Colorectal cancer in young patients: a retrospective cohort study in a single institution

Abstract

Background Young onset colorectal cancer is on the rise, with a disproportionate increase in incidence among young people, both in Australia and internationally. Current national guidelines for bowel cancer screening in average risk individuals include only patients greater than 50 years of age. It is well recognized that colorectal cancer is a highly treatable malignancy when detected at an early stage, and timely diagnosis yields a greater than 90% chance of cure and survival. The aims of this study were to define the clinical presentations leading to colonoscopy in young patients and assess the incidence of malignancy in this group. Methods This is a retrospective cohort study including all patients ≤35 years of age without any baseline indication for early bowel cancer surveillance that underwent colonoscopy at Caboolture Hospital from January 2017 to April 2018. Results A total of 224 patients underwent colonoscopy in the study period. A total of 210 (93.8%) had symptoms including rectal bleeding (51.7%), altered bowel habit (25.9%), abdominal pain (10.3%) and symptomatic anaemia (6.7%) prior to colonoscopy. Two cases of invasive adenocarcinoma were identified (0.89%, P < 0.01), both of which were symptomatic and were defined as stage IIIB disease on histopathology. Conclusion In a theoretically low‐risk population, the incidence of malignancy was nearly 1%. More advanced disease at diagnosis may be due to a delay in investigating these patients due to an overall low suspicion of cancer in young individuals. As such, investigation should be offered early to young patients presenting with any warning symptoms.

Increasing rate of colorectal cancer in younger patients: a review of colonoscopy findings in patients under 50 at a tertiary institution

“…23 It could also support the notion of a more aggressive subtype of CRC in younger populations. 18 Another interesting finding of this study is that patients diagnosed with CRC were symptomatic, which is consistent with studies by Dozois et al and Olivo et al 23,24 This suggests that red flag symptoms, such as PR bleeding, should not be ignored. In young patients some have advocated for a flexible sigmoidoscopy in the investigation of PR bleeding.…”

“…Another interesting finding of this study is that patients diagnosed with CRC were symptomatic, which is consistent with studies by Dozois et al . and Olivo et al 23,24 . This suggests that red flag symptoms, such as PR bleeding, should not be ignored.…”

“…It is argued that in young patients with no other risk factor, there is a low risk of proximal cancer, hence flexible sigmoidoscopy will have a low risk of missing significant lesions. [24][25][26][27][28] It also offers a quicker and safer procedure that does not require complete bowel preparation. However, in our study 36.4% of cancers were right sided.…”

Young-onset colorectal cancer risk among individuals with iron-deficiency anaemia and haematochezia

“…Prior studies retrospectively assessed symptoms in patients with YCRC at time of diagnosis, finding between 37% and 59% of symptomatic individuals had rectal bleeding at diagnosis; these symptoms sometimes led to delays in diagnosis because they were attributed to haemorrhoids. [41][42][43][44][45] Our findings suggest clinicians should recommend patients aged <50 years with haematochezia for complete diagnostic colonoscopy work-up, particularly those between ages 40 and 49 years, or if symptoms persist. If these results are replicated by other…”

Outcomes of Patients with Early Onset Colorectal Cancer Treated in a UK Specialist Cancer Center

“…Although we have not been able to investigate the prior diagnostic pathway of our patients, it has been previously suggested that young patients with CRC report symptoms for a longer period of time, prior to diagnosis, than their older counterparts [25,26]. It is possible that young CRC patients present with symptoms, such as bleeding per rectum, that are initially attributed to benign causes such as hemorrhoids, which may co-exist.…”