title: Colorectal cancer in patients under 50 years of age: a retrospective analysis of two institutions' experience.
abstract: OBJECTIVE
  To investigate the epidemiological characteristics of colorectal cancer (CRC) in patients under 50 years of age across two institutions.
  
  
  METHODS
  Records of patients under age 50 years of age who had CRC surgery over a 16 year period were assessed at two institutions. The following documents where reviewed: admission notes, operative notes, and discharge summaries. The main study variables included: age, presenting symptoms, family history, tumor location, operation, stage/differentiation of disease, and post operative complications. Stage of disease was classified according to the American Joint Committee on Cancer TNM staging system: tumor depth; node status; and metastases.
  
  
  RESULTS
  CRC was found in 180 patients under age 50 years (87 females, 93 males; mean age 41.4 ± 6.2 years). Young patients accounted for 11.2% of cases during a 6 year period for which the full data set was available. Eight percent had a 1(st) degree and 12% a 2(nd) degree family CRC history. Almost all patients (94%) were symptomatic at diagnosis; common symptoms included: bleeding (59%), obstruction (9%), and abdominal/rectal pain (35%). Evaluation was often delayed and bleeding frequently attributed to hemorrhoids. Advanced stage CRC (Stage 3 or 4) was noted in 53% of patients. Most tumors were distal to the splenic flexure (77%) and 39% involved the rectum. Most patients (95%) had segmental resections; 6 patients had subtotal/total colectomy. Poorly differentiated tumors were noted in 12% and mucinous lesions in 19% of patients of which most had Stage 3 or 4 disease. Twenty-two patients (13%) developed recurrence and/or progression of disease to date. Three patients (ages 42, 42 and 49 years) went on to develop metachronous primary colon cancers within 3 to 4 years of their initial resection.
  
  
  CONCLUSIONS
  CRC was common in young patients with no family history. Young patients with symptoms merit a timely evaluation to avoid presentation with late stage CRC.
authors.affiliation: Elizabeth A Myers, Joon Ho Jang, Richard L Whelan, Department of Colon and Rectal Surgery, St. Luke's Roosevelt Hospital, New York, NY 10019, United States.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Myers
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Feingold
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Forde
authors.forename: Tracey
authors.initials: T
authors.lastname: Arnell
authors.forename: Joon Ho
authors.initials: JH
authors.lastname: Jang
authors.forename: Richard L
authors.initials: RL
authors.lastname: Whelan
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002277:Carcinoma / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D003106:Colon / Q000473:pathology; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Colorectal cancer; Colorectal cancer screening; Early-age onset colorectal cancer; Sigmoidoscopy; Sporadic colorectal cancer
references.citation: Ann Surg. 1985 Nov;202(5):610-4
references.pmid: 4051610
references.citation: Am J Gastroenterol. 1997 Sep;92(9):1505-9
references.pmid: 9317073
references.citation: CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29
references.pmid: 22237781
references.citation: CA Cancer J Clin. 2000 Jan-Feb;50(1):7-33
references.pmid: 10735013
references.citation: Singapore Med J. 1995 Jun;36(3):306-8
references.pmid: 8553099
references.citation: Lancet. 2010 May 8;375(9726):1624-33
references.pmid: 20430429
references.citation: Dis Colon Rectum. 1990 Aug;33(8):714-9
references.pmid: 2165455
references.citation: Dis Colon Rectum. 1986 May;29(5):322-5
references.pmid: 3009108
references.citation: Gastroenterology. 2003 Feb;124(2):544-60
references.pmid: 12557158
references.citation: Surg Gynecol Obstet. 1974 Dec;139(6):909-13
references.pmid: 4421378
references.citation: Surg Gynecol Obstet. 1983 Oct;157(4):335-7
references.pmid: 6623323
references.citation: Gastroenterology. 1997 Feb;112(2):594-642
references.pmid: 9024315
references.citation: Cancer. 1988 Feb 15;61(4):835-40
references.pmid: 3338041
references.citation: World J Surg Oncol. 2010 Sep 15;8:82
references.pmid: 20840793
references.citation: Surg Gynecol Obstet. 1974 Feb;138(2):169-70
references.pmid: 4810853
references.citation: Pathol Annu. 1982;17 (Pt 1):1-46
references.pmid: 6289231
references.citation: Dis Colon Rectum. 1991 Apr;34(4):343-6
references.pmid: 1706654
references.citation: Gastroenterology. 1997 Oct;113(4):1146-58
references.pmid: 9322509
references.citation: Am J Surg. 1981 Dec;142(6):767-9
references.pmid: 6895579
references.citation: Cancer. 1994 Oct 1;74(7):1979-89
references.pmid: 8082105
references.citation: Dis Colon Rectum. 1978 Apr;21(3):169-71
references.pmid: 206417