title: Rectal carcinoma under 40 years of age: seven-year post-treatment follow-up at a tertiary care hospital in Pakistan.
abstract: OBJECTIVE
  To determine epidemiological characteristics, clinical presentation, histopathological features, and long-term follow-up of patients below 40 years of age with carcinoma rectum.
  
  
  METHODS
  The retrospective case series comprised all patients presenting with histopathological diagnosis of carcinoma rectum with age 15-40 years at the Aga Khan University Hospital between January 1994 and December 2004. Details regarding patient demographics, pre-operative assessment, management and tumour grade and stage were obtained from a prospectively maintained database. Continuous and categorical variables in the data were analysed.
  
  
  RESULTS
  Of the 23 patients in the study, 14 (60.89%) were male and 9 (39.13%) were female. Mean age of the subjects was 31+/- 5 years. Overall, 22 (95.6%) patients presented with rectal bleeding and 12 (52%) had altered bowel habit. The most common site for the tumour was lower rectum (n=20; 87%) and 13 (56.5%) required abdominoperineal resection. Local recurrence rate was 13% (n=3) and distant metastasis occurred in 2 (8.6%) patients during the seven year follow-up. Two (8.6%) patients died, and both had distant metastasis.
  
  
  CONCLUSIONS
  Carcinoma rectum is uncommon but an important malignancy in patients aged below 40 years. The clinician should have a high index of suspicion in young patients presenting with bleeding per rectum, altered bowel habit and weight-loss.
authors.affiliation: Department of Surgery, The Aga Khan University Hospital, Karachi.
authors.forename: Naveed
authors.initials: N
authors.lastname: Haroon
authors.affiliation: Department of Surgery, The Aga Khan University Hospital, Karachi.
authors.forename: Salma
authors.initials: S
authors.lastname: Khan
authors.affiliation: Department of Surgery, The Aga Khan University Hospital, Karachi.
authors.forename: Rehman
authors.initials: R
authors.lastname: Alvi
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010154:Pakistan / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D063128:Tertiary Health Care