Top

International Journal of Colorectal Disease

Published in:

01-01-2012 | Original Article

Despite aggressive histopathology survival is not impaired in young patients with colorectal cancer

CRC in patients under 50 years of age

Authors: Vera Simone Schellerer, Susanne Merkel, Silke Christiane Schumann, Anne Schlabrakowski, Thomas Förtsch, Claus Schildberg, Werner Hohenberger, Roland Siegfried Croner

Published in: International Journal of Colorectal Disease | Issue 1/2012

Abstract

Purpose

Colorectal carcinoma (CRC) is generally a disease of persons older than 50 years. Concerning younger patients, controversies still exist regarding features and prognosis of CRC. We performed this study to characterize CRC in young patients (≤50 years) as well as to evaluate outcome in comparison with older patients (>50 years) with CRC.

Methods

Clinical and histopathological parameters of 244 patients aged 50 years or less were compared with 1,718 patients aged more than 50 years.

Results

Compared with older patients, the younger had less adenocarcinomas (82.8% vs. 89.1%; p = 0.004) and less postoperative complications (18.4% vs. 28.7%; p = 0.001), and less Union Internationale Contre le Cancer stage I colon cancers (22.9% vs. 13.6%, p = 0.046) but elevated overall 5-year survival rates for M0 colon and rectal cancers (p = 0.005; p < 0.001). In young patients, the minority suffered from hereditary cancer syndromes (7.4%) and inflammatory bowel diseases (7.0%). Furthermore, up to 40% of young patients denied any cancers in their families. Cancer-related survival rates were significantly elevated in young patients with M0 rectal carcinoma (p = 0.014), whereas in M0 colon cancers, no differences were detectable (p = 0.542). In case of the presence of distant metastases, overall and cancer-related survival rates were similar in old and young patients.

Conclusion

Although young patients present with more aggressive histopathological subtypes and less early stages, cancer-related survival is not less favourable compared with older patients.

Saunders M, Iveson T (2006) Management of advanced colorectal cancer: state of the art. Br J Canc 95(2):131–138CrossRef

Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55(2):74–108PubMedCrossRef

Meyer A, Merkel S, Bruckl W, Schellerer V, Schildberg C, Campean V, Hohenberger W, Croner RS (2009) Cdc2 as prognostic marker in stage UICC II colon carcinomas. Eur J Canc 45:1466–1473CrossRef

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

Ganapathi S, Kumar D, Katsoulas N, Melville D, Hodgson S, Finlayson C, Hagger R (2011) Colorectal cancer in the young: trends, characteristics and outcome. Int J Colorectal Dis 26:927–934PubMedCrossRef

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):866–872PubMed

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

Alici S, Aykan NF, Sakar B, Bulutlar G, Kaytan E, Topuz E (2003) Colorectal cancer in young patients: characteristics and outcome. Tohoku J Exp Med 199(2):85–93PubMedCrossRef

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

10.

Minardi AJ Jr, Sittig KM, Zibari GB, McDonald JC (1998) Colorectal cancer in the young patient. Am Surg 64(9):849–853PubMed

11.

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

12.

Fairley TL, Cardinez CJ, Martin J, Alley L, Friedman C, Edwards B, Jamison P (2006) Colorectal cancer in U.S. adults younger than 50 years of age, 1998–2001. Cancer 107(5 Suppl):1153–1161PubMedCrossRef

13.

Parramore JB, Wei JP, Yeh KA (1998) Colorectal cancer in patients under forty: presentation and outcome. Am Surg 64(6):563–567, discussion 567–568PubMed

14.

Morris AM, Billingsley KG, Baxter NN, Baldwin LM (2004) Racial disparities in rectal cancer treatment: a population-based analysis. Arch Surg 139(2):151–155, discussion 156PubMedCrossRef

15.

Mitry E, Benhamiche AM, Jouve JL, Clinard F, Finn-Faivre C, Faivre J (2001) Colorectal adenocarcinoma in patients under 45 years of age: comparison with older patients in a well-defined French population. Dis Colon Rectum 44(3):380–387PubMedCrossRef

16.

Savas N, Dagli U, Akbulut S, Yuksel O, Sahin B (2007) Colorectal cancer localization in young patients: should we expand the screening program? Dig Dis Sci 52(3):798–802PubMedCrossRef

17.

