Colorectal cancer is the most common malignant tumor of the digestive tract and is generally considered a disease of the elderly by the public. However, in recent years, bowel cancer has shown a significant trend in younger patients.
Recently, a latest study by Fudan University Cancer Hospital Professor Ma Yanlei's team revealed for the first time that young people with onset of colorectal cancer younger than 50 years old (early-onset colorectal cancer) and older people with onset of colorectal cancer older than 50 years old (late-onset colorectal cancer) Intestinal cancer) in intestinal flora spectrum, generation There are significant differences in metabolic spectrum, changes in bacterial enzyme gene profiles, etc., and a diagnostic model is developed based on the "bacteria-metabolite-bacterial enzyme gene combination" marker. In the future, it is expected to use stool samples to achieve early detection of young people and patients at high risk of intestinal cancer. Screening and accurate detection will further promote the transformation and application of flora-based diagnostic strategies in the clinical frontline. Relevant results were recently published in Gut, the official journal of the British Society of Gastroenterology.
Don’t miss the “window period” of early diagnosis
In recent years, bowel cancer has shown a significant trend in younger people. According to estimates from the American Cancer Center, if this trend continues, the incidence of colorectal cancer in young people will double in the next 15 years, and 20% of colorectal cancer will occur in people under the age of 50.
In 2013, Shanghai included community colorectal cancer screening into public health services for the first time, but it was mainly targeted at the elderly. Colon cancer in young people is usually detected during medical treatment after symptoms such as changes in bowel habits, blood in the stool, diarrhea, alternating diarrhea and constipation, and local abdominal pain, but the best "window for early diagnosis" is often missed at this time. Expect".
"Although colonoscopy is a 'sharp tool' for detecting bowel cancer, the benefits of widespread use of colonoscopy for early screening among young people may not outweigh the risks, and over-diagnosis may cause unnecessary economic burdens." Ma Yanlei told reporters, "In Among young people aged 20 to 34, colorectal cancer patients only account for the total number of patients 1% of patients with colorectal cancer account for only 6.8% of the total number of patients in the 35 to 49 age group.”
Therefore, it is important to explore the development of better risk prediction tools to assist in the early identification of this type of high-risk young patients with bowel cancer. And establishing better screening strategies has become the focus of current clinical diagnostic research on colorectal cancer in young people.
Mapping the microbiota profile and metabolite profile of intestinal cancer in young people
The intestinal microbiota is an important microenvironment related to human intestinal health. At present, many studies have confirmed that intestinal microecological disturbance is a key environmental factor in the occurrence and development of colorectal cancer, and the intestinal microbiota of the elderly is significantly different from that of the young.
Are there pathogenic bacteria profiles and metabolite profiles with diagnostic value in young patients with bowel cancer? Are these microbiota and metabolites important pathogenic factors for colorectal cancer in young people?
In response to these problems, Ma Yanlei's team spent 4 years comparing a total of 549 Chinese young bowel cancer patients, elderly bowel cancer patients and age-matched healthy people, and conducted fecal metagenome and metabolomics sequencing analysis, and based on multiple Omic features were used to build a random forest model to identify intestinal cancer in young people.
researchers used a large sample cohort to characterize the intestinal flora and metabolite profiles of Chinese young bowel cancer patients for the first time in the world. The results showed that the intestinal flora of young patients with intestinal cancer was seriously imbalanced, and the diversity of fecal microorganisms was significantly reduced. Young intestinal cancer is also significantly different from elderly intestinal cancer in terms of the composition characteristics of the bacterial community spectrum and metabolic spectrum.
The study also found that the multi-omics characteristics of young people with colorectal cancer mainly include the enrichment of pathogenic bacteria, the enrichment of red meat diet-related bacteria, and the increase in tryptophan, bile acid, and choline metabolism; composed of red meat diet-related bacteria, Activation of reaction pathways composed of choline metabolites and bacterial choline metabolism enzymes may be potential intervention targets in the pathogenesis of colorectal cancer in young adults. On the other hand, the characteristics of elderly intestinal cancer are characterized by enrichment of Fusobacterium nucleatum, excessive consumption of short-chain fatty acids , and a shift in acetic acid / acetaldehyde metabolism to acetyl-CoA metabolism.
Provide strategies and directions for early screening and early diagnosis
Researchers built a random forest classifier model to evaluate the multi-omics label classification ability of young bowel cancer.It was finally confirmed that the prediction model based on the joint markers of metagenome , metabolome and bacterial enzyme genes has strong potential to distinguish young people with colorectal cancer from healthy people, and can be used for early screening of colorectal cancer in young people in the future.
"Based on the research on intestinal cancer, intestinal flora spectrum and multi-omics characteristics in young people, some health tips can be put forward for young people to prevent intestinal cancer." Ma Yanlei added, "First of all, we should avoid high-risk factors, quit smoking, and not eat fried foods. , try to eat less high cholesterol . High-fat foods. In addition, it is important to change bad eating habits, increase dietary fiber and vitamin intake, increase physical exercise appropriately and maintain a happy mood. "
This study believes that it is important for young people to increase their awareness of bowel cancer prevention. and ability are very important. On the one hand, develop healthy eating habits in daily life; on the other hand, if you have symptoms of abdominal discomfort or changes in bowel habits and stool shape, you should go to the hospital in time and actively undergo bowel cancer screening.
"Early detection of colorectal cancer or precancerous lesions has a significant effect on improving the quality of life and improving the treatment effect of colorectal cancer patients." Ma Yanlei said, "This work provides an opportunity to understand the pathogenesis of colorectal cancer in young people and explore suitable early stages of colorectal cancer in young people. The method of screening and early diagnosis provides a new perspective and direction.”
The original text is published in "Acta Medical Science" (2022-08-26 6th edition domestic)
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