COLORECTAL-CANCER IN PATIENTS UNDER 40 - PRESENTATION AND OUTCOME

Colorectal cancer is the third most frequent malignancy in adults of b oth sexes in this country, with 90 per cent of patients diagnosed afte r age 50 years. This disease is unusual in patients under 40 years of age, and controversy persists as to prognosis in this subset of patien ts. Patients diagnosed with invasive adenocarcinoma of the colon and r ectum from 1985 to 1997 were identified. They were then grouped accord ing to age (<40 or greater than or equal to 40). Charts were reviewed with respect to patient epidemiologic characteristics, clinical presen tation, 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. Thi rty-five (97%) had symptoms (pain,blood per rectum, weight loss, or al teration 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. Younge r patients were more likely to present with stage III or IV disease (7 8%) as well. Despite these findings, the median survival for younger p atients was no different than the older patients when compared by stag e. 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 t reated aggressively, as long-term survival may be anticipated, whereas the outcome for those with metastatic disease is poor.