Practical Considerations in Diagnosing and Managing Early-Onset GI Cancers

Abstract

The incidence of early-onset (EO) GI cancers occurring in individuals younger than age 50 years has been rising at an alarming rate over the past two decades. Although this rise in incidence among young patients correlates with increased rates of obesity, changes in diet, and alterations in the environment, the effects of these environmental factors on carcinogenesis, metastasis, and treatment response are unknown. Although several unique clinical trends exist among EO-GI cancers and their average-onset GI cancer counterparts, GI cancers are molecularly indistinct between younger and older patients, and no data support distinct treatment paradigms for patients with EO disease. The majority of EO-GI cancers are not explained by germline changes. There remains a critical need for further research to understand the pathogenesis and optimal management of EO-GI cancers. In addition, current screening strategies are not adequate to identify EO-GI cancers, and early biomarkers are needed. Specialized centers, with a focus on psychosocial aspects of cancer management, can address the unique care needs of patients with EO-GI cancers.

Colorectal cancer statistics, 2023

“…Overtreatment of early onset disease is an increasing concern and is the focus of ongoing clinical trials. 65,66 Notably, individuals aged 50-64 years have the highest overall survival (70%; Figure 8), likely reflecting more early detection (35% localized-stage disease vs. 26% in patients younger than 50 years; Figure 7). Studies suggest that tumor biology is a more important prognostic indicator for CRC than age.…”

“…However, aggressive disease management does not always beget better survival and is often associated with toxicity that negatively affects long‐term quality of life. Overtreatment of early onset disease is an increasing concern and is the focus of ongoing clinical trials 65,66 . Notably, individuals aged 50–64 years have the highest overall survival (70%; Figure 8), likely reflecting more early detection (35% localized‐stage disease vs. 26% in patients younger than 50 years; Figure 7).…”

Increased Risk of Young-Onset Digestive Tract Cancers Among Young Adults Age 20-39 Years With Nonalcoholic Fatty Liver Disease: A Nationwide Cohort Study

“…The incidence of young-onset digestive tract cancers, particularly colorectal, pancreatic, gastroesophageal, and gallbladder cancer, is increasing worldwide. [1][2][3] Cancer is the leading cause of disease-related deaths among young adults in high-income countries. 4 However, the majority of global deaths from young-onset cancers occur in low-and middle-income countries, where the young population has poor access to health care.…”

“…Only the risk factors for young-onset colorectal cancer, such as obesity, sedentary behavior, and dietary factors, have been studied. 1,18…”

Precision Medicine and Immunotherapy in GI Cancers

“…3 These trends are concerning and are not well understood and may relate to lifestyle considerations, including dietary content and patterns, obesity, alcohol, and environmental exposures. Lumish and Cercek 4 provide a comprehensive summary of this topic and review the particulars of young-onset GI cancers, offering important insights into therapeutic considerations and the special needs of this patient population.…”