Rectal Cancer in Patients Under 50 Years of Age

General population screening for colorectal cancer starts at 50, and incidence rates of rectal cancer in patients over 50 years old are decreasing. However, incidence of rectal cancer under age 50 is increasing. This paper analyzes short-and long-term outcomes for rectal cancer patients under 50 years of age.

Retrospective analyses of consecutive patient cohort, who all received surgical treatment for primary rectal adenocarcinoma at a single institute were used in the study. Outcomes were stratified based on age under or over 50 at the time of surgery.

A total of 582 patients was included, of whom 125 were younger than 50. ASA-score was higher for older patients, with no other significant differences in baseline characteristics. AJCC-staging, based on surgical pathology, differed significantly due to higher stage II-rate in the older group and higher stages III- and IV-rates in the younger group. Percentages of high-grade disease, small vessel-, and perineural invasion were higher for younger patients. Stage-for-stage oncologic survival analyses did not demonstrate a significant difference between younger and older patients. Additionally, an age under/over 50 did not have a significant effect in multivariable analyses for disease free-, and disease specific survival.

Patients who present with rectal cancer under the age of 50 do not seem to have more aggressive disease, while they present with more advanced disease when compared to patients older than 50. Identifying young people at risk of developing rectal cancer and start screening earlier in a selective group might improve disease stage on presentation.