An Overview of Colorectal Carcinoma in Young Indian Adults

PURPOSE: Rectal cancer is rare in younger age group. Most cases occur in the second decade of life and are clinically aggressive. The prognosis of these patients is generally poor. The purpose of this study is to analyze the presentation and outcome in young (50 years) patients diagnosed with colorectal carcinoma who were treated in our institute from the period of January 2007 to December 2010. METHODS: This study is based on data of 237 patients of rectal carcinoma treated in our institute from 2007 to 2010. Out of these patients, 66 patients (28%) were under the age of 40 years. This study evaluates the pattern of clinical presentation, natural history, treatment modalities, response to therapy, survival in the young patients and influence of clinical and histological factors on survival. RESULTS: From 2007 to 2010, a total number of 237 patients were diagnosed and treated for colorectal carcinoma in our hospital. Out of these 237 patients, sixty-six of them were forty years of age and less. These cases comprised of 28% of the total number of rectal cancers treated in our institute. The median age at presentation was 32 years. The male to female distribution was 1.36: 1, indicating a slightly higher male preponderance. None of the patients had a significant family history. A majority of the cases presented with bleeding per rectum (92%) followed by altered bowel habits (29%). Histology revealed majority of these tumors as adenocarcinomas which comprised of forty-nine (74%) of these tumors without mucin, seven (11%) tumours were mucinous adenocarcinomas and ten (15%) tumours were of signet ring cell variety. The majority of these tumours were moderately differentiated. Most of the cases presented in the late stage with raised CEA levels. Majority were treated with neoadjuvant therapy. Curative surgical excision was possible in only 44 patients, 6 were found unresectable, while 13 defaulted surgery. Majority of our young patients (40%) presented in the locally advanced stage and 29% had local recurrences and 38% of them developed distant metastasis, most commonly in the distant nodes followed by lung bones and liver. Survival analysis of both the young and the older group showed no significant difference in the overall survival (p = 0.31) but showed some difference in the disease free survival (p = 0.025) between the two groups which is statistically significant. CONCLUSION: The prognosis of rectal carcinoma in young individuals is poor because of late diagnosis at an advanced stage and the aggressive histologic forms encountered and also due to a lack of high index of suspicion in this age group resulting in delay in diagnosis and treatment