Prognosis of Colorectal Cancer in Patients Younger Than 40 Years Old

Abstract

Purpose. Although colorectal cancer occurs in older patients predominantly, it also affects young adults with an incidence varying between 2.1 and 3.2 percent. However, it is still controversial regarding the features and prognosis of colorectal cancer in young patients. This is a retrospective analysis of colorectal cancer in patients younger than 40 years old. Methods. Ninety-seven colorectal cancer patients with age under 40 years managed at Kaohsiung Veterans General Hospital between November 1990 to June 2004 were reviewed retrospectively. Symptoms, stages, tumor grade, histologic type and survival were studied. Results. Patients under the age of 40 years with colorectal cancer represented 5.2 per cent (n=97) of the 2,262 patients between Nov. 1990 and Jun. 2004. Forty-eight (49.5%) patients were male and forty-nine (50.5%) were female. The mean age was 33.1 years, with the youngest patient being 12 years of age. Rectal bleeding, change in bowel habits and abdominal pain were the most common symptoms. 5.2% were stage Ⅰ, 18.6% stage Ⅱ, 29.9% stage Ⅲ and 46.4% stage Ⅳ respectively. The overall 5-year survival rate of all patients was 29.8%. The 5-year survival rates for stage 1 to stage 4 were 100%, 79.1%, 39.1%, and 0%. Signet-ring cell tumor (p＜0.000), poorly differentiated histology (p=0.017) and vascular invasion (p=0.031) were poor prognostic indicators in young patients. Conclusions. Colorectal cancer in young patients appear to be more advanced in stage at presentation but have similar stage-related survival compared to published data of the general population. In our study, it seemed that there was no significantly higher incidence of unfavorable histologic type, poorly tumor grading and vascular invasion in comparison with literatures reported, but they were poor prognostic factors in young adults. The clinical management for young patients should be no difference from those for the old patients. The detection of colorectal cancer in young patients should be more alert because symptomatic presentation is not obviously different in two groups.