Colorectal Cancer in the Young Patient

Abstract

Colorectal cancer is the second most common cause of death from cancer in the UK. It is estimated that between 2 to 3 per cent of colorectal cancer occurs in patients younger than the age of 40 years. It remains unclear from the literature whether this group of patients has a worse prognosis from colorectal cancer than the population as a whole. There are no large series that report a 10-year survival in young patients diagnosed with colorectal cancer. The authors’ objective was to assess patients diagnosed with colorectal cancer younger than the age of 40 years to determine whether the 5- and 10-year survival rates in a tertiary referral center compares favorably with survival rates obtained at other centers and the population as a whole. A retrospective observational study was conducted and an analysis of the patient's notes was made, specifically looking at age at diagnosis, nature and duration of symptoms, predisposing risk factors for colorectal cancer, the site within the bowel of the colorectal cancer, the type of curative resection performed, Dukes’ stage, and details of 5- and 10-year follow-up to assess survival. Forty-nine patients age 40 years or younger received treatment for colorectal cancer at St. Mark's Hospital from 1982 to 1992. The overall 5- and 10-year survival was 58 per cent and 46 per cent respectively. The study provides more evidence to support the fact that young patients with colorectal cancer seem to present with more advanced disease. Despite this, the overall 5-year relative survival rate is comparable if not better than other studies, supporting recent evidence that the prognosis in this group of patients is no worse than for colorectal cancer in the population as a whole.

Epidemiological evaluation focusing on prognostic impact of young age in Egyptian patients with colorectal Cancer, NEMROCK experience

“…Considering age distribution, 34.7 % of our patients were 40 years old or younger which coincides with the previous Egyptian studies, in which the incidence of CRC in patients 40 years old or younger ranged from 30% to 40%5-7 In contrast to western countries where the risk of CRC begins to increase after the age of 40 years and rises sharply at ages 50 to 55 years; the risk doubles with each succeeding decade, and continues to rise exponentially, 90% of these cancers occur in people older than 50 years of age & the incidence of colorectal cancer peaks at about age 65 years.3 Similarly in the United Kingdom, only 2 to 3 per cent of colon cancer occurs in patients younger than the age of 40 years 13 , the high prevalence of the Egyptian CRC in the young could not be explained by Lynch or other hereditary syndromes 12,14,15 , but could be explained by exposure to oncogenic agents at younger age, an explanation which needs more evaluation via environmental and genetic testing.…”

Hepatocellular carcinoma in elderly: Clinical characteristics, treatments and outcomes compared with younger adults

“…Therefore, it was found that old age was associated with poorer prognosis in prostate cancer [ 3 ], thyroid cancer [ 4 ], lung cancer [ 5 ], etc. However, in some other cancers including colorectal [ 6 ], breast [ 7 ], and gastric cancers [ 8 ], older patients had improved outcome than younger patients. Therefore, aging might have distinct impacts on outcome of patients with different types of cancers.…”

Prognoses, outcomes and clinicopathological characteristics of very elderly patients with hepatocellular carcinoma who underwent hepatectomy

“…It is known that lung [8], prostate [9], and thyroid [10] cancers show poorer prognoses in elderly patients than in young patients. In contrast, gastric [11], colorectal [12], and breast [13] cancers show poorer prognoses in young patients than in elderly patients. There have been some reports concerning HCC; however, the conclusions of these reports are controversial [14,15].…”