Ashley Wiley was 41 and raising four young children when a Stage 3 colorectal cancer diagnosis dramatically altered her life. “I didn’t have any risk factors,” she recalls, now 42. “I’m active, I eat healthy, I felt well… Nothing in my brain allowed me to reckon this was possible.” Wiley’s experience reflects a concerning trend: a rising incidence of colorectal cancer in younger adults, prompting a critical reevaluation of screening guidelines and treatment approaches.
For decades, colorectal cancer was largely considered a disease of older adults, typically diagnosed after age 50. However, rates among individuals under 50 have been steadily increasing, with some studies showing a significant jump in recent years. This shift has spurred researchers at institutions like the University Health Network (UHN) in Toronto to investigate the underlying causes and develop more effective therapies for this growing population. Understanding the reasons behind this increase is crucial and research is exploring factors ranging from dietary habits and obesity to the potential role of environmental exposures like microplastics and the composition of the gut microbiome.
“Because the exact reasons are still not fully understood, it’s important to continue investing in research,” says Dr. Enrique Sanz Garcia, a medical oncologist at the Princess Margaret Cancer Centre, specializing in colorectal cancer research. “This will help us learn more about why this rise is happening and support the development of public-health policies that may reduce risk — such as promoting access to healthier foods and reducing intake of ultra-processed foods, which may play a role in colorectal cancer development.” The Princess Margaret Cancer Centre is a leading academic hospital and research centre, part of the UHN, dedicated to cancer care, research, and education. Learn more about the Princess Margaret Cancer Centre.
While the search for answers continues, UHN is actively involved in developing and implementing novel treatments for both advanced and early-stage colorectal cancer. These include targeted drugs, immunotherapy, and less invasive surgical techniques designed to improve patient outcomes and quality of life. Doctors are also emphasizing the importance of awareness and early detection, encouraging individuals to be vigilant about potential symptoms and to discuss any concerns with their healthcare providers.
Recognizing the Subtle Signs
Wiley’s initial symptom was blood in her stool following her pregnancies, which she initially attributed to common postpartum hemorrhoids. “My GP said it was almost like we found this by mistake,” she explains, highlighting the potential for colorectal cancer to be overlooked, particularly in younger individuals. This experience underscores the importance of not dismissing seemingly minor symptoms and seeking medical attention when necessary.
Dr. Sanz Garcia explains that colorectal cancer can manifest in various ways. “Some people notice changes in their bowel habits, such as switching between diarrhea and constipation. Others may notice blood in their stool,” he says. More advanced stages can present with symptoms like unexplained weight loss, persistent fatigue, or a loss of appetite. However, he stresses that many people in the early stages experience no noticeable symptoms at all.
In these cases, the cancer is often detected through routine blood tests revealing anemia or through screening tests like the Fecal Immunochemical Test (FIT). The FIT test, which looks for hidden blood in the stool, is a reliable method for early detection. “Doing this test every two years is a reliable way to detect early signs of colorectal cancer or pre-cancerous lesions,” Dr. Sanz Garcia states. “If the FIT test comes back positive, the next recommended step is colonoscopy.” More information about colonoscopy at UHN.
Following her colonoscopy, imaging revealed Wiley’s cancer had spread to the outer layer of the rectum, resulting in a Stage 3 diagnosis. She promptly began a course of radiation therapy at the Princess Margaret Cancer Centre, followed by chemotherapy. Fortunately, Wiley responded well to treatment and is now undergoing non-operative management, a relatively new approach that avoids the require for rectal removal or a permanent ostomy bag.
“I remember the surgeon said, ‘We found a tumour… and we’re going to cure it,’” Wiley recounts. “Those words were really important, even as my world started spinning.” She now undergoes imaging every three months to monitor her progress.
Advancing Colorectal Cancer Treatment at UHN
Wiley credits the comprehensive care and unwavering support of her UHN team with allowing her to regain a sense of normalcy and focus on her family. “The professionalism, efficiency and complete care from the surgical, radiation and medical oncology teams have allowed me to relax into what is now a really excellent quality of life,” she says. “That’s why we went through all the treatments — so I could have a full, high-quality life with my family.”
Driven by her positive experience, Wiley and her husband, Dave, are participating in the Princess Margaret Cancer Foundation Ride in June, a major fundraising event for cancer research. Learn more about the Princess Margaret Cancer Foundation Ride. She emphasizes the vital role of research in her own outcome.
“The reason I’m in the position I’m in is largely because of research,” Wiley explains, noting that the non-operative approach was only recently made available through clinical trials. “People who had this diagnosis years before me had very different outcomes, and their experiences forged the path my team could take. That’s why supporting research feels so important.”
UHN researchers are at the forefront of developing innovative treatments, including advancements in early detection and the creation of targeted drugs for common colon cancer mutations, such as the KRAS gene. “KRAS-targeting drugs have shown encouraging activity in some patients, but many new agents are currently being studied for a broader population at centres across Canada, including UHN,” says Dr. Sanz Garcia. “There is hope that these drugs will move into later-stage trials and eventually become part of routine care.”
Immunotherapy, which harnesses the body’s immune system to fight cancer, is already a standard treatment for patients with specific genetic mutations, such as microsatellite instability or mismatch repair deficiency. UHN is also conducting clinical trials to explore new immunotherapy approaches for patients who don’t respond to conventional treatments. “Early results are encouraging,” Dr. Sanz Garcia notes, “and these approaches may play a larger role in the future.” Learn more about immunotherapy at the Princess Margaret Cancer Centre.
The increasing incidence of colorectal cancer in younger adults underscores the need for continued research, increased awareness, and improved screening strategies. UHN’s ongoing perform in this area offers hope for more effective treatments and improved outcomes for patients facing this challenging diagnosis. Researchers are also investigating the potential impact of lifestyle factors, including diet and gut health, on colorectal cancer risk, aiming to develop preventative measures and personalized treatment plans.
Disclaimer: This article provides general information about colorectal cancer and should not be considered medical advice. Please consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
The next step in UHN’s research will be the analysis of data from ongoing clinical trials evaluating the efficacy of new KRAS-targeting drugs and immunotherapy combinations. Results are expected to be presented at major oncology conferences in late 2024 and early 2025.
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