Managing early-onset rectal cancer

The rising incidence of early-onset colorectal cancer (EOCRC) is emerging as a global healthcare challenge. Across many countries, increasing numbers of adults under the age of 50 are being diagnosed with colorectal cancer, often at more advanced stages of disease. This trend is prompting physicians to rethink not only how these patients are treated, but also how long-term survivorship issues such as fertility preservation are addressed.

The patient

A recent case at Baptist Health Herbert Wertheim Cancer Institute highlights both the complexity of treating younger patients with rectal cancer and the importance of balancing cancer control with quality-oflife considerations.

The patient, a 37-year-old woman undergoing in-vitro fertilisation (IVF), sought medical attention after experiencing rectal bleeding, changes in bowel habits and unintended weight loss. Because some of her symptoms overlapped with those commonly associated with fertility treatment, diagnosis was delayed. Further evaluation ultimately revealed stage III locally advanced rectal cancer.

According to Michael Chuong, M.D., Medical Director of Radiation Oncology at Baptist Health Herbert Wertheim Cancer Institute, younger patients often require a highly individualised treatment approach that extends beyond the immediate goal of curing the disease.

“Many younger patients are thinking not only about surviving cancer, but also about preserving their future fertility and quality of life,” said Dr Chuong. “These considerations should be part of treatment planning from the beginning.”

The treatment

Treatment for locally advanced rectal cancer typically involves a multidisciplinary approach that combines chemotherapy, radiation therapy and surgery. While these therapies can be highly effective, they can also affect reproductive health and increase the risk of long-term side effects that may impact survivorship.

Given the patient’s age and desire for future fertility, proton therapy was selected as the radiation treatment modality. Unlike conventional radiation therapy, proton therapy delivers radiation with greater precision, helping to reduce exposure to surrounding healthy tissues and organs.

For patients with pelvic cancers, this can be particularly important. By minimising radiation exposure to reproductive organs, bowel, bladder and bone marrow, proton therapy may help reduce the risk of infertility, premature menopause and other treatmentrelated complications that can affect long-term quality of life.

The patient completed proton therapy with concurrent chemotherapy and experienced minimal side effects. Following treatment and surgery, pathology demonstrated an excellent response, with no residual nodal disease identified. She remains in remission and continues to pursue family-building options.

Fertility preservation

As the incidence of EOCRC continues to rise worldwide, fertility preservation is becoming an increasingly important component of cancer care. Younger patients are often diagnosed during their reproductive years, making early discussions about fertility, survivorship and treatment-related risks an essential part of comprehensive care.

For international patients seeking specialised cancer treatment, access to multidisciplinary expertise can be just as important as access to advanced technologies. Coordinated care involving medical oncologists, radiation oncologists, surgeons and fertility specialists helps ensure that treatment decisions address both immediate cancer outcomes and future life goals.

At Baptist Health Herbert Wertheim Cancer Institute, this collaborative approach supports the development of personalised treatment plans designed to optimise outcomes while minimising long-term treatment-related effects.

As cancer care continues to evolve, success is no longer measured solely by survival. Increasingly, it is defined by the ability to help patients move forward after treatment with their health, quality of life and future opportunities intact.