Study of Colorectal Malignancy in Young Patients

Abstract

Background: Colorectal cancers are one of the leading causes of cancer related deaths worldwide. Its a common knowledge that the colorectal cancers usually occur in older age groups. This has led to low index of suspicion of having this malignancy in young patients who are less than 40 years of age. We conducted this study of colorectal cancers in young patient to emphasise the importance of keeping in entity in mind while dealing with the patient presenting with complaints consistent with colorectal malignancy even if there age is less than forty year. the stage at which the diagnosis is made is of crucial importance in colorectal malignancy and a delayed diagnosis can have serious consequences for the patient. Objectives: (1) To determine incidence of colorectal malignancy in young patient.(2) To study the symptom complex (3) To determine sex and site distribution (4) To determine operability and respectability of tumour in young patients (5) To study the histopathological types and grading in young patients. Methods: This study was a prospective cohort study of 42 cases of colorectal malignancy of age 40 years and below conducted in patients admitted in department of surgery at a tertiary care institute. The duration of study was 2 years. Results: In this study of colorectal cancers in young patient maximum number of patients were found in the age group of 31-40 years (69.4%) followed by in the age group of 21-30 years (28.57%)and 11-20 years (2.38 %). Males were found to be affected more (54.76%) than females (45.23%). Most common site of involvement was found to be rectum(57.14%) followed by rectosigmoid (16.66%) , caecum and descending colon (11.90%).Most common sign was found to be bleeding per rectum (69.04%) and most common symptom was found to be altered bowel habits (50%) followed by pain abdomen (59.52%). Mucinous adenocarcinoma (52.38% ) was found to be most common histological type of colorectal malignancy followed by adenocarcinoma (42.85%). Most patients were diagnosed in Stage C (47.61%) of duke staging followed by stage B (23.80), stage D (19.04%) and stage A (9.52%). Metastasis were seen in 6 patients. 38 patients were operated. Most common surgical procedure done was abdominoperineal resection (11 patients) followed by Palliative sigmoid colostomy (10 patients ), Right hemicolectomy (5 patients), anterior resection (5 patients), while left colectomy and palliative transverse colectomy was done in 3 patients each. Only 1 patient underwent total proctocolectomy with ileostomy. 4 patients were not operated as they had advanced stages of the disease.Adjuvant chemotherapypy and radiotherapy was given in all patients except in 2 patients who had favourable histological stage and was under follow up. Total 9 patients died during follow up period. 2 refused treatment and 31 patients are still under follow up. Conclusion: Our study was aimed at analysing colorectal malignancy in young patients. It should promote high index of suspicion on the part of treating surgeons about this entity even in young pa...