Colorectal cancer: are the "young" being overlooked?

Colorectal cancer (CRC) is increasing in young patients. We aimed to assess the trends of CRC and its corresponding clinical presentation in the young.

Cancer registry patients were divided into 3 groups according to age:<50, 50-75, and >75 years. Charts were reviewed for average-risk patients <50 years of age to assess clinicopathological data.

We identified 3,599 patients between 1982 and 2010. Patients aged <50 years increased from 6.8% in (1982-1990) to 8.5% in (2000-2010) with a decrease in the 50-75-year age group from 45.5% to 43.4% (P = .03). One hundred eighty-eight patients were <50 years of age at the time of diagnosis. None had screening tests. Eighty-four percent had symptoms including rectal bleeding (76.5%), abdominal pain (58%), and an altered bowel pattern (71%). Twenty-one percent had symptoms for >6 months before diagnosis. Forty percent had stage III and 20% stage IV disease. This is unlike the 50-75-year age group in which the majority of patients had stage I disease.

Young CRC patients are mostly symptomatic. Advanced disease at presentation could be caused by a delay in investigating these patients. Colonoscopy should be offered early to young patients presenting with warning symptoms.