Back to Annual Meeting Program

Background: Patients under 50 years old are not screened for colorectal cancer (CRC) unless they have symptoms or family history. However, recent studies have shown a rising incidence of rectal cancer in young patients. This study examines patient and tumor characteristics of rectal cancer patients younger than 50.

Methods: Retrospective chart review was performed on patients who had radical resection for primary rectal cancer at two tertiary institutions by board-certified colorectal surgeons, 2002-2008.

Results: 57 of 294 patients (19.4%) were less than 50 years of age. 28 (49.1%) were male and the mean age was 42 (24-49 years). One patient had IBD (1.8%), 12 (21.1%) a family history of CRC and 13 (22.8%) a family history of CRC-related cancer. No patients had personal history of CRC or CRC-related cancer. The most common indication for colonoscopy was rectal bleeding (48%). 77.3% of the patients with accurate preoperative stage recorded had locally advanced tumors (>T2) and 41 out of the 57 (71.9%) received neoadjuvant treatment. When compared to patients over 50, young rectal cancer patients were more likely to be female (X2=4.63, p=0.031), however, there were no differences in personal history of CRC or CRC-related cancer, family history or smoking. 20 of 41 patients with complete preoperative data had low tumors (<6cm from anal verge; not different than patients over 50). Younger patients were more likely to have poorly or undifferentiated tumors (X2=9.276, p=0.002); this difference remained significant in a logistic regression model (Wald test 8.11, p=0.004), controlling for gender and other factors. Lymphovascular or perineural invasion and the presence of mucin were not more commonly found in the younger group. Six (14.6%) young rectal cancer patients had complete response to neoadjuvant therapy; complete and any response to neoadjuvant was not different between the groups.

Conclusions: Patients younger than 50 with rectal cancer are more likely to have poorly or undifferentiated tumors. They may also be more likely diagnosed at an advanced stage. Interestingly, these young patients are not more likely to have a family history or personal history of CRC or CRC-related cancer. These results suggest that younger patients may have worse prognostic factors and we should be aggressive in evaluating symptoms in young patients regardless of their history.