When Ashleigh Wolsey’s bowel habits began to change in increasingly unsettling ways, she wasn’t entirely surprised. She’d had similar problems in her teens and assumed that it was irritable bowel syndrome (IBS) returning.
Now 37, the logistics worker found herself constipated for days, then suddenly rushing to the loo every hour, before being unable to go again. Even when she was able, she says, it never felt as though she had properly emptied her bowels.
‘It was very little and often,’ she explains. ‘And the near-constant constipation left me in a lot of pain.’
But it wasn’t until Ashleigh noticed a spattering of blood in the toilet bowl on a flight to Madrid that she realised she needed to get it checked.
‘It wasn’t a lot of blood, but enough that I knew something wasn’t right,’ she says.
‘I used to have IBS when I was younger, so I assumed the change in my bowel habits was down to that. And because it only slowly got worse, I didn’t fully appreciate how bad things had become.’
In March 2024, Ashleigh booked in to see her GP in Surrey – about six months after her symptoms first began. Blood tests and a stool sample checking for trace signs of blood – used to help diagnose bowel cancer and known as a FIT test – came back clear.
‘Doctors told me it was probably just IBS,’ says Ashleigh. ‘But I persisted. And because my dad had died of stomach cancer at just 55, they listened.’
Ashleigh Wolsey, pictured with her friend Gemma, booked in to see her GP in Surrey about six months after her symptoms first began
Ashleigh found out her symptoms had been caused by a tumour growing in her rectum
Ashleigh was referred for a colonoscopy to check her intestine, which she booked through her work’s private healthcare. It was in the recovery room following the procedure that Ashleigh received the news – her symptoms had been caused by a 1.5in (4cm) tumour growing in her rectum, blocking her back passage.
After further tests, Ashleigh was told the cancer was already stage three – meaning it had spread into nearby lymph nodes.
‘I felt almost numb,’ she says. ‘It was such a huge shock that I remember feeling nothing. It’s one of those things that you never think is going to happen to you.’
Yet experts speaking to The Mail on Sunday say Ashleigh is among a growing number of younger people being diagnosed with rectal cancer, a form of bowel cancer. While cases of the disease in older adults have fallen – thanks to increased screening and awareness – diagnoses in younger people have continued to rise year on year.
Findings recently announced by researchers in the US show that deaths from rectal cancer in people under 45 are rising up to three times faster than deaths from colon cancer – which affects deeper inside the intestine – in the same age group.
Even more worrying, rectal cancer death rates are expected to keep climbing for at least another decade if current trends continue.
The findings, set to be presented at the Digestive Disease Week conference currently taking place in Chicago, follow another recent report naming rectal cancer as the biggest driver of the early-onset bowel cancer epidemic. In an announcement highlighting the data, entitled ‘Rectal cancer is striking earlier and killing faster’, the authors wrote: ‘Rectal cancer deaths among older millennials are accelerating, with growth in mortality far outpacing colon cancer.’
Dr Mythili Menon Pathiyil, the study’s lead author and a gastroenterology fellow at SUNY Upstate Medical University in New York, added: ‘Colorectal cancer is no longer considered predominantly a disease of older adults.
‘Rectal cancer, especially, is becoming a growing problem in younger individuals, and we need to act early to reverse this trend.’
Developing in the final section of the large bowel, just above the anus, rectal cancer is a form of bowel cancer that affects around 16,000 Britons each year.
Like colon cancer, many of its symptoms can also be caused by other conditions – including IBS – meaning they are often ignored or dismissed until the disease has progressed.
Recent figures show as many as three in four younger patients are diagnosed only after the disease has already spread, making treatment more difficult.
When caught early and still confined to the bowel, five-year survival rates are about 91 per cent. That falls to 74 per cent once it has spread nearby, and just 13 per cent once it has spread to distant organs.
Commonly overlooked symptoms are similar to other forms of bowel cancer, and include blood in the stool, abdominal pain and changes in bowel habits. Patients often experience iron deficiency – which can occur due to internal bleeding from the tumour – as well as unexplained weight loss. Bloating and pain after eating are also common.
Tumours that develop in the rectum can also press on nerves which usually signal when stool has built up and needs to be excreted – giving the feeling of never fully emptying the bowels after using the loo.
Likewise, while bleeding from tumours higher up in the colon tends to appear as dark red or even black stool, bright red blood can indicate bleeding lower down in the bowel or in the rectum. While this is a clear warning sign of rectal cancer, it is often dismissed as haemorrhoids, or piles.
