Colorectal cancer survivorship in teenagers

Overview

Colorectal cancer survivorship is the phase of life after treatment for a cancer in the colon or rectum (the large bowel). This article helps teenagers who have finished or are still in treatment understand what to expect, how to stay healthy, and how to thrive.

Colorectal cancer is rare in teenagers, but it does happen. Thanks to improved treatments, more teenagers are becoming survivors and living long, active lives.

It affects teenagers (ages 13 to 19) who have been treated for colorectal cancer. It can also affect young adults into their 20s who were diagnosed during their teen years.

Symptoms

Common symptoms

• Changes in bowel habits (constipation, diarrhea, or feeling of incomplete emptying)
• Blood in or on the stool (bright red, dark, or tarry)
• Unexplained tiredness that doesn't get better with rest
• Cramping or belly pain that comes and goes
• A feeling that the bowel does not empty completely
• Unintended weight loss

Symptoms in children

• Lack of usual energy or trouble keeping up in school
• Difficulty concentrating or memory changes after treatment
• Growth and puberty delays that need extra monitoring
• Nutritional problems due to changes in appetite or digestion

Symptoms in older adults

• Same warning signs can be more subtle, like gradual fatigue or loss of appetite
• New-onset anemia (low blood count) without a clear cause
• Change in stool caliber (narrow stools) that lasts more than a few weeks

Causes

Main causes

• In teenagers, colorectal cancer is usually linked to inherited genetic conditions, such as familial adenomatous polyposis (FAP) or Lynch syndrome, or to long-standing inflammatory bowel disease like Crohn's disease or ulcerative colitis.

Risk factors

• Family history of colorectal cancer, especially at a young age
• Known genetic mutations (e.g., APC or mismatch repair genes)
• Personal history of inflammatory bowel disease
• Previous abdominal radiation therapy for another cancer
• Lifestyle factors are less important in teens, but a low-fiber, high-processed-food diet may contribute over time

When to see a doctor

See a doctor urgently if:

• Any new or sudden severe symptoms listed under Emergency
• Blood in stool that you can see
• Unexplained weight loss or fever lasting more than a day

Book a routine appointment if:

• Scheduled follow-up appointments — don't skip them, they are there to protect you
• Any persistent change in bowel habits for more than two weeks
• Questions about late effects, medications, or lifestyle

Diagnosis

For teenagers in survivorship, diagnosis refers to regular surveillance tests to check for recurrence and to monitor for long-term side effects. These tests are usually scheduled every few months at first, then less often over time.

Tests that may be done

• Colonoscopy (a camera test of the large bowel)
• Computed tomography (CT) scan of the chest, abdomen, and pelvis
• Blood tests, including a tumor marker called CEA
• Kidney and liver function blood tests
• Nutritional and growth assessments for teens

What to expect at your appointment

Follow-up visits usually include a physical exam, blood tests, and sometimes imaging. The team will talk about your energy, mood, weight, and any new symptoms. It's a time to ask questions and plan your next stage of life.

Treatment

Survivorship care is not about treating cancer anymore — it's about looking after your overall health, managing any long-term effects of treatment, and monitoring for any signs of recurrence. Your team will create a personalised plan for you.

Self-care at home

• Drink plenty of fluids to stay hydrated and ease constipation
• Eat a balanced diet with plenty of fruit, vegetables, and whole grains
• Try gentle physical activity like walking, stretching, or swimming to rebuild strength
• Keep a symptoms diary to spot changes early and discuss them with your team
• Avoid tobacco and limit alcohol if you're of legal age — they can raise the risk of new cancers

Medical treatments

Your doctor may prescribe medicines to control digestive symptoms, pain, or nausea. For teenagers, hormone or growth treatments may be needed if puberty or growth is affected. These must be discussed with your consultant — never self-medicate.

When is surgery considered?

Sometimes further surgery may be needed for a bowel blockage, an abscess, or to reconstruct the lower bowel. These decisions are individualised, and you'll be involved in the discussion.

Living with this condition

Life after colorectal cancer treatment takes time to find a new rhythm. You might track your energy, allow rest days, and slowly return to school, sports, and social life.

Lifestyle tips

• Eat small, frequent meals if digestion is sensitive
• Stay active — aim for what feels right for you, not a rigid goal
• Prioritise sleep and manage stress with breathing or mindfulness
• Build a support network of friends, family, and your care team
• Respect your body's limits while gently expanding them

Diet and exercise

Choose fibre-rich foods to keep bowel habits regular, but go easy at first — some people find too much fibre can cause gas or bloating. Stay well-hydrated, include lean protein for healing, and exercise in short bursts. A dietitian can help you build a plan around your unique bowel function.

Mental health and emotional wellbeing

Survivorship often brings anxiety, body image concerns, and worries about recurrence. You might also experience 'survivor guilt' or frustration about missed school or social activities. These feelings are completely valid. Talking to a counsellor, psychologist, or support group can make a huge difference.

Prevention

You can't prevent the original cancer, but you can lower your risk of recurrence by attending follow-up appointments, keeping a healthy weight, moving more, and avoiding tobacco. For teens with genetic syndromes, regular screening and risk-reducing surgery may be options to discuss.

Vaccines

Stay up to date with recommended immunisations, including flu and HPV, and ask your doctor about any vaccines you might have missed during treatment. Don't avoid vaccines without talking to your team.

Screening programmes

Your own follow-up plan acts as survival screening. For your close family, ask your doctor about genetic counselling and testing if your cancer was linked to an inherited condition.

Complications

If left untreated

• If you skip follow-up appointments, a late recurrence may go unnoticed until it's more advanced.
• Long-term side effects like bowel obstruction or nutritional deficiencies can become serious without monitoring.
• Unaddressed mental health struggles can affect school, relationships, and quality of life.

Long-term outlook

It is normal to feel uncertain, but the outlook for teen colorectal cancer survivors has improved dramatically. Many young people complete treatment, go to college, start careers, and build families. With good support and honest communication, you can take charge of your future.

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