How Biomarkers Are Helping Doctors Treat People Battling Colon Cancer
- A woman, 30, was diagnosed with stage 3 bowel (or colorectal) cancer after suffering from constant stomach pains and fatigue.
- She is part of a growing trend of more and more younger people being diagnosed with the disease.
- Research published in CA: A Cancer Journal for Clinicians found the proportion of cases in people younger than 55 years old "increased from 11% in 1995 to 20% in 2019."
- This rise “is likely a combination of factors, including diet and genetics as well as access to care and some environmental factors," Dr. Heather Yeo, a surgical oncologist who specializes in colorectal cancers at Weill Cornell Medicine, previously told SurvivorNet.
- Treatment of colorectal cancer is being improved by the use of biomarkers, which can help inform what therapies will be most effective for the patient.
- Biomarkers used for colon cancer include genetic mutations like MMR, MSI, KRAS, BRAF and HER2, as well as bloodstream carcinoembryonic antigen (CEA).
- People diagnosed with colon cancer are encouraged to talk with their doctor about being tested for their biomarkers and how their results may affect their treatment plan.
A 30-year-old woman who became increasingly tired and experienced stomach pains thought she was simply overworked. But when her symptoms worsened, she learned the true cause was much more serious: colon cancer.
However, Megan Horrocks, now part of a growing and concerning trend of more and more young people getting colon cancer, refuses to let the disease rule her world.
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“I thought maybe I’m getting a bit gluten intolerant. I was getting really bloated and had a sore stomach. It was all very subtle, it was probably going on for six months," Horrocks explained to Liverpool Echo, a U.K.-based news outlet.
Horrocks noted she started experiencing symptoms while working long hours as a spa therapist. She admitted she initially believed her increased fatigue was a result of her job.
“I was fatigued but I thought maybe that was down to 16-hour days and leading a busy life. It wasn’t consistent, that’s why I put it off,” Horrocks said.
WATCH: Common Misconceptions About Colon Cancer
Her worsening symptoms ranged from tiredness to stomach bloating. As they persisted, she decided to see her doctor.
Tests revealed she had stage 3 bowel cancer just before her 30th birthday.
Bowel cancer is also referred to as colorectal cancer in the U.S. This type of cancer affects your large intestine (or colon) or the end of your intestine, also called the rectum.
Doctors may also simply call it colon or rectal cancer, depending on where it is.
Colon cancer is the third most common cancer among men and women in the U.S. and it's impacting younger people in greater numbers.
Horrocks learned her cancer had metastasized or spread to her lymph nodes, and her doctors suggested surgery to remove it.
The cancer diagnosis hit close to home because she lost her dad a few years earlier to cancer.
“My mom broke down, I just felt like I needed to be strong for her," a determined Horrocks said.
After learning she had bowel cancer, she was referred by her doctor to receive radiotherapy and chemotherapy.
Chemotherapy involves drugs designed to target cancer cells and kill them. Sometimes chemo is given before colon cancer surgery to help shrink the tumor, which makes the recovery easier.
Similarly, radiation therapy is a treatment method designed to target and kill cancer cells and shrink the tumor. Radiation treatment uses high-energy X-rays aimed at cancer cells.
Three months after her diagnosis, doctors said that while she had some scar tissue, they couldn't find any signs of the tumor. She has continued undergoing radiotherapy to kill any remaining cancer cells.
WATCH: Treating Early-Stage Colon Cancer
Why Is Colon Cancer Impacting Younger People?
Horrocks' experience with colon cancer is the latest young person to share her colon cancer story. In recent years, an increasing number of people younger than 55 are being diagnosed with colon cancer and health experts are researching why.
"We don't know for sure why we are seeing earlier onset and death from colon cancer," Dr. Heather Yeo, a surgical oncologist who specializes in colorectal cancers at Weill Cornell Medicine, told SurvivorNet.
Research published in CA: A Cancer Journal for Clinicians found the proportion of cases in people younger than 55 years old "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 told Axios.
Research is ongoing to determine why younger people are being diagnosed in larger numbers.
"It is likely a combination of factors, including diet and genetics as well as access to care and some environmental factors," Dr. Yeo added.
Phil Daschner, a program director in the National Cancer Institute's Division of Cancer Biology, stressed that research continue on this phenomenon because "it may affect [approaches for] the treatment and survivorship of early-onset colon cancer."
Expert Colon Cancer Resources
Advancements in Colorectal Cancer: Biomarkers
In recent years, doctors have improved the treatment of colon cancer by using biomarkers.
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.
WATCH: Biomarkers in Colon Cancer Treatment
"In colon cancer, we're starting to look more and more at people's biomarkers, so we're starting to actually 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," Yeo tells SurvivorNet.
"Those are the areas that people want to be able to target a little bit more. We're getting close to more 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," Dr. Yeo added.
Different types of biomarkers include 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
- Bloodstream carcinoembryonic antigen (CEA)
Different types of genetic mutations within the tumor may include:
MMR/MSI testing is recommended for anyone diagnosed with colon cancer, according to the National Comprehensive Cancer Network guidelines.
CEA is a protein that is produced by most tumor cells and can be picked up in the bloodstream.
High CEA levels do not establish a colon cancer diagnosis, but higher CEA levels correlate with a worse prognosis and potential metastasis, or cancer spread.
Carcinoembryonic antigen is also very important for the post-treatment follow-up to make sure the cancer hasn't returned.
If you are facing a colon cancer diagnosis, be sure to ask your doctor before treatment starts for a CEA blood sample.
Questions for Your Doctor
If you are diagnosed with colorectal cancer, here are some questions you can ask your doctor to help understand your situation and what you may expect:
- Which biomarkers are relevant in the treatment of my colon cancer?
- Should I have MSI-High Testing?
- How will the results help guide my treatment?
- If I am determined to be MSI-High, will it change the course of my treatment?
- How do you monitor these biomarkers?
- Can my tumor be monitored via CEA-testing?
- How will I know if the treatment is working?
- What potential side effects should I expect from treatment?
- I'm struggling to pay my medical bills. Are there resources available to help me?