COLORECTAL-CARCINOMA IN PATIENTS 30 YEARS OF AGE AND YOUNGER

Thirty-seven cases of colorectal cancer in patients aged 30 years or y ounger have been treated at the University of Virginia Health Sciences Center from 1957 through 1992. The present series, comprising patient s treated from 1978 through 1992, updates a series presented from our institution comprising patients treated from 1957 through 1977. For th e 36-year series, 24 patients (65%) were female, and 13 (35%) were mal e. Sixteen patients (43%) were black, and 21 patients (57%) were white . Sites of tumor and their frequency were rectosigmoid, 14 (38%), left colon, five (14%), splenic flexure, two (5%), transverse colon, three (9%), hepatic flexure, two (5%), right colon, two (5%), and cecum, si x (16%). Twenty-two patients (59%) presented with abdominal pain, wher eas 15 (41%) presented with hematochezia or hemoccult positive stools. The average time of onset of symptoms to diagnosis was 2.3 months. Th irty-four of 37 patients (92%) presented with advanced stage disease. Only four patients had precancerous conditions: one each with Gardner' s Syndrome, Turcot's Syndrome, ulcerative colitis, and villous adenoma . Twenty-five patients (68%) underwent surgery for cure, and ten (27%) received palliative procedures. Nothing could be done for two patient s (5%). Twenty-one patients (57%) had mucinous histology, 13 (35%) had typical adenocarcinoma, one (3%) had small cell carcinoma, and histol ogy was unavailable in two (6%). Nodes were negative in only 10 (27%) patients, of which only three had mucinous histology. There have been five 5-year survivors and three patients alive and disease free at las t follow up, ranging from 30 months to 48 months. We conclude that the re are few survivors among patients aged 30 years or younger with colo rectal, carcinoma. Most patients present with extensive disease and mu cinous histology. Lesions are commonly beyond the transverse colon (57 %). Abdominal pain and hematochezia or hemoccult positive stools are t he most common presenting symptoms. These symptoms should alert the ph ysician to include colorectal carcinoma in the differential diagnosis for young patients.