Kate Middleton's struggle with abdominal cancer: Unraveling the rise in incidence among 30 and 40-year-olds
Key Takeaways
Catherine, The Princess of Wales announced that she was diagnosed with cancer after undergoing abdominal surgery in January.
While the Princess did not specify which type of cancer was diagnosed with nor what kind of abdominal surgery she had, there are several types of abdominal cancer—many of which are affecting younger people more and more.
Experts say that colorectal, pancreatic, and liver cancers are occurring more and more in young people, including women. Symptoms include sudden weight loss, stomach pain, vomiting, and bloody stool.
Catherine, The Princess of Wales, announced on March 22 that she was diagnosed with an unspecified form of cancer after undergoing major abdominal surgery in January. The January 17 news statement by Kensington Palace indicated that the surgery was planned. The Palace also said in January that the condition was non-cancerous.[][][]
The Princess now says she is now undergoing “preventive” or “adjuvant” chemotherapy, often used after surgery to prevent cancer from returning.[]
While the Princess’s condition remains unspecified, her diagnosis has resulted in waves of global conversation around abdominal cancer, especially cancers that occur in younger, healthy people.
Your patients may be wondering what abdominal surgery refers to, what abdominal cancer is, and whether younger women are at risk of developing it.
Anton Bilchik, MD, PhD, a surgical oncologist, Chief of Medicine, and Director of the Gastrointestinal and Hepatobiliary Program at Providence Saint John’s Cancer Institute in Santa Monica, CA, says that abdominal cancers generally involve the stomach, liver, gallbladder, pancreas, colon, and rectum.
For biological women, gynecological cancers might also fall into the ‘abdominal’ category. “The pelvis can be considered part of the abdomen,” Dr. Bilchik says, “but in the medical world, we consider this the pelvic region. So the phrase ‘abdominal surgery’ is extremely vague.”
Dr. Bilchik says that growing abdominal cancer rates are an unfortunate reality—and that he’s seeing many patients in their 20s and 30s with cancer diagnoses. A few types of cancers stand out to him as particularly high-risk and increasing in incidence.
“What has taken the whole medical world by storm is the massive increase in young people under 50 with colorectal cancer (CRC), for example,” he says. According to the Yale School of Medicine, the number of adults under 55 being diagnosed with colorectal cancer today compared to a decade ago has nearly doubled. CRC is a leading cancer type in women.[][]
“We are seeing younger people diagnosed every single week, [whereas they used to be over 65]. But, for several unknown reasons, there’s a rapid increase in CRC cancer,” Dr. Bilchik says.
Rates of pancreatic cancer, which the World Health Organization (WHO) estimates is the third-leading cancer-related cause of death in the US, are also rising, Dr. Bilchik says.
According to an examination of pancreatic cancer incidence trends from 2000 to 2018 published in Cancer (Basel), younger women of all races and ethnicities experienced a greater rate of increase in pancreatic cancer compared to men. In younger Hispanic and Black women, the rates were even higher. Pancreatic cancer has a 5-year survival rate of about 12.5%.[][]
Dr. Bilchik says that liver cancer rates are also rising. The American Cancer Society estimated that in 2023, 13,630 cases in women would have been diagnosed and that 10,720 women would have died of these cancers). These rates for all genders have more than tripled since 1980, while death rates have more than doubled.[]
“The cause of liver cancer has changed in the sense that it used to be caused primarily by alcohol use and hepatitis. Today, the most common cause is fatty liver disease,” Dr. Bilchik says.
Stomach cancer, on the other hand, has declined in incidence and mortality over the last few decades, according to a 2022 article published in World Journal of Gastroenterology. It is currently the fourth-leading cause of cancer deaths in both men and women.[]
“Usually, when stomach cancer presents, it presents in a more advanced stage,” Dr. Bilchik says. This is especially true in non-Asian countries, as Asian countries, he says, have higher rates of stomach cancer and thus have better screening guidelines. “The United States doesn’t have the same guidelines, so by the time [a patient] presents with stomach cancer, it’s typically more advanced.”
He says that while CRC is more common than other types of abdominal cancers, its treatments are often more effective, and its outcomes are generally better than those of other cancer types.
“Many of these cancers can be treated with surgical removal alone, but some also require other treatments like chemotherapy or radiation therapy,” says Anne Peled, MD, the co-director of the Breast Care Center of Excellence at Sutter Health California Pacific Medical Center.
Dr. Bilchik says that symptoms for many of these cancers include sudden weight loss, stomach pain, vomiting, and bloody stool. Patients with a family history of any of these cancers should see a geneticist, he recommends.
He says that patients whose immediate family members—like siblings or parents—were diagnosed with abdominal cancer at a younger age should get screened. In this case, physicians will want to screen patients 10 years before the age at which their family member was diagnosed, Dr. Bilchik says.
What is driving the increase in abdominal cancer rates?
The risk factors for abdominal cancers, excluding pelvic cancers, include obesity, sedentary lifestyle, smoking, and family history. “There are several possible explanations, but no one has a good theory as to why people who are young, healthy, not obese, don’t smoke, exercise, aren’t diabetic, and have no family history…are being diagnosed with cancer,” Dr. Bilchik says.
When it comes to CRC, “there’s been a ton of research, particularly in CRC, on the relationship between processed food and red meat,” Dr. Bilchik explains.
Dr. Bilchik says that disruption of the body’s bacteria-filled microbiome could also result in cancer. “Some studies suggest [that] antibiotics may impact some of the important immune bacteria. There is a known association between bacteria in our body and illness—in particular cancer. That [could be] a potential cause in a young person,” Dr. Bilchik adds.
Another area being explored? Inflammation. “Inflammation plays an important role in cancer development. Smoking, obesity, and processed foods cause inflammation,” he says. To reduce inflammation, patients should focus on exercising, not smoking, and reducing stress.
“Some chronic conditions like inflammatory bowel disease or gastritis, or infections like HPV or HIV, can also make people more likely to develop certain types of abdominal cancers,” adds Dr. Peled.
Making sense of Princess Catherine’s announcement
Dr. Bilchik adds that patients may be confused by the term “preventive chemotherapy,” which the Princess says she is receiving.
“The medical term is ‘adjuvant chemotherapy,’” Dr. Bilchik says. Patients will typically receive it after surgery, when the cancer may be entirely removed, but cancer cells could still be present.
“What the current situation with Princess Catherine will bring to the forefront is that cancers are not an older person's disease. People are going to be a lot more aware of cancer prevention and screening,” Dr. Bilchik says. “It’s also a warning to parents in terms of having their kids stay away from vending machines, reduce processed food, and exercise. These are important factors.”
Lastly, Dr. Bilchik says that when it comes to news coverage around celebrity illnesses, it’s important that patients are encouraged to consider the source. Experts, he says, are the only sources who should be speaking about public health crises.