Young Colorectal Cancer Patients Research Articles

The Role of Deleted in Colorectal Cancer (Dcc) and P53 Mrna Expression In Young Colorectal Cancer Patients

Background : The incidence of colorectal malignancies at a young age, and the absence of sufficient data to explain about it, including in terms of gene mutations that play a role. The research will be done here is to determine whether changes in mRNA expression of genes DCC ( deleted in colorectal cancer ) and p53 play a role in colorectal malignancy is less than 40 years of age. Researchers also will perform immunohistochemistry to look at protein expression of the gene and protein expression was evaluated whether these correlated with mRNA expression.
 Methods : This study is an observational analytic cross sectional design, carried out in the Laboratory of Biomedical Faculty of Medicine Sebelas Maret University from June 2013 to March 2014. Subjects were 30 patients with stage III colorectal adenocarcinoma, with details of the 15 subjects for each group. Subjects taken by consecutive sampling. Immunohistochemical examination of paraffin block preparation and reverse transcriptase - polymerase chain reaction (RT - PCR) of tumor tissue samples for evaluation of the presence of the protein and mRNA expression of DCC and p53 genes .Statistical analysis using the chi-square test and Phi correlation. 
 Results : the 4 subjects in the age group ≤ 40 years was not accompanied by DCC protein expression while in the age group > 40 years of protein expression obtained in all preparations. Expression of p53 protein more available in the age group > 40 years ( 3 subjects ), in the age group ≤ 40 years is only found in 1 subject. Examination results of RT-PCR to assess the mRNA expression results are consistent with the results of immunohistochemistry. Eleven subjects from the age group ≤ 40 years obtained DCC mRNA expression, whereas p53 mRNA expression was found in 12 subjects. From statistical analysis using the chi-square test and Phi correlation, we found significant association between protein and mRNA expression of DCC with colorectal cancer aged ≤ 40 years. Correlation of test results, obtained significant correlation between mRNA expression of DCC with colorectal cancer aged ≤ 40 years and the results of protein expression were significantly correlated with mRNA expression of DCC and p53 genes. 
 Conclusion : the expression of p53 protein and mRNA did not play a role in colorectal cancer ≤ 40 years of age. Protein expression was positively correlated with mRNA expression .

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

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.

Screening for Lynch syndrome in young Saudi colorectal cancer patients using microsatellite instability testing and next generation sequencing.

Individuals with Lynch syndrome (LS) have germline variants in DNA mismatch repair (MMR) genes that confer a greatly increased risk of colorectal cancer (CRC), often at a young age. Identification of these individuals has been shown to increase their survival through improved surveillance. We previously identified 33 high risk cases for LS in the Saudi population by screening for microsatellite instability (MSI) in the tumor DNA of 284 young CRC patients. The aim of the present study was to identify MMR gene variants in this cohort of patients. Peripheral blood DNA was obtained from 13 individuals who were at high risk of LS due to positive MSI status and young age (<60 years at diagnosis). Next generation sequencing, Sanger sequencing and Multiplex Ligation-dependent Probe Amplification were used to screen for germline variants in the MLH1, MSH2, MSH6 and PMS2 MMR genes. These were cross-referenced against several variant databases, including the International Society for Gastrointestinal Hereditary Tumors Incorporated database. Variants with pathogenic or likely pathogenic significance were identified in 8 of the 13 high risk cases (62%), comprising 4 in MLH1 and 4 in MSH2. All carriers had a positive family history for CRC or endometrial cancer. Next generation sequencing is an effective strategy for identifying young CRC patients who are at high risk of LS because of positive MSI status. We estimate that 7% of CRC patients aged <60 years in Saudi Arabia are due to LS, potentially involving around 50 new cases per year.

P-305 - Colorectal cancer in younger patients

P-305 - Colorectal cancer in younger patients

Young colorectal cancer patients often present too late.

