A new study published in Nature Medicine found that colon cancer tumors in younger patients have distinct cellular characteristics; its co-senior author said younger patients generally have more aggressive disease and are more resistant to standard therapies, mostly chemotherapy.
The study analyzed 189 tumors from colorectal cancer patients aged 29 to 94, measuring gene activity in more than 850,000 cancer cells. Researchers sought to determine whether colon cancer in younger people was the same disease occurring earlier in life or something different.
The findings indicate that younger patients generally have more aggressive disease and are more resistant to standard therapies such as chemotherapy, according to Dr. Ana Anderson, a co-senior author of the study who leads the cancer immunology program at the Gene Lay Institute at Brigham and Women's Hospital in Boston.
Tumors in younger patients contained a higher proportion of stromal cells, such as fibroblasts, which can suppress the immune response and form a protective barrier that makes chemotherapy less effective. Stromal cell presence declined with age, with the youngest patients having the highest number of stromal cells relative to cancer cells, while the oldest patients had the fewest stromal cells and the highest number of cancer cells.
Younger patients also showed increased activity of long non-coding RNAs, which are associated with cellular signaling in cancer. These molecules became linked to cancer research in the late 2000s; some poorly understood ones are referred to as dark RNAs. Anderson said this was the finding she considered most promising.
The study also found gene activity in younger patients that suggests stronger signaling between cells, potentially helping cancer cells move and invade nearby tissue.
While the researchers could not pinpoint why tumors in younger patients look different, Anderson noted there is considerable interest in lifestyle factors and environmental exposures as potential contributors. "Nothing specific has been pinned down," she said.
The recommended screening age for most people was lowered from 50 to 45 a few years ago. Anderson said it was wise to see a doctor sooner if you experience common colon cancer symptoms such as rectal bleeding, abdominal pain, bloating, or changes in bowel movements. For those who are extra cautious, she said it is never a bad idea to stay active and cut down on inflammatory foods such as ultraprocessed snacks and alcohol.
Analysis
Why This Matters
- Rising colon cancer rates in people under 50 have puzzled researchers; this study provides biological evidence that the disease may be fundamentally different in younger patients, requiring different treatment approaches.
- The finding that stromal cells create a protective shield around tumors helps explain why younger patients often respond poorly to standard chemotherapy, pointing to the need for alternative treatment targets.
- The identification of long non-coding RNAs as a potential driver of cancer in younger patients opens up new avenues for drug development and personalized therapies.
Background
Colorectal cancer is one of the most common cancers worldwide. In recent years, incidence rates have been rising among adults under 50, while declining in older age groups, a trend that has prompted earlier screening recommendations. The reasons for this shift remain unclear, with possible explanations including diet, microbiome changes, and environmental exposures.
Key Perspectives
- Dr. Ana Anderson (co-senior author, Gene Lay Institute at Brigham and Women's Hospital): Says the goal was to see if colon cancer in younger people is the same disease or something different. She notes the study found younger patients "generally have more aggressive disease and they are generally more resistant to the standard of care therapies." She describes the long non-coding RNA finding as the most promising, calling it "a world of biology to be discovered there."
What to Watch
- Further research into the role of long non-coding RNAs in younger colon cancer patients, which Anderson described as a focus for future work.
- Investigation of immune cell differences between younger and older tumors, as immune cells were "under-captured" in this study.
- Whether lifestyle and environmental factors can be linked to the distinct tumor biology observed in younger patients.
Checked
12 claims in this story checked against 1 source: 11 supported.
Show each claim
- SupportedThe study found that colon cancer tumors differ in younger patients.All Content from Business Insider: “A new study found cellular differences between colon cancer tumors in younger and older patients.”
- Partly supportedResearchers say younger patients generally have more aggressive, treatment-resistant disease.All Content from Business Insider: “The study's researchers couldn't definitely state that colon cancer in younger patients is always more aggressive — that would require more study. However, what they did find was that younger patients "generally have more aggressive disease and they are generally more resistant to the standard of care therapies, which is mostly chemotherapy," Anderson said.”
- SupportedThe study was published in Nature Medicine.All Content from Business Insider: “A new study published in Nature Medicine analyzed 189 tumors from colorectal cancer patients aged 29 to 94”
- SupportedThe study analyzed 189 tumors from patients aged 29 to 94.All Content from Business Insider: “A new study published in Nature Medicine analyzed 189 tumors from colorectal cancer patients aged 29 to 94”
- SupportedThe study measured gene activity in more than 850,000 cancer cells.All Content from Business Insider: “including measurements of gene activity in more than 850,000 cancer cells.”
- SupportedResearchers sought to determine whether colon cancer in younger people was the same disease occurring earlier or something different.All Content from Business Insider: “"Is it the same colon cancer but just happening in younger people , or is there something different about it?"”
- SupportedTumors in younger patients generally had more stromal cells relative to cancer cells.All Content from Business Insider: “the youngest patients tended to have the highest number of stromal cells in proportion to cancer cells.”
- SupportedStromal cells can suppress the immune response and make chemotherapy drugs harder to work.All Content from Business Insider: “Stromal cells, such as fibroblasts, can produce factors that suppress the immune response, making it harder for chemotherapy drugs to work.”
- SupportedYounger patients had higher activity of long non-coding RNAs, and some poorly understood ones are called “dark RNAs.”All Content from Business Insider: “Younger patients also had higher activity of long non-coding RNAs (lncRNAs), which are associated with cellular signaling in cancer.”
- SupportedAnderson said the long non-coding RNA finding was the one she considered most promising.All Content from Business Insider: “For that reason, she said it was the finding she considered most promising.”
- SupportedAnderson said, “Nothing specific has been pinned down.”All Content from Business Insider: “"There's a lot of interest in lifestyle factors and environmental exposures as potential contributors; however, nothing specific has been pinned down," Anderson said.”
- SupportedAnderson said the recommended screening age for most people was lowered from 50 to 45 a few years ago.All Content from Business Insider: “She noted that the recommended screening age for most people was lowered from 50 to 45 a few years ago”