Clinical Presentation, Management, and Outcomes of Adolescents and Young Adults With Colorectal Cancer

Colorectal cancer (CRC) is rare in adolescents and young adults (AYAs), yet incidence is rising, and prognosis is inferior compared to older patients. This analysis characterized variation in management and outcomes among AYA patients with CRC.

A retrospective analysis across four institutions of patients 10-22 y with colorectal adenocarcinoma diagnosed between 1/1/2010 and 12/31/2022. Patients with carcinoid tumors and predisposition syndrome prior to diagnosis with CRC were excluded.

There were 34 patients with median age at diagnosis of 19 y (interquartile range: 16, 21). Twenty-one patients (62%) had colon cancer and 13 (38%) had rectal cancer. The median time to diagnosis was 2.1 mo (range 2 d to 1 year). At presentation, 25 patients (74%) had ≥ T3 stage, 10 (29%) had metastatic disease, and 24 (71%) had ≥1 positive lymph node. Surgery was performed by a combined pediatric and adult surgical team for two patients (6%). Fewer than 12 lymph nodes were collected in six patients (18%). On final pathology, there were 24 patients (71%) with ≥ T3 disease and 13 (38%) with a histological feature associated with poor prognosis. With a median follow-up time of 2.2 y (interquartile range: 1.6, 6.9), 17 patients (50%) were alive with no evidence of disease, 5 (15%) alive with disease, nine (26%) deceased, and 3 (9%) unknown.

Our study highlights the range of presentations and outcomes in AYA CRC. Given the rarity but increasing prevalence of this disease, initiatives to improve collaboration between pediatric and adult providers may result in optimizing care and outcomes.