Current screening and health education strategies on colorectal cancer (CRC) remain focused on individuals >50years old. However, CRC in young adults is not uncommon. This paper aims to explore how CRC presents in young adults and their clinical outcomes. All patients aged <50years diagnosed with CRC from January 2007 to December 2015 were reviewed. Patient demographics, clinical symptoms, and outcomes of treatment were collected. Of 1367 patients diagnosed with CRC, 154 (11.6%) were aged <50years. The median age of diagnosis was 45years (range, 19-49). The majority (61%) of the patients presented acutely via the emergency department and the three most common presenting symptoms were abdominal pain (n=94; 61.0%), change in bowel habits (n=74; 48.1%), and per rectal bleeding (n=69; 44.8%). Most of the primary cancers were left sided (n=122, 79.2%) in location and 33 (21.4%) patients had metastatic disease on presentation. 138 (89.6%) patients were treated with curative intent, including 17 (51.5%) with metastatic disease on presentation. There were 31 (22.5%) patients who developed disease recurrence at a median duration of 10.0 (range, 0.5-94.0) months. The younger group (<45years old) were more likely to present acutely and had more aggressive tumor biology. The majority of young CRC patients present acutely and their presenting symptoms are often vague. There is a need to educate young adults on the possibility of harboring CRC and its typical presenting symptoms to enable earlier detection.

Colorectal cancer in patients under the age of 40 years: experience from a tertiary care centre in the Czech Republic

Introduction: Colorectal cancer (CRC) in young patients is not an uncommon disease. Reports on its behaviour in young patients are conflicting. The aim of this study was to investigate patient and tumour characteristics, treatment and prognosis of this disease.Methods: Our study group comprised all patients under the age of 40 years treated with CRC at the Department of Surgery at Motol University Hospital in Prague between the years 2005 and 2015.Results: Thirty-eight patients under 40 years of age diagnosed with CRC were included in the study. Five patients had Lynch syndrome and six had first-degree relatives with CRC. There were 22 rectal tumours. All but four patients underwent resection of the primary tumour, all patients received chemotherapy and 13 patients received biological therapy. Disease recurrence occurred in 25.8%. Five-year survival was 47.9%. Advanced disease and adverse histological subtypes were identified as poor prognostic factors.Conclusions: Colorectal cancer in young patients has a high incidence of predisposing conditions, aggressive histological features and advanced disease. Young patients are of a good state of health and thus should receive aggressive therapy. Clinicians should pay more attention to symptoms of CRC in young patients to be able to initiate early treatment.

Clinical characteristics and treatment progress of adolescent and young adult with colorectal cancer

Colorectal cancer is one of the most common malignant tumors of digestive system. There are significant differences between young patients and other ages in aspects of the disease features, biological characteristics, risk factors, clinical treatment and prognosis, etc. And the analysis of young colorectal cancer patients' characteristics can provide new ideas for clinical treatment. Key words: Colorectal neoplasms; Age groups

Population-based study demonstrating an increase in colorectal cancer in young patients.

New Zealand has among the highest rates of colorectal cancer in the world and is an unscreened population. The aim of this study was to determine the trends in incidence and tumour location in the New Zealand population before the introduction of national colorectal cancer screening. Data were obtained from the national cancer registry and linked to population data from 1995 to 2012. Incidence rates for colorectal cancer by sex, age (less than 50 years, 50-79 years, 80 years or more) and location (proximal colon, distal colon and rectum) were assessed by linear regression. Among patients aged under 50 years, the incidence of distal colonic cancer in men increased by 14 per cent per decade (incidence rate ratio (IRR 1·14), 95 per cent c.i. 1·00 to 1·30; P = 0·042); the incidence of rectal cancer in men increased by 18 per cent (IRR 1·18, 1·06 to 1·32; P = 0·002) and that in women by 13 per cent (IRR 1·13, 1·02 to 1·26; P = 0·023). In those aged 50-79 years, there was a reduction in incidence per decade of proximal, distal and rectal cancers in both sexes. In the group aged 80 years and over, proximal cancer incidence per decade increased by 19 per cent in women (IRR 1·19, 1·13 to 1·26; P < 0·001) and by 25 per cent in men (IRR 1·25, 1·18 to 1·32; P < 0·001); among women, the incidence of distal colonic cancer decreased by 8 per cent (IRR 0·92, 0·86 to 0·98); P = 0·012), as did that of rectal cancer (IRR 0·92, 0·86 to 0·97; P = 0·005). The increasing incidence of rectal cancer among younger patients needs to be considered when implementing screening strategies.

Incidence of colorectal cancer in young patients.

