Colorectal cancer in patients under forty : Presentation and outcome. Discussion

Colorectal cancer is the third most frequent malignancy in adults of both sexes in this country, with 90 per cent of patients diagnosed after age 50 years. This disease is unusual in patients under 40 years of age, and controversy persists as to prognosis in this subset of patients. Patients diagnosed with invasive adenocarcinoma of the colon and rectum from 1985 to 1997 were identified. They were then grouped according to age (<40 or ≥40). Charts were reviewed with respect to patient epidemiologic characteristics, clinical presentation, tumor staging, and survival. Twelve women and 24 men less than 40 years of age (median, 31 years/range, 13-39 years) were diagnosed with colorectal adenocarcinomas. This represented 8.6 per cent of the total patients diagnosed with colorectal cancers during this time. Thirty-five (97%) had symptoms (pain, blood per rectum, weight loss, or alteration in bowel habits) before diagnosis, and 23 (64%) had multiple symptoms. Younger patients had more poorly differentiated tumors (28%) and more mucinous adenocarcinomas (26%) than the older group. Younger patients were more likely to present with stage III or IV disease (78%) as well. Despite these findings, the median survival for younger patients was no different than the older patients when compared by stage. Colorectal cancer in young adults is rare, but should be considered in the differential diagnosis for all patients with gastrointestinal symptomatology. The presentation of these patients is not unlike that of older patients. Those patients with early-stage disease should be treated aggressively, as long-term survival may be anticipated, whereas the outcome for those with metastatic disease is poor.