Young-Onset Colorectal Cancer in Patients With No Known Genetic Predisposition

Abstract

Early recognition of colorectal cancer (CRC) in young patients without known genetic predisposition is a challenge, and clinicopathologic features at time of presentation are not well described. We conducted the current study to review these features in a large population of patients with young-onset CRC (initial diagnosis at age ≤50 yr without established risk factors). We reviewed the records of all patients aged 50 years or younger diagnosed with a primary CRC at our institution between 1976 and 2002. Patients with inflammatory bowel disease, polyposis syndromes, or a known genetic predisposition for CRC were excluded. Data regarding clinical and pathologic features at time of initial presentation were abstracted by trained personnel. We identified 1025 patients, 585 male. Mean age at presentation was 42.4 years (standard deviation 6.4). Eight hundred eighty-six (86%) patients were symptomatic at time of diagnosis. Clinical features in symptomatic patients included rectal bleeding (51%), change in bowel habits (18%), abdominal pain (32%), weight loss (13%), nausea/vomiting (7%), melena (2%), and other (26%). Evaluation of asymptomatic patients was pursued with findings of anemia (14%), positive fecal occult blood test (7%), abdominal mass (2%), mass on digital rectal exam (2%), and other (80%). Site of primary tumor was colonic in 51% and rectal in 49%. Synchronous malignant lesions were noted in 1%. Mucinous and signet cell histology was seen in 11% and 2%, respectively. Tumor grade distribution was grade 1 (2%), grade 2 (54%), grade 3 (34%), and grade 4 (7%). The stage distribution was stage I (13%), stage II (21%), stage III (32%), and stage IV (34%). To our knowledge, the current study is the largest cohort of young-onset CRC patients with no known genetic predisposition for disease. Most patients were symptomatic, had left-colon or rectal cancers and presented with more advanced stage disease. Our findings should promote increased awareness and the aggressive pursuit of symptoms in otherwise young, low-risk patients, as these symptoms may represent an underlying colorectal malignancy.

Clinico-Pathological Patterns and Survival Outcome of Colorectal Cancer in Young Patients: Western Saudi Arabia Experience

“…This percentage is similar to that reported in Jordan (20.2%) (Al-Jaberi et al, 2003), and Egypt (22%) (Veruttipong et al, 2012). Noteworthy, in western population, the incidence of the disease has increased in the 30-39 years group at an annual rate of 3% in men and 2% in women from 1992 to 2005 (Siegel et al, 2009) Some studies suggest that young CRC patients are diagnosed more frequently in advanced stage (Dozois et al, 2008). A publication based on the SEER database has demonstrated a higher frequency of stage III and IV disease in younger compared to older patients that was highly statistically significant (O'Connell et al, 2004a).…”

Mean ADC values discriminate rectal mucinous carcinomafrom rectal nonmucinous adenocarcinoma

“…Another study showed an average age at presentation (54.2 ± 16.25 years) that was statistically less than that of AC patients (mean age at presentation: 58.73 ± 13.62 years) (32). Dozois et al demonstrated that MC patients had an average age at presentation of 42.2 years (33). Interestingly, rectal cancers were more frequent under the age of 50.…”

Mucinous carcinoma of the rectum: a distinct clinicopathological entity

“…It is relatively rare to find such tumours in the rectum, being most commonly found in the proximal colon. One of the largest studies examining the outcomes of mucinous tumours investigated 16,991 patients and found that just over 18 % of all mucinous tumours were found in the rectum compared with 29 % of non-mucinous tumours [9]. A recent meta-analysis of outcomes in mucinous colon cancer, which included some studies with rectal tumours, reported that mucinous tumours were more frequently found proximal to the splenic flexure compared to non-mucinous adenocarcinoma [10].…”

“…A study by Dozois et al [16], which investigated the characteristics of colon and rectal cancer in patients below the age of 50, found that patients with mucinous tumours had a mean age at presentation of 42.2 years. Furthermore, rectal cancers were found to be more common below the age of 50 (49.1 vs. 21.9 %).…”