Sporadic colorectal cancer (CRC) is traditionally diagnosed after de sixth decade of life, although a small percentage of cases are diagnosed in patients under 40 years of age, and incidence is increasing. There exists a great volume of controversy regarding clinical outcome of young patients diagnosed with colorectal cancer (CRC) when compared to elder counterparts. Our aims were to evaluate the rate of CRC in young patients, to review the pertaining literature and to discuss outcomes and clinical prognosis. A retrospective review involving patients with CRC was undertaken, focusing on age at diagnosis. The information extracted from this literature review showed a trend towards a decreased incidence in older people with an opposite effect among adolescents and young adults. Moreover, biological aggressiveness in young adults diagnosed with CRC has not been fully recognized, although it is usually diagnosed later and in association with adverse histological features. Besides that, these features don't affect outcome. These apparent increase in CRC incidence among young patients during the last decades raises the need for a greater suspicious when evaluating common symptoms in this group. Thus, educational programs should widespread information for both population and physicians to improve prevention and early diagnosis results.

Progress of colorectal cancer in young patients

Colorectal cancer (CRC) generally occurs in older patients, however the proportion of young patients with CRC is increasing in recent years, which has drawn lots of scholar's attention, but their research results were controversial. The current literature from several fields, including clinicopathological characteristic of young CRC patients, the optimal age cutoff between young and elder CRC patients, and the prognosis, early screening and diagnosis in young CRC patients will be reviewed. Key words: Colorectal neoplasms; Young Adult; Survival

Underuse of microsatellite instability testing and predictors of high microsatellite instability disease among young colorectal cancer patients.

534 Background: The purpose was to identify predictors of non-adherence to MSI testing in young CRC patients and identify factors associated with an increased risk of high microsatellite instability (MSI-H) disease. Methods: Patients 18-49 years old diagnosed with invasive colorectal adenocarcinoma between 2010-2012 and known MSI testing status were identified using the National Cancer Data Base. Multivariable logistic regression was used to identify independent predictors of receipt of MSI testing, as well as MSI-H status among those tested. Results: Among 17,218 patients identified, only 7,422 (43%) underwent MSI testing; the proportion of patients tested increased between 2010 (36%) and 2012 (48%; p &lt; 0.001). Higher educational level, early stage disease, and number of regional lymph nodes examined &gt; 12 were independently associated with MSI testing, whereas older age (40-49), Hispanic ethnicity, non-private insurance status, non-academic/research facility, facility location, rectosigmoid/rectal tumor location, non-mucinous histology, unknown grade, non-receipt of definitive surgery were associated with underuse. Among 6,358 tested patients with known MSI status, 531 (8%) patients had MSI-H disease. Lower income, previous cancer history, and stage II disease were independently associated with MSI-H status, whereas older age (40-49), female sex, advanced comorbidity, non-metropolitan facility status, facility location, distal tumor location, non-mucinous histology, unknown/lower tumor grade, and non-receipt of chemotherapy were inversely associated with MSI-H status. Conclusions: Despite national guidelines, significant underuse of routine MSI testing in young patients diagnosed with colorectal cancer persists. Interventions are warranted to improve adherence to guideline-based care in these patients, particularly among those at increased risk of MSI-H disease. [Table: see text]

The correlation between mismatch repair status and clinicopathological characteristics in Chinese colorectal cancer patients.

544 Background: Our study aimed to explore the relationship between mismatch repair (MMR) status and clinicopathological characteristics in Chinese patients with colorectal cancer (CRC). Methods: A total of 2684 patients with histologically confirmed adenocarcinoma of CRC were consecutively recruited between May 2011 and May 2015 at Sun Yat-sen University cancer center. The exclusion criteria included multiple primary tumors, synchronous and metachronous CRC, and familial adenomatous polyposis. The CRC was defined as left colon with the tumor located below the splenic flexure or rectum, otherwise grouped as right colon. Correlations of MMR status and patient’s demographics, tumor characteristics and TNM staging (exclude 315 CRC patients receiving neoadjuvant therapy) were investigated. Results: We found that deficient MMR (dMMR) status was more likely detected in younger CRC patients compared to the the elderly (12.7% vs 7.5%, P &lt; 0.001). The dMMR rate in right colon cancer was significantly higher than that in left colon cancer and rectal cancer (22.7% vs 7.2% vs 5.2%, P &lt; 0.001).With respect to tumor differentiation, we found that the mucinous adenocarcinoma had the highest rate of dMMR(24.4%), followed by poorly differentiated adenocarcinoma(18.5%), signet-ring cell carcinoma(17.6%), well differentiated adenocarcinoma(9.5%), moderately differentiated adenocarcinoma(8.9%), and neuroendocrine carcinoma (0%) ( P &lt; 0.001). In addition, the proportions in stage I, stage II, stage III and stage IV CRC were 9.7%, 16.5% , 8.5% and 3.9%, respectively ( P &lt; 0.001). There was no significant difference in gender (P = 0.114). Conclusions: At the first time, our study demonstrated that dMMR status was most likely detected at younger age (less than 59 years) and stage II right colon mucinous adenocarcinoma in large volume Chinese patients, which was similar to the results in western countries.

