(P15) Rectal Cancer in Patients Less Than 50 Years Old: Presenting Symptoms, Staging and Treatment Decisions in a Single Institution

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There is a well-documented increase in rectal cancers among younger patients with little understanding of their clinical presentation, baseline characteristics and treatment strategies. The aim of this study is to characterize the population of young patients (age less than 50) diagnosed with rectal cancer in our institution. This is a retrospective, single institution study. We identified 27 patients under the age of 50 diagnosed with rectal cancer between 2013 and 2017. Medical records were reviewed for patient characteristics, molecular studies and treatment plans. The median age at diagnosis was 41 years (range 28-48). There were 12 women. 5 patients (19%) had rectosigmoid disease. Patients were diagnosed with stage I (n = 3), Stage II (n = 8), stage III (n = 13) or stage IV (n = 3) disease. All stage IV patients were diagnosed with liver metastases at presentation and were treated with curative intent. All patients were diagnosed with adenocarcinoma; 3 (11%) had mucinous adenocarcinoma and 1 (4%) with mixed adeno-neuroendocrine carcinoma of the rectum (MANEC). The median follow up from date of diagnosis was 21 months (range 2-49). Two patients (7%) had a diagnosis of Crohn’s or Ulcerative Colitis. Five patients (19%) reported a family history of colorectal cancer and 1 (4%) reported a family history of Crohn’s disease. Ten patients (37%) reported a positive smoking history. The three most common presenting symptoms included rectal bleeding (n = 19, 70%), change in bowel habits/stool caliber (n = 12, 44%) and weight loss (n = 6, 22%). The median time between initiation of symptoms and tissue diagnosis was 3 months (range 0-12 months). All 27 patients were micro satellite stable. Molecular studies were documented for 12 patients (44%). Of those, 5 were noted to have clinically significant DNA variants, most commonly KRAS (n=4). 21 patients (78%) were treated with neoadjuvant chemoradiation therapy with Xeloda prior to definitive surgery. Those who were not were either unable to tolerate concurrent Xeloda (n = 1), received neoadjuvant chemotherapy alone (n = 2) or did not receive neoadjuvant therapy prior to resection (n = 3). There were no grade 3 toxicities following neoadjuvant chemoradiation treatment. Eleven patients (41%) had additional neoadjuvant chemotherapy prior to surgery; most commonly with FOLFOX (n = 6) or CAPOX (n =4.) Seventeen patients (63%) underwent surgical resection; most commonly Low Anterior Resection (n= 10), Abdominal Perineal Resection (n = 6). Twelve patients (44%) received adjuvant chemotherapy, most commonly FOLFOX (n = 10). Our single-institution retrospective analysis demonstrates that early-onset rectal cancer afflicts almost equally men and women, mostly non-smokers, in their early 40s. These patients predominantly present with rectal bleeding. Most patients received standard neoadjuvant chemoradiation followed by definitive resection and adjuvant chemotherapy, but alternative strategies such as neoadjuvant chemotherapy were often employed. Further study comparing this growing clinical cohort is needed.