Early Incidence of Malignant and Pre-Malignant Colorectal Lesions: Evaluation of 310 Cases

Abstract

Introduction: The colorectal carcinoma (CRC) presents a high rate of morbidity and mortality in the world. Recent studies suggest an increase in the incidence of sporadic lesions at early ages, questioning the anticipation of CRC screening. Very recently, the American Cancer Society has released a new recommendations saying that the screening of CRC should begginning at age of 45 years. The main of this study was to determine the incidence of colic lesions (polyps / CCR) in individuals aged 40-49 years, evaluating their clinical and pathological characteristics. Methods: Retrospective and monocentric study in patients with age between 40 and 49 years-old, whose performed a colonoscopy/flexible rectosigmoidoscopy between January/2010 and June/2017, with a diagnostic of polyps or coloretal carcinoma. Patients with diagnosis of inflammatory bowel disease were excluded. Results: A total of 2106 patients were included, obtaining the diagnosis of polyps/CCR in 310 (15%). The majority (58%) were men, with a median age of 43 years (IQR 41 - 46). There was a relevant familiar history, mainly of CRC, in 24% of cases, and the presence of symptoms motivated the colonoscopy in 38% of individuals. Among the population with diagnosis of polyps, 77% has less than three lesions and in 39% of cases the lesion was a size between 5 and 9 mm. The majority (66%) of lesions were located to the rectum and sigmoid colon. The polyps were adenomatous in 55% of cases; of these, 79% had a tubular structure and 92% had low grade dysplasia. The presence of adenomas was associated with lesions greater than 5 mm (p<0.001) and the presence of symptoms (p=0.017). In 41% of cases, the adenomas were classified as advanced, which was associated with male Gender (p=0.073) and the presence ofsynchronous lesions (p=0.002). The diagnosis of CRC occurred in 31 patients (10%) and 52% of cases were in stage 4. The majority were in the rectum and sigmoid colon and their presence was associated with the existence of symptoms prior to colonoscopy (p=0.001) and the positivity for synchronous lesions (p=0.001). Conclusion: The incidence of colorectal lesions, namely advanced adenomas and CRC was higher than expected and described in the literature, reinforcing the eventual need to revise current recommendations.