Higher Incidence of Early-Onset Colorectal Cancer in Southeastern Appalachian Kentucky Due to Genetic and Epigenetic Characteristics

Introduction: The aim of this project is to evaluate the genetic and epigenetic factor (smoking) associated with colorectal cancer (CRC) in Southeastern (SE) Appalachian Kentucky. The highest CRC incidence in the United States is in SE KY. The age adjusted CRC incidence rate in KY is 61.3% for males and 44% for females, but in SE KY, the rates are higher (Males: 67.3%; Females: 47.8%). Methods: 41 CRC patients' data were collected retrospectively from 2012-15 from the ARH hospital in Hazard, KY. We performed germ line genetic testing for Lynch syndrome at Myriad Genetic Lab for 18 of the 41 CRC patients. The other 23 patients had tumor screening for Lynch syndrome using immunohistochemical staining of the four mismatch repair proteins at Mayo Lab. We further analyzed data according to age, sex, smoking habits, location of tumor (right-sided or left-sided), family history of CRC, age of diagnosis, and type of MMR gene mutation. Results: 51.2% of patients were male. 30.6% were smokers. 10 of the 41 CRC patients were diagnosed under age 50 (22.7%) compared to 10% expected frequency of CRC cases under age 50. 35.63% of smokers with CRC were diagnosed under age 50. 55% of Lynch (+) CRC patients were smokers. Of the 9 Lynch patients, 4 were left-sided, 4 were right-sided, and 1 had two synchronous left and right tumors. Of the 10 Lynch CRC negative patients, 7 were right-sided, 3 were left-sided. 55.7% of Lynch CRC patients were under 50 years. Of the 9 Lynch (+) test patients, 5 had a MSH2 exon 1-6 deletion mutation, 2 had MLH1 mutations, 1 had a MSH6 mutation, and 1 had a PMS2 mutation. IHC stains were all negative on 23 patients. Of the 29 patients who had detailed family history of CRC, 14.5% had one FDR with CRC, 18% with two FDRs, 16.4% with 3 FDRs, 1.8% with four FDRS, and 1.8% with five FDRs. Conclusion: The incidence of CRC under age 50 is higher in SE Appalachian KY. There seems to be a high correlation between smoking and CRC under age 50 and between Lynch syndrome and CRC under age 50. Our Lynch patients had colon cancer located equally in both proximal and distal colon, indicating increasing incidence of left-sided Lynch syndrome. The MSHS2 exon 1-6 deletion, also known as the American Founder Mutation which has been previously linked to families from SE KY, seems to be the predominate mutation seen in Lynch syndrome patients from this region. Genetic factors, positive family history and smoking may be responsible for the higher incidence of CRC in younger patients in our region.

Clinicopathological Features of Colorectal Cancer Patients Under the Age of 50: Recent Experience and Case-Control Study of Prognosis in a Japanese Cohort

Background/Aims: The incidence of colorectal cancer (CRC) in young people is increasing, indicating an urgent need for understanding young-onset CRC. This study serves to clarify the characteristics and prognosis of young CRC patients. Methods: Using a detailed database, various clinicopathological findings including symptoms, family history and prognosis of 70 young CRC patients under 50 years who underwent surgical resection between 2005 and 2011 were compared to 786 old CRC patients over 50 years. For the comparison of prognosis, a matched 1:4 case-control study adjusting for gender, tumor location, tumor differentiation type, and Union For International Cancer Control stage was conducted. Results: The young group had a higher proportion of rectal cancer (51.4 vs. 36.4%, p = 0.004) and a higher positive rate for the Amsterdam criteria II (7.1 vs. 1.9%, p = 0.02) than the old group. There was no significant difference in overall survival (OS) or cancer-specific survival (CSS) between the young and old groups (5-year OS: 84.7 vs. 76.9%, p = 0.18; 5-year CSS: 84.7 vs. 82.8%, p = 0.55). Conclusion: This study may add a new perspective to understanding young-onset CRC. The prognosis of young CRC patients was equivalent to that of old CRC patients.

