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INTRODUCTION: The overall incidence of colorectal cancer (CRC) in Western countries is falling in part due to aggressive adenoma surveillance programs. It has been previously noted that more patients (pts) under age 50 are developing CRC and are more likely to present with Stage 3 or 4 disease yet average risk pts under 50 are excluded from CRC screening programs. This review was undertaken to investigate CRC in pts under 50 at 2 institutions to determine if the above trends are observed in this population.

METHODS: The records of pts under the age of 50 who underwent an operation for CRC between July 1996 and July 2011 at 2 hospitals were reviewed. The main study variables included: age, symptoms, family history, tumor location, resection performed, and stage & differentiation of disease.

RESULTS: Over the 15 year period, a total of 174 CRC pts under age 50 were identified that underwent surgery (90 males, 85 females; mean age 41.4, range 17-49). Pts under 50 accounted for 12% of all CRC cases (all ages) for the 5 year period (2006-2011) for which the full data set was available. Sixteen pts (9%) had a first degree, 17 pts (10%) had a second degree, and 3% had both a first and second degree family history of CRC; 125 pts (71%) had a negative family history. The vast majority (93%) presented with symptoms: the most common were bleeding (57%), obstruction (9%), and abdominal/rectal pain (35%). Not uncommonly, work-up and diagnosis were delayed because of patient and/or doctor complacence. Bleeding was often attributed to hemorrhoids; 2 pts had symptoms for 18-24 months prior to colonoscopy. Advanced CRC (Stage 3 or 4) was found in 95 pts (55%). The tumor locations were: right or transverse, 46 (26%); descending or sigmoid, 59 (34%); rectal, 69 (40%). The vast majority of pts had segmental resections. Five pts had a subtotal/total abdominal colectomy, of which 2 had a first degree family history. Most pts (70%) had moderately or well differentiated cancers, whereas 21 pts (12%) had poorly differentiated lesions and 34 (19%) had mucin producing CRC’s, of which almost two thirds had Stage 3 or 4 disease.

CONCLUSIONS: Young patients with sporadic CRC continue to present with advanced disease. In this series the tumors were predominantly located in the distal colon and rectum. The vast majority of these pts had no contributing family history similar to the situation for the over 50 CRC population. An alarming number of young pts have symptoms that are often attributed to common benign colorectal problems and that lead to a delay in diagnosis. Clinicians must maintain a low threshold for evaluating young symptomatic patients to exclude an occult cancer as the outcome of CRC treatment strongly depends on the stage at diagnosis.