Colorectal carcinoma in Nepalese young adults: presentation and outcome

All cases of primary colorectal carcinoma treated at the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu during a period of 5 years were retrospectively reviewed in order to promote a greater awareness of the potential for colorectal carcinoma in young adults under 40 years of age. Of the total 91 patients, 26 (28.6%) were younger than 40 years, and this group included more female patients than the older age group. All patients were symptomatic (single or multiple symptoms) for an average period of 7.6 months (range 1 week to 2 years) before seeking medical advice. In the younger group, rectum was the most frequent site of tumors (76.9%) which was significantly higher than in older age group (36.9%). Younger patients were more likely to present with stage III or IV disease (92.3% vs 61.5%) than the older age group (p = 0.001). Moreover, the younger patients had a significantly higher incidence of poorly differentiated and mucinous carcinoma (p = 0.000). Potentially curative resection was performed in only 10 younger patients and most of them had a recurring disease at a median of 11 months. Curative colectomy was more common in > or = 40 age group (29.2% vs 15.4%). The overall 2-year survival rate was significantly lower in younger age group than in the older patients (4% vs 55%, p = 0.0003).