Long-Term Outcome and Prognostic Factors of Sporadic Colorectal Cancer in Young Patients: A Large Institutional-Based Retrospective Study.

The prognosis of early-onset sporadic colorectal cancer (CRC) patients remains controversial. The objective of this study was to assess the long-term outcome and prognostic factors of sporadic CRC in young patients.From 2006 to 2011, 8207 patients underwent curative or palliative surgery for CRCs in our institution. A total of 693 patients who were ≤45 years old with sporadic CRC were enrolled as the young group. A total of 1823 patients aged between 56 and 65 years were identified as middle-aged control group for this study. Survival outcome and prognostic factors were compared between the two groups.Young patients had higher recurrence rate than older patients in stages I and II (8.8% vs 2.7%, P <0.001). There was no significant difference of recurrence rate in stage III and IV cancers (27.5% vs 27.9%, P = 0.325). Metachronous cancers were developed more frequently in young patients (1.4% vs 0.6%, P = 0.038). Advanced stage CRC was diagnosed significantly more common in the young group (55.6% vs 47.9%, P = 0.001). High microsatellite instability (MSI) tumors are less likely to have advanced stage cancers (odds ratio (OR) 0.23, 95% confidence interval (CI) = 0.07-0.70) or cancer recurrence (OR 0.11, 95% CI = 0.01-0.85) in young patients. Cancer-specific survival was worse in young patients than that in older patients (81.2% vs 87.8%, P <0.001). However, there was no significant difference in cancer-specific survival for each stage between the two groups. Independent prognostic factors for survival in young patients were undifferentiated cancer (hazard ratio (HR) 2.30, 95% CI = 1.23-4.31) and 3 months or longer duration of symptom (HR 2.57, 95% CI = 1.34-4.94). Young women had better survival compared with young men (HR 0.55, 95% CI = 0.33-0.90).Prognosis of sporadic CRC in young patients is poorer than older patients, because of poorer histologic differentiation and delay in diagnosis. Early detection of CRC confers survival benefit to young patients. Because of higher recurrence rate and metachronous cancer risk, post-operative surveillance is also important in young patients.

Young patients with synchronous colorectal liver metastases.

An increasing proportion of patients are presenting with colorectal cancer at an early age. A proportion of these occur with genetic syndromes; however the majority present as sporadic. The purpose of this study is to investigate the prognosis and treatment of young patients with sporadic metastatic colorectal cancer. Following IRB approval, patients with sporadic metastatic colorectal cancer at 40 years or under were identified. Patient charts and pathology reports were analyzed retrospectively for clinical and pathological factors. Three hundred and two patients were identified; 148 with liver metastases only, and 154 with extra-hepatic disease. Five-year overall survival was 19%, 28% for liver only disease, and 12% for extrahepatic disease. For patients with liver metastases only, factors associated with survival on univariable analysis included diagnosis in the 2000's, unilobular hepatic disease, smaller volume liver metastases, intrahepatic pump chemotherapy, resection of the primary, and resection of liver metastases. On multivariable analysis factors associated with survival included resection of the primary, resection of liver metastases, and diagnosis in the 2000's. Sporadic metastatic colorectal cancer in young patients appears to have a similar prognosis to that in older patients. The most significant prognostic factor was the ability to resect all sites of disease. J. Surg. Oncol. 2016;113:473-476. © 2016 Wiley Periodicals, Inc.

Colorectal cancer in young patients: is it a distinct clinical entity?

