Colorectal carcinoma in young patients

Abstract

Utilizing Tumor Registry records dating from 1935 to 1988, 50 patients diagnosed with colorectal adenocarcinoma at the age of 40 years or younger were retrospectively studied with respect to sex, race, family history, delay in diagnosis, primary tumor location, tumor differentiation, mucin production, stage at presentation, and the effect of these factors on 5-year survival. This younger group of patients was compared to a computer-generated, randomly selected group of 50 patients 40 years of age or older. There was no difference with respect to sex, racial distribution, family history, symptoms at presentation, or expediency of physician diagnosis between the two groups. Younger patients waited significantly longer to seek medical attention than did their older counterparts. However, those patients who delayed presentation had no higher incidence of advanced disease than those patients who presented earlier. Younger patients had a higher incidence of poorly differentiated, advanced, right-sided tumors. This is in contrast to a predominance of well-differentiated, less advanced, rectosigmoid lesions in the older patients. There was no age-related difference in the incidence of mucin-producing tumors. Overall 5-year survival was 75% in older patients, in contrast to only 51% in younger patients (P = 0.01). We conclude in this study that it is advanced stage at presentation that is the most significant prognostic indicator in patients of all ages. The high incidence of poorly differentiated, right-sided tumors is responsible for the majority of young patients presenting with advanced disease, resulting in their poorer prognosis.

Câncer colorretal: características clínicas e anatomopatológicas em pacientes com idade inferior a 40 anos

“…Em outro estudo, foi observado tempo médio decorrido entre os primeiros sintomas e o diagnóstico de 4,9 meses (9) . Marble et al observaram que pacientes mais jovens esperam significativamente mais tempo antes de procurar a assistência médica, quando comparados aos pacientes mais velhos com idade superior a 40 anos (3) .…”

“…Pelo fato de os indivíduos mais jovens julgarem-se portadores de enfermidades de pequena relevância clínica, o perí-odo entre o início dos sintomas e o diagnóstico pode ser estendido (3) .…”

Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review

“…By and large, patient age (Worden and Weisman, 1975;MacAdam, 1979;McDermott et al, 1981;Turunen and Peltokallio, 1982;Pitluk and Poticha, 1983;Galloway et al, 1984;MacArthur and Smith, 1984;Marshall and Funch, 1986;Robinson et al, 1986;Samet et al, 1988;Dent et al, 1990;Mor et al, 1990;Prohaska et al, 1990;Marble et al, 1992;Kemppainen et al, 1993;Curless et al, 1994;Arbman et al, 1996;Porta et al, 1996;Mulcahy and O'Donoghue, 1997 Factor included only if supported by studies providing strong or moderate levels of evidence * Found in .50% of studies considering factor; * * found in .75% of studies considering factor 1999; Mariscal et al, 2001;McCaffery et al, 2003) and sex (Worden and Weisman, 1975;MacAdam, 1979;McDermott et al, 1981;Turunen and Peltokallio, 1982;Marshall and Funch, 1986;Robinson et al, 1986;Samet et al, 1988;Dent et al, 1990;Kemppainen et al, 1993;Porta et al, 1996;Mulcahy and O'Donoghue, 1997;Majumdar et al, 1999;Sladden et al, 1999;Young et al, 2000;Mariscal et al, 2001;Cockburn et al, 2003;McCaffery et al, 2003) had no impact on delay. Furthermore, there was no relationship between delay and lower socioeconomic status …”

Risk factors for advanced sporadic colorectal neoplasia in persons younger than age 50

“…However, nearly 7 percent of colorectal cancer occurs in persons younger than 50 years, many of whom have no recognizable risk factors recognized prior to diagnosis 2 . In some studies, such younger persons present with more advanced disease and have a less favorable prognosis [3,4].…”