Colorectal cancer in patients under 50 years of age: a retrospective analysis of two institutions' experience

World J Gastroenterol. 2013 Sep 14;19(34):5651-7. doi: 10.3748/wjg.v19.i34.5651.


Aim: 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.

Conclusion: 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.

Keywords: Colorectal cancer; Colorectal cancer screening; Early-age onset colorectal cancer; Sigmoidoscopy; Sporadic colorectal cancer.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Carcinoma / epidemiology*
  • Carcinoma / genetics
  • Carcinoma / pathology
  • Carcinoma / surgery
  • Colon / pathology
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / genetics
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / surgery
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • New York / epidemiology
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Young Adult