Several key differences between colon and rectal cancer may help explain the latter’s rising death rates in under-50s.
Because the rectum lacks the protective outer layer – called the serosa – of the colon, it is easier for tumours to break through and spread locally. As a result, studies show that rectal cancer is up to ten times more likely than colon cancer to recur after treatment.
And in early-onset cancer patients in particular, rectal tumours tend to be more aggressive and less treatable, says Dr Mohammad Ilyas, professor of pathology at the University of Nottingham. And treatment therefore often differs depending on the tumour’s location in the bowel wall.
‘A rectal cancer is considered locally advanced when a scan confirms it has grown through the bowel wall into the tissue around the rectum – or when nearby lymph nodes are involved,’ he says. ‘At this stage, most patients will undergo chemotherapy or targeted radiation to shrink the tumour, followed by surgery to remove it.
‘But as tumours located further up the colon are easier to remove, colon cancers are often removed surgically first, with patients later undergoing chemotherapy to kill off any remaining cancer cells.’
Despite these differences, similar factors are thought to be driving the rise in both colon and rectal cancers, says Professor Sarah Berry, a nutritional science expert at King’s College London. She is running the UK’s Prospect trial – a study monitoring the diet, lifestyle and genetics of thousands of young, healthy Britons to identify which characteristics are shared by those who develop bowel cancer before 50.
Already, she says, researchers have learned much about what may be behind the spike in cases among younger people – and, crucially, how to reduce the risk. ‘We estimate that around 60 per cent of bowel cancer cases are due to diet and lifestyle factors,’ she says. ‘And while there’s still a lot that’s unexplained, there’s a lot that we do know.’
Alcohol has been linked to an increased risk of the disease, as have smoking, obesity and sedentary behaviour. But bowel cancer risk also appears to be closely linked to diet.
‘Research has shown that one of the biggest risk factors is a low-fibre diet,’ she says.
After nearly a year of operations and chemotherapy, Ashleigh is cancer-free – but the fear of the disease returning is never far away
Studies show that nearly 95 per cent of British adults do not consume the recommended 30g of fibre each day. The nutrient – found in fruit and vegetables, as well as whole grains, pulses and legumes – feeds beneficial gut bacteria and helps the digestive system move efficiently.
Low-fibre diets, by contrast, can slow digestion, meaning waste sits in the lower bowel for longer – potentially giving harmful bacteria and cancer-linked chemicals more time to damage cells.
‘We know that a high intake of red or processed meat is linked to bowel cancer, as well as sweetened beverages like soda,’ Prof Berry says. ‘There is also growing evidence that additives and emulsifiers – used to stabilise food products – may increase risk.’
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Changes in the British diet over recent decades could therefore be contributing to the rise in bowel cancer, she explains, with diets now higher in ultra-processed foods than ever before.
‘There’s still a lot we don’t know, but we do know that the microbiome – the collection of bacteria in the gut – of people with early-onset bowel cancer is different from those without the disease,’ she adds. ‘And these dietary factors – low fibre, excess sugar, high intake of emulsifiers and additives – alter the microbiome in ways that may be harmful.’
As well as raising awareness of prevention, campaigners say more widespread testing is vital.
‘Bowel cancer has long been seen as a disease that only affects older people,’ says Genevieve Edwards, chief executive of Bowel Cancer UK. ‘That assumption is no longer safe, and it is putting lives at risk.’
She advises that anyone experiencing worrying symptoms should ask their GP for a FIT test, which can be done at home.
Crucially, she adds, the bowel cancer screening programme – which currently offers FIT tests every two years to adults from the age of 50 – must ‘evolve alongside new research’.
‘No one should be told they are too young for cancer,’ she says.
It is a conclusion echoed by the American research team behind the latest study.
‘It’s less about changing guidelines and more about changing how we think about it – recognising that colorectal cancer in young adults is no longer rare,’ said Dr Pathiyil.
Today, after nearly a year of operations and chemotherapy, Ashleigh is cancer-free. But the fear of the disease returning is never far away.
‘It’s something that lives with you daily,’ she says. ‘So now all I want to do is raise awareness so others don’t have to go through what I did. I’ve connected with so many people who have been in the same situation at such a young age – it’s quite scary.
‘But if something feels off, go to your GP – don’t be embarrassed – and ask for a FIT test. Cancer can happen to anybody.’
