonoscopy every ten years.

By Dr Clara Wu
Head, Department of Emergency Medicine, and Consultant in Emergency Medicine
Union Hospital