Young-onset colorectal cancer in patients with no known genetic predisposition: Can we increase early recognition and improve outcome?

Eric Dozois, Lisa Allyn Boardman, Weerapat Suwanthanma, Paul John Limburg, Robert R. Cima, Julie L. Bakken, Robert A. Vierkant, Jeremiah A. Aakre, David Larson

Research output: Contribution to journalArticle

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Abstract

Early recognition of colorectal cancer (CRC) in young patients without known genetic predisposition is a challenge, and clinicopathologic features at time of presentation are not well described. We conducted the current study to review these features in a large population of patients with young-onset CRC (initial diagnosis at age ≤50 yr without established risk factors).We reviewed the records of all patients aged 50 years or younger diagnosed with a primary CRC at our institution between 1976 and 2002. Patients with inflammatory bowel disease, polyposis syndromes, or a known genetic predisposition for CRC were excluded. Data regarding clinical and pathologic features at time of initial presentation were abstracted by trained personnel.We identified 1025 patients, 585 male. Mean age at presentation was 42.4 years (standard deviation 6.4). Eight hundred eighty-six (86%) patients were symptomatic at time of diagnosis. Clinical features in symptomatic patients included rectal bleeding (51%), change in bowel habits (18%), abdominal pain (32%), weight loss (13%), nausea/vomiting (7%), melena (2%), and other (26%). Evaluation of asymptomatic patients was pursued with findings of anemia (14%), positive fecal occult blood test (7%), abdominal mass (2%), mass on digital rectal exam (2%), and other (80%). Site of primary tumor was colonic in 51% and rectal in 49%. Synchronous malignant lesions were noted in 1%. Mucinous and signet cell histology was seen in 11% and 2%, respectively. Tumor grade distribution was grade 1 (2%), grade 2 (54%), grade 3 (34%), and grade 4 (7%). The stage distribution was stage I (13%), stage II (21%), stage III (32%), and stage IV (34%).To our knowledge, the current study is the largest cohort of young-onset CRC patients with no known genetic predisposition for disease. Most patients were symptomatic, had left-colon or rectal cancers and presented with more advanced stage disease. Our findings should promote increased awareness and the aggressive pursuit of symptoms in otherwise young, low-risk patients, as these symptoms may represent an underlying colorectal malignancy.

Original languageEnglish (US)
Pages (from-to)259-263
Number of pages5
JournalMedicine
Volume87
Issue number5
DOIs
StatePublished - Sep 2008

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Genetic Predisposition to Disease
Colorectal Neoplasms
Melena
Neoplasms
Occult Blood
Inborn Genetic Diseases
Hematologic Tests
Rectal Neoplasms
Inflammatory Bowel Diseases
Colonic Neoplasms
Nausea
Abdominal Pain
Habits
Vomiting
Anemia
Weight Loss
Histology
Hemorrhage

ASJC Scopus subject areas

  • Medicine(all)

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Young-onset colorectal cancer in patients with no known genetic predisposition : Can we increase early recognition and improve outcome? / Dozois, Eric; Boardman, Lisa Allyn; Suwanthanma, Weerapat; Limburg, Paul John; Cima, Robert R.; Bakken, Julie L.; Vierkant, Robert A.; Aakre, Jeremiah A.; Larson, David.

In: Medicine, Vol. 87, No. 5, 09.2008, p. 259-263.

Research output: Contribution to journalArticle

Dozois, Eric ; Boardman, Lisa Allyn ; Suwanthanma, Weerapat ; Limburg, Paul John ; Cima, Robert R. ; Bakken, Julie L. ; Vierkant, Robert A. ; Aakre, Jeremiah A. ; Larson, David. / Young-onset colorectal cancer in patients with no known genetic predisposition : Can we increase early recognition and improve outcome?. In: Medicine. 2008 ; Vol. 87, No. 5. pp. 259-263.
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