Early onset colorectal cancer is bowel cancer diagnosed before the age of 50. It makes up about 10 to 15% of colorectal cancers, and incidence is rising by about 2% a year according to colorectal surgeon Dr Scott Mackenzie. In Episode 113, a patient, a colorectal surgeon and a GI pathologist look at what the condition means for clinicians.

Age is no guide. Many of these patients have few symptoms and present at stage three or four. Helen Worthington describes her diagnosis of stage four bowel cancer at 39 and what she would like doctors to know. Dr Mackenzie explains why persistent bowel symptoms and rectal bleeding need investigation at any age, and why family history is the most practical risk marker. Dr Tristan Rutland covers how these tumours differ under the microscope, including the poorly differentiated, mucinous and signet ring types seen more often in younger patients.

Younger patients are easy to reassure. The guests suggest a low threshold for colonoscopy referral when a younger patient has a persistent change in bowel habit or rectal bleeding, and genetic assessment after any early onset diagnosis. The episode introduces you to the symptoms, risk markers and pathology findings relevant to this group, so you can feel more prepared for the younger patient with bowel symptoms.

This is the story of early onset colorectal cancer.

Our Special Guests:

Helen Worthington is an Adelaide-based primary educator, wife and mum with almost 20 years in schools as a classroom teacher and in leadership roles. In 2025, at 39, she was diagnosed with stage four bowel cancer. She is on extended leave from teaching and having chemotherapy.

Dr Scott Mackenzie studied medicine in Aberdeen, completed basic surgical training in Glasgow, then subspecialty training in general and colorectal surgery in Edinburgh. He was the international colorectal fellow at Concord Hospital in Sydney, and is now a senior lecturer in surgery and a surgeon in the Colorectal Surgery Department at Liverpool Hospital. Scott is a returning guest.

Dr Tristan Rutland is an anatomical pathologist and associate professor at the University of Western Australia, with a subspecialty and research interest in GI pathology and asbestos-related diseases. He received the Conrad Muller RCPA Outstanding Teaching Award in 2020 and the Resident Advocate Award from the College of American Pathologists in 2022. Tristan is a regular guest.

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Pleomorphic adenoma is the most common parotid gland tumour. It is benign, usually presents as a painless, slow-growing lump near the jaw, and was first described by surgeon Theodor Billroth in 1859. In Episode 112, ENT surgeon Dr Rowan Valentine explains how it is assessed and managed.

Meet the mixed tumour. In 1859, German-born Austrian surgeon Theodor Billroth gave the first medical description of a slow-growing, painless, encapsulated tumour that occurs mainly in the parotid gland, beside the jaw. Under the microscope it showed a mix of tissue types, so he called it a “mixed tumour”. Today we know it as a pleomorphic adenoma.

Billroth also performed the first laryngectomy and the first successful partial gastrectomy for gastric cancer, and he was a friend of the composer Johannes Brahms. Dr Travis Brown tells his story at the start of the episode.

Jaw lumps raise worry. Dr Valentine walks through what he asks, what he examines, and what he recommends when a patient presents with a parotid lump.

• History: how long the lump has been there, whether it hurts, whether it changes in size, and whether the patient has noticed any weakness of the face.
• Examination: mobility of the lump, the overlying skin, tenderness, sensation near the ear, and the function of each branch of the facial nerve.
• Red flags: pain, skin involvement, a history of skin cancer excisions on the head and neck, and facial nerve paralysis.
• Biopsy limits: in Dr Valentine’s words, fine needle aspirates and core biopsies have about 90% accuracy in separating benign from cancerous lumps.
• Surgery: what the operation involves, how the facial nerve is protected, and the risks Dr Valentine quotes to patients.
• Follow-up: why recurrence can follow if the capsule of the tumour is breached, and how that shapes surveillance.

Long-standing lumps are easy to set aside. Dr Valentine explains why a lump that has been present for years still deserves a plan, and his closing advice for doctors is that a parotid lump is cancerous until proven otherwise. The episode introduces you to the questions, examination findings and red flags an ENT surgeon looks for, so you can feel more prepared for the patient who says, “I’ve had this for years.”

