Colorectal carcinoma in young patients: CT detection of an atypical pattern of recurrence

Colonic adenocarcinoma is an uncommon but aggressive neoplasm in patients under the age of 40. The goals of this study were to evaluate the utility of computed tomography (CT) in preoperative staging and detection of postoperative recurrences in young patients with colon cancer and to evaluate the pattern of recurrent disease. We reviewed 51 cases of adenocarcinoma in patients aged 40 years and younger. CT preoperatively staged 21 (72%) of 29 patients correctly and had a 100% positive predictive value for metastatic disease. Recurrent disease occurred in 23 (76%) of 30 nonstage D patients with at least 2 years of disease-free follow-up. CT accurately detected 21 (91%) of 23 cases of recurrent disease. Local recurrences were detected in 20 (87%) of 23 patients. Isolated local disease was the most frequent pattern of recurrence, seen in 17 (74%) of 23 patients. Hepatic metastases were rare and occurred in nine (13%) of 51 patients. Young patients with colon cancer have an increased prevalence of isolated local recurrences and decreased rate of hepatic metastases than the older population. In order to detect early, and therefore resectable recurrent disease, CT examinations should be obtained early and often in the postoperative period.