An Active 41-Year-Old Father of Two Was Taken By Surprise When Bowel Habit Changes Led to an Egg-Sized Tumor In His Colon

“I’m active, healthy, and try to work out a lot. It kind of took me by surprise,” he told WXIA news.

Those persistent bowel changes pushed him to see a doctor and undergo a colonoscopy — a screening that ultimately caught his cancer early.

“It caught it early enough during screening, so the surgery ended up being curative, and a serious issue got corrected before it turned into something even more serious,” Keating said.

Throughout the ordeal, his family became his source of fuel to fight.

“Family is literally the lynchpin and pinnacle of my life, the cornerstone of my life along with my faith,” he said.

Keating’s story reflects a national trend: more adults under 50 are being diagnosed with colorectal cancer.

Dr. John Marshall, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University and Chief Medical Consultant at the Colorectal Cancer Alliance, says the shift has been building for more than a decade.

“At the beginning of my career, there were really no patients under the age of 50,” Dr. Marshall told SurvivorNet.

“Now approximately half of my patients are under the age of 50.”

While colorectal cancer remains most common in people over 55, cases in younger adults have risen by 2.4% each year from 2012 to 2021, according to the American Cancer Society.

This surge prompted updated screening guidelines: average‑risk adults should now begin screening at 45 instead of 50, with earlier testing recommended for those with symptoms or a family history.

This change was recommended by advocacy organizations in 2018 and officially supported by the U.S. Preventive Services Task Force (USPSTF) in 2021.

The new recommendation led to more people getting screened earlier. Since 2018, there has been a 17% increase in colorectal cancer cases for people between the ages of 45 and 49, directly related to the new screening guideline.

WATCH: Deciding When to Operate on Colon Cancer

Researchers are still working to understand what’s driving the rise in younger patients.

Dr. Marshall believes the answer may lie in the gut microbiome — the community of bacteria, viruses, and other microorganisms in the digestive tract. Potential influences include diet, microplastics, and antibiotic exposure, but more research is needed to pinpoint the cause.

Colon Cancer Warning Signs

The most poignant signature of colon cancer is a change in bowel habits. Changes in the size or shape of bowel movements may cause constipation or diarrhea. A change in stool color, particularly black or tarry stools, can indicate bleeding from a tumor deep in the colon.

WATCH: Colon cancer symptoms.

Other symptoms can be harder to pinpoint, such as abdominal pain and unintentional weight loss. Finally, some tumors bleed a small amount over a long period, resulting in anemia (low red blood cell count) that is picked up on blood work.

Colon Cancer Cases Rising in Adults Under 50—Screening Rates Are Climbing Too, Especially Among 45-49 Year Olds

The average age at which people are diagnosed with colon cancer is 68 for men and 72 for women, according to the American Cancer Society.

However, the National Cancer Institute reports that since the 1990s, colorectal cancer cases have been rising among adults younger than 50. Research published in CA: A Cancer Journal for Clinicians found that cases in people younger than 55 “increased from 11% in 1995 to 20% in 2019.”

“We know rates are increasing in young people, but it’s alarming to see how rapidly the whole patient population is shifting younger, despite shrinking numbers in the overall population,” cancer epidemiologist and lead study author Rebecca Siegel said.

WATCH: Deciding When to Operate on Colon Cancer

Researchers are still trying to determine why younger people are being diagnosed in more significant numbers. Some experts point to risk factors, which include obesity, physical inactivity, and smoking, as a possible explanation for the increase.

“We don’t know for sure why we are seeing earlier onset and death from colon cancer,” Dr. Yeo told SurvivorNet.

“It is likely a combination of factors, including diet and genetics as well as access to care and some environmental factors,” Dr. Yeo added.

A new study published in the peer-reviewed medical journal JAMA Network examined colorectal cancer screening rates between 2016 and 2023. Researchers conducting the study analyzed more than 7.8 million colorectal cancer screenings conducted at more than 1,350 hospitals throughout the United States.

A point of note from the study was that the rate of colorectal cancer screenings appeared to correlate with guideline changes from the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) for people at average risk to begin screening at age 45.