This is the story of pleomorphic adenomas.

Our Special Guest:

Dr Rowan Valentine is an adult and paediatric ear, nose and throat (ENT) surgeon. He trained in Adelaide, completed a PhD during his surgical training, and spent a year at the University of Florida on an anatomy fellowship. He supervises surgical trainees and medical students, and he is a regular guest on This Medical Life.

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This Medical Life podcast is available on all podcasting services, Apple Podcasts, YouTube, and Spotify. Members of the RACGP are able to log the hours as CPD (Education) that they listen to the episodes under self record via Quick log. We invite you to help support us on our donation page.

See omnystudio.com/listener for privacy information.

New guidelines are here. The Prostate Cancer Foundation of Australia and the Australian Government Department of Health, Disability and Ageing have released the 2026 Guidelines for the Early Detection of Prostate Cancer. One in seven Australian men will be diagnosed with prostate cancer. The aim is to find early prostate cancer in the men most at risk, while sparing low-risk men tests they do not need.

The story starts in forensic science. In the 1960s, crime labs needed a better way to detect semen than finding sperm, which break down within minutes to an hour. Dr Travis Brown explains how the Japanese forensic scientist Mitsuhara identified a protein he called gamma-seminoprotein. Teams at Cornell and the University of California found the same protein under other names. Today we call it PSA. By the 1970s, researchers saw it was raised in advanced prostate cancer, and its long, debated path as a screening test began.

The last guidelines came out in 2016. Since then, two things have shifted the balance of risk and benefit: access to multiparametric MRI, and the move from transrectal to transperineal biopsy. In this episode, Ken walks through the key changes:

• Free-to-total PSA ratio is no longer needed. MRI is better at sorting risk. About 80% of men with a confirmed PSA above 3 already have a free-to-total ratio below 25%.
• Ages 45 to 49 (higher risk): refer when PSA is above 1 ng/mL. This group includes men with a brother with prostate cancer, a father diagnosed at 65 or younger, or a BRCA mutation.
• Ages 50 to 69: the threshold stays at 3 ng/mL, or 2 ng/mL for higher-risk men.
• Ages 70 and over: for men likely to live more than seven years, the threshold is 5.5 ng/mL. Men below 5.5 can reasonably stop testing.
• Repeat the test in one to three months. About 30% of men with a PSA above 3 will test well below 3 on repeat, often due to BPH-related variation.
• GPs should now start the conversation. The 2016 guidelines had GPs respond when a man raised it. The new guidelines, endorsed by the RACGP, ask GPs to raise PSA testing with men aged 50 to 69.

Not for prostate cancer screening. In the evidence, rectal exams by non-specialists added as many false positives as false negatives. Ken notes that urologists still gain useful information from it, and a rectal exam remains relevant when you are looking for rectal cancer.

Men with a first-degree relative with prostate cancer, men with BRCA mutations, and men of African ancestry. The guidelines also name Aboriginal and Torres Strait Islander men as a priority population because of poorer access to care. Ken adds that men in regional Victoria have worse prostate cancer outcomes than men in the city.

This is the story of the 2026 Early Detection of Prostate Cancer.

Useful Link:

2026 Guidelines for the Early Detection of Prostate Cancer in Australia

Our Special Guest:

Professor Ken Sikaris is a chemical pathologist and head of clinical integration at Dorevitch Pathology. He is a NATA laboratory assessor, a founding fellow of the RCPA Faculty of Science and a principal examiner in pathology informatics. Ken was one of the first people to measure PSA in Australia, bringing in some of the first test kits around 1989. He helped write the new guidelines.

Listen:

This Medical Life podcast is available on all podcasting services, Apple Podcasts, YouTube, and Spotify. Members of the RACGP are able to log the hours as CPD (Education) that they listen to the episodes under self record via Quick log. We invite you to help support us on our donation page.

See omnystudio.com/listener for privacy information.