Characteristics and symptomatology of colorectal cancer in the young

• Published in: Surgery Vol. 173; no. 5; pp. 1137 - 1143
• Main Authors: Skalitzky, Mary Kate, Zhou, Peige P., Goffredo, Paolo, Guyton, Kristina, Sherman, Scott K., Gribovskaja-Rupp, Irena, Hassan, Imran, Kapadia, Muneera R., Hrabe, Jennifer E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2023
• Subjects: Adult; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - pathology; Early Detection of Cancer; Humans; Neoplasm Staging; Rectum - pathology; Retrospective Studies
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2023.01.018

The incidence of colorectal cancer in patients <50 years has rapidly risen recently. Understanding the presenting symptoms may facilitate earlier diagnosis. We aimed to delineate patient characteristics, symptomatology, and tumor characteristics of colorectal cancer in a young population.
A retrospective cohort study was conducted evaluating patients <50 years diagnosed between 2005 and 2019 with primary colorectal cancer at a university teaching hospital. The number and character of colorectal cancer–related symptoms at presentation was the primary outcome measured. Patient and tumor characteristics were also collected.
Included were 286 patients with a median age of 44 years, with 56% <45 years. Nearly all patients (95%) were symptomatic at presentation, with 85% having 2 or more symptoms. The most common symptoms were pain (63%), followed by change in stool habits (54%), rectal bleeding (53%), and weight loss (32%). Diarrhea was more common than constipation. More than 50% had symptoms for at least 3 months before diagnosis. The number and duration of symptoms were similar in patients older than 45 compared to those younger. Most cancers were left-sided (77%) and advanced stage at presentation (36% stage III, 39% stage IV).
In this cohort of young patients with colorectal cancer, the majority presented with multiple symptoms having a median duration of 3 months. It is essential that providers be mindful of the ever-increasing incidence of colorectal malignancy in young patients, and that those with multiple, durable symptoms should be offered screening for colorectal neoplasms based on symptoms alone.