• CRC screenings among adults aged 45–49 increased nearly tenfold, from 2.9% to 17.8% of all screenings between 2016 and 2023.
• Monthly screening volume for this age group rose 955%, compared to a 46% increase among adults aged 50–75.
• The surge reflects rapid guideline adoption in hospital settings and early uptake even before the USPSTF changes.

The findings from the study highlight the impact of hospitals following recommended screening guidelines for their patients. It’s important to note that the study does not account for at-home colorectal screenings.

What Treatment Options Exist for Colon Cancer?

“There are a lot of advances being made in colorectal cancer,” Dr. Yeo previously told SurvivorNet.

Colon cancer treatment is more targeted, meaning doctors often test for specific changes or genetic mutations that cause cancer growth.

Biomarkers are key to tailoring specific treatments. Biomarkers are molecular patterns becoming more commonly used in colon cancer diagnosis, prognosis, and management.

According to the National Cancer Institute, a biomarker is “a biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or a condition or disease,” such as cancer.

“In colon cancer, we’re starting to look more and more at people’s biomarkers, so we’re starting to take the cancers, sequence them, understand where the different mutations are to figure out whether or not someone has a normal gene here or an abnormal gene,” Dr. Yeo explained.

WATCH: Biomarkers in Colon Cancer

“Those are the areas that people want to be able to target a little bit more. We’re getting close to more of what we would call precision medicine, meaning we can start looking at people’s genetic mutations and think about how they might respond to different drugs.”

There are different types of biomarkers, including DNA, proteins, and genetic mutations found in blood, tumor tissue, or other body fluids. The biomarkers most commonly used in colon cancer management are:

Genetic mutations within the tumor, such as MMR/MSI, KRAS, BRAF, and HER2
Bloodstream carcinoembryonic antigen (CEA)

CEA is a protein produced by most tumor cells (but not all) and can be picked up in the bloodstream. High CEA levels do not establish a colon cancer diagnosis. However, higher CEA levels correlate with a worse prognosis and potential metastasis.

Carcinoembryonic antigen is important for post-treatment follow-up to ensure the cancer hasn’t returned. Be sure to check with your doctor before treatment starts to ensure a CEA blood sample has been obtained.

More on Treating Colon Cancer

Surgery and chemotherapy are common approaches to colorectal cancer.

Some examples of Food and Drug Administration (FDA) approved chemotherapy drug treatments include:

• FOLFOX: leucovorin, 5-FU, and oxaliplatin (Eloxatin)
• FOLFIRI: leucovorin, 5-FU, and irinotecan (Camptosar)
• CAPEOX or CAPOX: capecitabine (Xeloda) and oxaliplatin
• FOLFOXIRI: leucovorin, 5-FU, oxaliplatin, and irinotecan
• Trifluridine and tipiracil (Lonsurf)

WATCH: Understanding Your Options with Metastatic Colon Cancer

Among metastatic colon cancer patients, multiple treatment options exist, including surgical and non-surgical options.

One treatment option includes an oral treatment called Fruquintinib, which is a targeted therapy for adults who have metastatic colorectal cancer and have tried other treatments.

Results from a trial published last year showed the drug improved overall survival and progression-free survival, which measures the amount of time before the cancer returns or spreads. It works by blocking the growth of blood vessels, which increases tumor growth.

Once you get to the metastatic setting, many patients “just run out of options,” Jennifer Elliott, head of solid tumors at Takeda, explained to SurvivorNet at the ASCO Annual Meeting. So it was critically important for Takeda to do this deal to in-license fruquintinib. We hope to give patients another option.”

Fruquintinib has been approved in China since 2018 and was originally developed by the Chinese biopharmaceutical company HUTCHMED. Takeda Oncology acquired the exclusive worldwide license for the drug outside of mainland China, Hong Kong, and Macau in January 2023.

Questions to Ask Your Doctor

If you are facing a colon cancer diagnosis, here are some questions you may ask your doctor.

• What are my treatment options based on my diagnosis?
• If I’m worried about managing the costs of cancer care, who can help me?
• What support services are available to me? To my family?
• Could this treatment affect my sex life? If so, how and for how long?
• What are the risks and possible side effects of trea

Learn more about SurvivorNet's rigorous medical review process.

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