Clinicopathologic Features of Young Onset Colorectal Cancer Patients: Results From a Large Cohort at a Single Cancer Center

Abstract

Introduction: Whereas the overall incidence of colorectal cancer (CRC) in the United States (US) is decreasing, its incidence in young adults (<50 years old) is increasing. The cause of this remains unclear, and the characteristics of patients with young onset CRC have not been fully elucidated. The aim of this study is to describe the demographics, clinical and pathologic features of patients with young onset CRC. Methods: We performed a retrospective review of all patients with CRC diagnosed between ages 20 and 49 years evaluated at Memorial Sloan Kettering Cancer Center from January 2004 to April 2015. We excluded those with a history of a hereditary CRC syndrome, inflammatory bowel disease, or prior diagnosis of CRC. Patient demographics, presenting symptoms, smoking history, family history of cancer, medical and surgical history, tumor characteristics, and pathology were obtained from the electronic medical record. Baseline characteristics were compared to those found in a nationally representative cohort of cancer-free individuals age 20 to 49 in the US National Health and Nutrition Examination Survey (NHANES). Results: We identified 3,238 young onset CRC patients. Median age of CRC diagnosis was 44; 52% were male (Table 1). Compared with the NHANES population, patients had a lower body mass index (BMI), a higher rate of hypertension and diabetes, and were more likely to have never smoked (Figure 1). The most common presenting symptoms were rectal bleeding (49%), followed by abdominal pain/bloating (33%) and change in bowel habits (25%) (Figure 2). The majority of patients presented with left sided cancers (69%), at late stage disease (65% at stages 3 or 4) (Table 2), and had no family history of CRC (68%) (Table 1).Figure: Comparison of clinical variables for MSK patient population vs. NHANES cancer-free population <50 years old.Figure: Percentage of patients who presented with a given symptom ABBREVIATIONS: BRBPR (bright red blood per rectum); FOBT+ (Fecal occult blood test positive).Table: Table. Demographic Characteristics of Patients ( N =3,238)Table: Table. Cancer Characteristics of MSK Patients Overall and by Age Decade ( N , 3,238)Conclusion: To date, this is the largest single center study describing the demographics, clinical and pathologic features of young onset CRC. Most patients presented with symptoms of rectal bleeding or abdominal pain, left sided cancers, later stage disease and had no family history of CRC. Compared to a US nationally representative population, these patients had a greater prevalence of hypertension and diabetes. More data are needed to better understand risk factors for young onset CRC, and to help identify high-risk patient populations who may benefit from earlier screening.