The big ‘C’ is now a youngster’s disease

Cancer in young adults is often not diagnosed accurately as docs attribute symptoms to other causes and patients neglect signs due to lifestyle

Dhanya, 22, represents the new epidemic that is slowly spreading across India and the world. It is the increasing incidence of different types of cancer in young adults. For the pain in her epigastrium, which aggravates after meals, Dhanya consulted several doctors, from general practitioners to gastroenterologists, but with no relief. She was treated with antacids, anti-depressants and pain-killers. Eventually, she started vomiting after meals.

Finally, one gastro-enterologist decided to do an endoscopy. The diagnosis: Dhanya had cancer of the stomach.

Take the case of Susanna, who developed a lumpy feel and pain in her right breast. She consulted different doctors, ranging from gynaecologists to surgeons, but there was no accurate diagnosis, since no doctor suspected breast cancer in an 18-year-old. By this time the cancer diagnosed was done, she was in stage 3. The psychological trauma of a mastectomy at that age with an added risk of recurrence makes the issue complicated. Eventually, her breasts were saved through oncoplastic surgery.

Ovarian cancer is the second-most common cancer in women. Ovarian tumors arising from germ cell lines are also increasing. Younger the age, the epithelial ovarian cancers show more aggressiveness. That is not all.

Srikanth, 29, a techie from Bengaluru, is an example of another type of epidemic sweeping the country, albeit slowly. A teetotaler, he had a 4-cm long non-healing ulcer in the throat, with a palpable lymph node on the right upper neck. The biopsy revealed squamous cell cancer.  On close interrogation, he confided that he was gay and had frequent oral sex with multiple partners. His cancer was a HPV virus induced type, which was sexually transmitted, and has emerged as a new threat among the youth in the West, but proving to be common in this country too. Cancers of the lips, tongue and cheek too are common in this group. Women who are lesbians also fall in similar high risk group. Countries like Australia, New Zealand, UK, France, Germany and USA have taken several measures to limit the epidemic by vaccination of teens.

• Infection with some types of human papilloma virus (HPV) can increase the risk of cervical and oral cavity, tongue and lip cancers.
• Treatment with chemotherapy or radiation therapy for childhood cancer can increase the risk of getting a second cancer, especially leukaemia, later on.
• Oral sex among gays and lesbians (HPV virus) is associated with a risk of oral cavity and throat cancers. Young age cancer victims are always diagnosed late.

The reasons are:

• These years are often a time of transition, when people begin living on their own and establish their own identity and lifestyle. Concerns, other than health, such as going to college, starting a career, dating, or starting a family are often higher on their priority list.
• Even when a young person does go to the doctor, cancer is not usually high on the list of probable causes because it is uncommon in this age group. Doctors might be more likely to think symptoms like pain or feeling tired are due to other causes rather than cancer, which might delay the diagnosis, and could prove fatal.

There aren’t many widely recommended screening tests for people in this age group. But in several cancers a watchful expectation can help a clinician detect it early. The risk of cervical cancer rises in a woman during her 20s and 30s, especially among those who have multiple sex partners. So the American Cancer Society and many other groups recommend that women get screened for cervical cancer with liquid based Pap tests starting at age 21.There should be throat and oral cavity examinations for gays and lesbians, who are at a higher risk for oral cavity cancer.

Women should be aware of how their breasts normally look and feel, and should have any changes checked by their doctor. Unlike in older people, cancer treatment for the young is difficult especially when the emotional element is so high. More so when it leads to sacrificing organs like breasts, limbs, ovaries, uterus, stomach, colon, and testicles. Hence, organ and functionpreserving surgeries (cosmetic oncology) are the need of the hour with good psychological counselling.

In older people, many cancers are linked to lifestyle-related risk factors, such as smoking, being overweight, eating an unhealthy diet, not getting enough exercise, and drinking too much alcohol. These types of risk factors usually take many years to influence cancer risk, so they may not play a large role in cancers afflicting young adults. Cancer occurs because of mutations in the genes inside our cells. Genes, which are made of DNA, contain the instructions for nearly everything our cells do. Some genes gain control when our cells grow, divide into new cells, and die.

Changes in these genes can cause cells to grow out of control. Some people inherit gene changes from a parent that increase their risk of certain cancers. But most cancers are not caused by inherited gene changes alone.

This can sometimes lead to cancer earlier in life than expected.

Dr Thomas Varughese
Oncologist and surgeon,specialised in reconstructive surgery