Lin JT, Wang WS, Yen CC, Liu JH, Yang MH, Chao TC, Chen PM, Chiou TJ (2005) Outcome of colorectal carcinoma in patients under 40 years of age. J Gastroenterol Hepatol 20(6):900–905PubMedCrossRef

18.

Liang JT, Huang KC, Cheng AL, Jeng YM, Wu MS, Wang SM (2003) Clinicopathological and molecular biological features of colorectal cancer in patients less than 40 years of age. Br J Surg 90(2):205–214PubMedCrossRef

19.

Sobin LHWC (2002) UICC TNM classification of malignant tumors, 6th edn. Wiley, New York

20.

Jass JR (1989) Histological typing of intestinal tumours. In: Sobin L, Morson BC (eds) International histological classification of tumours. Springer, Berlin, p 127

21.

Hamilton SR, Aaltonen AL, World Health Organization Classification of Tumours (2000) Pathology and genetics of tumours of the digestive system. IARC, Lyon

22.

Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69(10):613–616PubMedCrossRef

23.

Hohenberger W, Merkel S, Weber K (2007) Lymphadenectomy with tumors of the lower gastrointestinal tract. Chirurg 78(3):217–225PubMedCrossRef

24.

Hohenberger W, Reingruber B, Merkel S (2003) Surgery for colon cancer. Scand J Surg 92(1):45–52PubMed

25.

Schofield L, Watson N, Grieu F, Li WQ, Zeps N, Harvey J, Stewart C, Abdo M, Goldblatt J, Iacopetta B (2009) Population-based detection of Lynch syndrome in young colorectal cancer patients using microsatellite instability as the initial test. Int J Cancer 124(5):1097–1102PubMedCrossRef

26.

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):1033–1040PubMed

27.

Semmens JB, Platell C, Threlfall TJ, Holman CD (2000) A population-based study of the incidence, mortality and outcomes in patients following surgery for colorectal cancer in Western Australia. Aust N Z J Surg 70(1):11–18PubMedCrossRef

28.

Bulow S (1980) Colorectal cancer in patients less than 40 years of age in Denmark, 1943–1967. Dis Colon Rectum 23(5):327–336PubMedCrossRef

29.

Lynch HT, Lemon SJ, Karr B, Franklin B, Lynch JF, Watson P, Tinley S, Lerman C, Carter C (1997) Etiology, natural history, management and molecular genetics of hereditary nonpolyposis colorectal cancer (Lynch syndromes): genetic counseling implications. Cancer Epidemiol Biomarkers Prev 6(12):987–991PubMed

30.

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

31.

Karsten B, Kim J, King J, Kumar RR (2008) Characteristics of colorectal cancer in young patients at an urban county hospital. Am Surg 74(10):973–976PubMed

32.

Goodwin RA, Asmis TR (2009) Overview of systemic therapy for colorectal cancer. Clin Colon Rectal Surg 22(4):251–256PubMedCrossRef

33.

Chew MH, Koh PK, Ng KH, Eu KW (2009) Improved survival in an Asian cohort of young colorectal cancer patients: an analysis of 523 patients from a single institution. Int J Colorectal Dis 24(9):1075–1083PubMedCrossRef

Title: Despite aggressive histopathology survival is not impaired in young patients with colorectal cancer
CRC in patients under 50 years of age
Authors: Vera Simone Schellerer
Susanne Merkel
Silke Christiane Schumann
Anne Schlabrakowski
Thomas Förtsch
Claus Schildberg
Werner Hohenberger
Roland Siegfried Croner
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 1/2012
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-011-1291-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Despite aggressive histopathology survival is not impaired in young patients with colorectal cancer

CRC in patients under 50 years of age

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2012

Common bile duct obstruction by intraluminal colorectal metastasis without evidence of liver or intraabdominal nodal metastasis

Violation of treatment guidelines — hazard for rectal cancer patients

Intra-abdominal dilation of artificial bowel sphincter pressure-regulating balloon: a case report

Focused preoperative patient stoma education, prior to ileostomy formation after anterior resection, contributes to a reduction in delayed discharge within the enhanced recovery programme

Postoperative complications after closure of a diverting ileostoma—differences according to closure technique

Knock-down of ubiquitin-specific protease 22 by micro-RNA interference inhibits colorectal cancer growth