Colorectal carcinoma in the first three decades of life

Sixteen cases of colorectal adenocarcinoma in patients 30 years of age and younger were treated at the University of Virginia Medical Center between 1957 and 1977. Ten patients (63%) were black, and seven patients (44%) were black females. The high incidence of this tumor in young blacks in our patient population appears to be a recent development, becoming clinically manifested since 1965. Pain was the major presenting symptom, and bleeding was a constant finding in the patients with rectosigmoid lesions. Eighty-six percent had metastases at the time of diagnosis despite a short duration of symptoms. Five-year survival in 11 patients with mucinous adenocarcinoma was 18%, while the three patients with well-differentiated glandular carcinoma had a 5-year survival of 33%. Material was unavailable for histologic review in two cases. Fourteen of 16 patients eventually died of their carcinoma, and one patient died of malignant lymphoma. Additional factors which correlated with length of survival were resectability, extent of bowel wall invasion, and the presence of lymph node capsular invasion. Nodal capsular invasion is an especially sensitive marker for short-term survival and has not been previously reported in colonic tumors.