Skip to main content

Advertisement

SpringerLink
Log in

Colorectal cancer in the young: trends, characteristics and outcome

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Colorectal cancer (CRC) in young patients is associated with a poor outcome due to advanced stage at diagnosis and poor differentiation.

Aim

The aim of this study is to compare clinicopathological characteristics, overall survival (OS) and disease-free survival (DFS) of young (≤40 years) and older patients with CRC.

Methods

A total of 2,538 patients including 59 young patients (age ≤40 years) with CRC were identified over 20 years. The clinicopathological variables of young patients were compared with a group of consecutive older patients (n = 416) spanning both decades. Survival analysis was done using Kaplan–Meier, log-rank and Cox regression models.

Results

The frequency in young patients increased from 1.4% to 3.0% from first to second decade (overall −2.3%, p = 0.006). There was a higher frequency of tumours with poor differentiation (43% vs. 16%, p = < 0.001), T4 stage (47% vs. 30%, p = 0.005) and vascular invasion (VI; 38% vs. 29%, p = 0.13) in younger group. There was no significant difference in OS (p = 0.116) and DFS (p = 0.261) between the two groups. Node-negative young patients had a significantly better OS (p = 0.046). Young patients with VI had significantly reduced OS (p = 0.043), whereas young patients without VI had significantly better OS (p = 0.012). Multivariate analysis showed T4 status (p = 0.001) and vascular invasion (p = 0.002) as independent prognostic factors for OS and T4 status (p = 0.004) as independent factor influencing DFS.

Conclusion

The frequency of CRC in young patients increased significantly. Vascular invasion is the single most important prognostic factor in young CRC. Along with vascular invasion, high proportion of T4 status in young patients increases the chances of recurrence and negates any survival advantage in young patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Atkin WS, Cuzick J, Northover JM, Whynes DK (1993) Prevention of colorectal cancer by once-only sigmoidoscopy. Lancet 341(8847):736–740

    Article  PubMed  CAS  Google Scholar 

  2. O’Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY (2003) Rates of colon and rectal cancers are increasing in young adults. Am Surg 69(10):866–872

    PubMed  Google Scholar 

  3. O’Connell JB, Maggard MA, Livingston EH, Yo CK (2004) Colorectal cancer in the young. Am J Surg 187(3):343–348

    Article  PubMed  Google Scholar 

  4. Taylor MC, Pounder D, Ali-Ridha NH, Bodurtha A, MacMullin EC (1988) Prognostic factors in colorectal carcinoma of young adults. Can J Surg 31(3):150–153

    PubMed  CAS  Google Scholar 

  5. Palmer ML, Herrera L, Petrelli NJ (1991) Colorectal adenocarcinoma in patients less than 40 years of age. Dis Colon Rectum 34(4):343–346

    Article  PubMed  CAS  Google Scholar 

  6. Marble K, Banerjee S, Greenwald L (1992) Colorectal carcinoma in young patients. J Surg Oncol 51(3):179–182

    Article  PubMed  CAS  Google Scholar 

  7. Cusack JC, Giacco GG, Cleary K, Davidson BS, Izzo F, Skibber J et al (1996) Survival factors in 186 patients younger than 40 years old with colorectal adenocarcinoma. J Am Coll Surg 183(2):105–112

    PubMed  CAS  Google Scholar 

  8. Adloff M, Arnaud JP, Schloegel M, Thibaud D, Bergamaschi R (1986) Colorectal cancer in patients under 40 years of age. Dis Colon Rectum 29(5):322–325

    Article  PubMed  CAS  Google Scholar 

  9. Beckman EN, Gathright JB, Ray JE (1984) A potentially brighter prognosis for colon carcinoma in the third and fourth decades. Cancer 54(7):1478–1481

    Article  PubMed  CAS  Google Scholar 

  10. Lee PY, Fletcher WS, Sullivan ES, Vetto JT (1994) Colorectal cancer in young patients: characteristics and outcome. Am Surg 60(8):607–612

    PubMed  CAS  Google Scholar 

  11. Heys SD, Sherif A, Bagley JS, Brittenden J, Smart C, Eremin O (1994) Prognostic factors and survival of patients aged less than 45 years with colorectal cancer. Br J Surg 81(5):685–688

