Young colorectal cancer patients often present too late

Current screening and health education strategies on colorectal cancer (CRC) remain focused on individuals >50 years old. However, CRC in young adults is not uncommon. This paper aims to explore how CRC presents in young adults and their clinical outcomes.

All patients aged <50 years diagnosed with CRC from January 2007 to December 2015 were reviewed. Patient demographics, clinical symptoms, and outcomes of treatment were collected.

Of 1367 patients diagnosed with CRC, 154 (11.6%) were aged <50 years. The median age of diagnosis was 45 years (range, 19-49). The majority (61%) of the patients presented acutely via the emergency department and the three most common presenting symptoms were abdominal pain (n = 94; 61.0%), change in bowel habits (n = 74; 48.1%), and per rectal bleeding (n = 69; 44.8%). Most of the primary cancers were left sided (n = 122, 79.2%) in location and 33 (21.4%) patients had metastatic disease on presentation. 138 (89.6%) patients were treated with curative intent, including 17 (51.5%) with metastatic disease on presentation. There were 31 (22.5%) patients who developed disease recurrence at a median duration of 10.0 (range, 0.5-94.0) months. The younger group (<45 years old) were more likely to present acutely and had more aggressive tumor biology.

The majority of young CRC patients present acutely and their presenting symptoms are often vague. There is a need to educate young adults on the possibility of harboring CRC and its typical presenting symptoms to enable earlier detection.