The incidence of colorectal cancer in young patients is increasing. It remains unclear if the disease has unique features in this age group. This was a single-center, retrospective cohort study which included patients diagnosed with colorectal cancer at age ≤40years in 1997-2013 matched 1:2 by year of diagnosis with consecutive colorectal cancer patients diagnosed at age >50years during the same period. Patients aged 41-50years were not included in the study, to accentuate potential age-related differences. Clinicopathological characteristics, treatment, and outcome were compared between groups. The cohort included 330 patients, followed for a median time of 65.9months (range 4.7-211). Several significant differences were noted. The younger group had a different ethnic composition. They had higher rates of family history of colorectal cancer (p=0.003), hereditary colorectal cancer syndromes (p<0.0001), and inflammatory bowel disease (p=0.007), and a lower rate of polyps (p<0.0001). They were more likely to present with stage III or IV disease (p=0.001), angiolymphatic invasion, signet cell ring adenocarcinoma, and rectal tumors (p=0.02). Younger patients more frequently received treatment. Young patients had a worse estimated 5-year disease-free survival rate (57.6 vs. 70%, p=0.039), but this did not retain significance when analyzed by stage (p=0.092). Estimated 5-year overall survival rates were 59.1 and 62.1% in the younger and the control group, respectively (p=0.565). Colorectal cancer among young patients may constitute a distinct clinical entity. Further research is needed to validate our findings and define the optimal approach in this population.

Histomorphological characteristics of colorectal carcinoma in the young and elderly: Is there a difference?

Introduction: Colorectal carcinoma is among the leading causes of cancer related mortality. There has been an increase in incidence of CRC in the younger age group. Also young patients with CRC reveal different tumor characteristics than average age or older age groups. Aims: This study was undertaken to analyze the differences in Histomorphological characteristics, based on gender, subsite of the tumor, tumor differentiation and disease stage of CRC in young and elderly age group. Materials and Methods: Histopathologically confirmed cases of colorectal cancer from the year 2007-2013 were taken from the Department of Pathology. Sub group analyses of histomorphological features of CRC in patients 40 yrs using chi square or Fischer’s exact test. P value of < 0.05 was considered significant. Results: Hundred and three cases of colorectal cancer were included in the study. 20.3% of cases were below the age of 40yrs. In patients less than 40 years, most common site of lesion was the rectum, followed by sigmoid colon and caecum. Mucin secreting/signet ring carcinoma (38.09%) and moderately differentiated carcinoma (28.5%) was more common in young patients, than elderly patients. 16.6% of young patients had Dukes stage A, 66.6% had stage B and 16.6% stage C disease. Conclusion: Colorectal cancer in young patients are associated with aggressive histopathological characteristics and advanced stage at diagnosis. Most of the lesions were seen in rectum followed by sigmoid colon. This emphasizes the development and implementation of effective screening program in young patients

Colorectal cancer in young patients: A case report

The incidence of colorectal cancer is increasing in patients younger than 50 years. In this population, the disease appears to be more aggressive and advanced at the time of diagnosis, although initial symptoms are similar. Majority of the cases are sporadic tumors, but some are related to hereditary syndromes such as Lynch syndrome, which is why genetic testing is indicated. We report the case of a 17-year-old patient with colorectal cancer and no family history of bowel cancer.

Lower body mass index predicts worse cancer-specific prognosis in octogenarians with colorectal cancer

High body mass index (BMI) is a risk factor for colorectal cancer. However, the prognostic impact of BMI and other factors may differ between elderly and younger colorectal cancer patients. We analyze here prognostic factors in the surgical management of octogenarians with colorectal cancer and clarify the prognostic impact of BMI. Cox regression analysis and propensity score methods were used to retrospectively examine the association of BMI with mortality in 1613 octogenarian patients who underwent curative surgery for stage 0-III colorectal cancer. In the Cox regression analysis, lower BMI (<18.5kg/m(2); p=0.001), age≥83years (p=0.008), American Society of Anesthesiology class≥3: (p=0.001), performance status≥2 (p=0.003), Union for International Cancer Control (UICC) stage≥III (p=0.001), and postoperative adverse events (p=0.001) were independently associated with decreased overall survival. Lower BMI (p=0.001) and UICC stage≥III (p=0.001) were independently associated with decreased cancer-specific survival. After covariate adjustment, lower BMI was a risk factor for overall [hazard ratio (HR) 1.62; 95% confidence interval (CI) 1.26-2.05; p=0.0004] and cancer-specific survival (HR 2.00; 95% CI 1.39-2.87; p=0.0038) compared with normal BMI (18.5-24.9kg/m(2)). Lower BMI is significantly and independently associated with increased mortality risk in octogenarians who undergo curative surgery for colorectal cancer. Lower BMI should be used for prognosis assessment in octogenarians with colorectal cancer.