    Article  PubMed  CAS  Google Scholar 

  12. O’Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY (2004) Do young colon cancer patients have worse outcomes? World J Surg 28(6):558–562

    Article  PubMed  Google Scholar 

  13. Durno CA, Gallinger S (2006) Genetic predisposition to colorectal cancer: new pieces in the pediatric puzzle. J Pediatr Gastroenterol Nutr 43(1):5–15

    Article  PubMed  Google Scholar 

  14. LaQuaglia MP, Heller G, Filippa DA, Karasakalides A, Vlamis V, Wollner N et al (1992) Prognostic factors and outcome in patients 21 years and under with colorectal carcinoma. J Pediatr Surg 27(8):1085–1089, discussion 9–90

    Article  PubMed  CAS  Google Scholar 

  15. Kravarusic D, Feigin E, Dlugy E, Steinberg R, Baazov A, Erez I et al (2007) Colorectal carcinoma in childhood: a retrospective multicenter study. J Pediatr Gastroenterol Nutr 44(2):209–211

    Article  PubMed  Google Scholar 

  16. Hill DA, Furman WL, Billups CA, Riedley SE, Cain AM, Rao BN et al (2007) Colorectal carcinoma in childhood and adolescence: a clinicopathologic review. J Clin Oncol 25(36):5808–5814

    Article  PubMed  Google Scholar 

  17. Bleyer A, Barr R, Hayes-Lattin B, Thomas D, Ellis C, Anderson B (2008) The distinctive biology of cancer in adolescents and young adults. Nat Rev Cancer 8(4):288–298

    Article  PubMed  CAS  Google Scholar 

  18. Courtney ED, West NJ, Kaur C, Ho J, Kalber B, Hagger R, Finlayson C, Leicester RJ (2009) Extramural vascular invasion is an adverse prognostic indicator of survival in patients with colorectal cancer. Colorectal Dis 11:150–156

    Article  PubMed  CAS  Google Scholar 

  19. Cleary J, Peters TJ, Sharp D, Hamilton W (2007) Clinical features of colorectal cancer before emergency presentation: a population-based case control study. Fam Pract 24(1):3–6

    Article  PubMed  Google Scholar 

  20. Griffin PM, Liff JM, Greenberg RS, Clark WS (1991) Adenocarcinomas of the colon and rectum in persons under 40 years old. A population-based study. Gastroenterology 100(4):1033–1040

    PubMed  CAS  Google Scholar 

  21. Chung YF, Eu KW, Machin D, Ho JM, Nyam DC, Leong AF et al (1998) Young age is not a poor prognostic marker in colorectal cancer. Br J Surg 85(9):1255–1259

    Article  PubMed  CAS  Google Scholar 

  22. Makela JT, Kiviniemi H (2010) Clinicopathological features of colorectal cancer in patients under 40 years of age. Int J Colorectal Dis 25(7):823–828

    Article  PubMed  Google Scholar 

  23. Quah HM, Joseph R, Schrag D, Shia J, Guillem JG, Paty PB et al (2007) Young age influences treatment but not outcome of colon cancer. Ann Surg Oncol 14(10):2759–2765

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

Angela Cook and E. D. Courtney helped with database.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, St. George’s Hospital, Blackshaw Road, London, SW17 0QT, UK

    Senthil Ganapathi, Devinder Kumar, Nikolaos Katsoulas, David Melville & Robert Hagger

  2. Department of Cancer Genetics, St. George’s Hospital, Blackshaw Road, London, SW17 0QT, UK

    Shirley Hodgson

  3. Department of Pathology, St. George’s Hospital, Blackshaw Road, London, SW17 0QT, UK

    Caroline Finlayson

Authors
  1. Senthil Ganapathi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Devinder Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nikolaos Katsoulas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Melville
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shirley Hodgson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Caroline Finlayson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robert Hagger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Devinder Kumar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ganapathi, S., Kumar, D., Katsoulas, N. et al. Colorectal cancer in the young: trends, characteristics and outcome. Int J Colorectal Dis 26, 927–934 (2011). https://doi.org/10.1007/s00384-011-1174-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-011-1174-z

Keywords

Search

Navigation