Colorectal Cancer in Young Adult Population in Kashmir Valley: Tertiary Care Centre Experience

Abstract

Background: Colorectal cancer has been defined and discussed as a disease of middle or late life. However, no age-group is exempt, and adenocarcinoma of the colon has been reported in young age. Malignant disease is frequently found in young adults in our Kashmir valley.
 Objective (s): This aim was to study the clinic pathological features, diagnosis, management and outcome of colorectal cancer in young adults under the age of 40.
 Material and Methods: This combined Retrospective (January 2002 to May, 2004) Prospective (June 2004 to September 2006) Observational Study was conducted in the department of General and Minimal Access Surgery, SKIMS,. Total of 62 young colorectal carcinoma patients were studied. The case records of all the patients of colorectal cancer less than 40years of age admitted in the department of General Surgery were reviewed retrospectively. In the prospective study all the patients less than 40 years of age with colorectal carcinoma admitted in our department were registered. Following the confirmation of diagnosis, the patients were subjected to exploratory laparotomy. The nature of the surgical procedure depended upon the intra-operative findings. All the patients were subjected to postoperative chemotherapy and in selected cases to postoperative chemo-radiation. The patients were followed for a period of five years .The patients were thoroughly examined and investigated on follow up to rule out any recurrence or metastasis.
 Results: Most of our patients (83.9%) were admitted through outpatient department (OPD) and only 10 patients (16.1%) were admitted through emergency. In our study, the male: female ratio was 1.58: 1.The mean age in our study was 30.2 years. Bleeding per rectum was the most common (74.2%) presenting symptom followed by altered bowel habits (72.6%). Carcinoembryonic antigen (CEA) levels show significant decline after surgery/adjuvant therapy. Colonoscopy detected synchronous growths in 5.3% of patients. Rectum was the most common site of lesion (32.2%) while combined rectum and sigmoid colon (including recto sigmoid) accounted for 62.7% of lesions. Resection with intention of cure was performed in 68.3% of patients, palliative procedure in 26.7% and biopsy in 5% of patients. Postoperative complications were recorded and managed accordingly. Typical adenocarcinoma was seen in 80.6% of patients. None of our patients had Dukes stage A presentation. 13.6% of patients had local recurrence and 25.4% had metastasis on follow up. 
 Conclusion: Colorectal cancers in young adults are quite common in Kashmir valley. Outcome of CRC in young patients is significantly related to the procedure - whether done with curative intention or for palliation. Henceforth, surgical treatment should be radical and optimized with adjuvant therapy where possible to achieve the best prognosis. The diagnosis of colorectal cancer should be done at the early and curable stage for better outcome.