Colorectal cancer: are the "young" being overlooked?

Abstract

Background: Colorectal cancer (CRC) is increasing in young patients. We aimed to assess the trends of CRC and its corresponding clinical presentation in the young.

Methods: Cancer registry patients were divided into 3 groups according to age:<50, 50-75, and >75 years. Charts were reviewed for average-risk patients <50 years of age to assess clinicopathological data.

Results: We identified 3,599 patients between 1982 and 2010. Patients aged <50 years increased from 6.8% in (1982-1990) to 8.5% in (2000-2010) with a decrease in the 50-75-year age group from 45.5% to 43.4% (P = .03). One hundred eighty-eight patients were <50 years of age at the time of diagnosis. None had screening tests. Eighty-four percent had symptoms including rectal bleeding (76.5%), abdominal pain (58%), and an altered bowel pattern (71%). Twenty-one percent had symptoms for >6 months before diagnosis. Forty percent had stage III and 20% stage IV disease. This is unlike the 50-75-year age group in which the majority of patients had stage I disease.

Conclusions: Young CRC patients are mostly symptomatic. Advanced disease at presentation could be caused by a delay in investigating these patients. Colonoscopy should be offered early to young patients presenting with warning symptoms.