Colorectal cancer in the young: A five-year review of cases

OBJECTIVES: The objectives of this paper were: 1) to determine the relative frequency of colorectal cancer in the young, and 2) to compare the clinical features of young patients with colorectal cancer to those patients in the older age group.METHODS: A total of 322 colorectal cancer patients (136 colon, 186 rectum) seen and treated by our section from 1995 to 1999 were reviewed.RESULTS: In the five-year period, 32 colon cancer patients (24 percent) and 41 rectal cancer patients (22 percent) were less than 40 years old. The overall frequency of young patients with colorectal cancer was 23 percent. For colon cancer, there was a predominance of right-sided lesions in young patients (69 percent versus 31 percent in the older group). Both groups of patients had advanced disease (chi square, p=0.38). Aggressive histology of cancers was seen in 63 percent of the younger patients and 24 percent of the older patients (chi square, p=0.007). Most of the rectal cancers seen in both groups were distal third lesions (90 percent in young patients and 86 percent in older patients). Both groups of patients presented with advanced disease at the time of surgery (chi square p=0.71). Pathologic examination showed an aggressive tumor type in 30 percent of the young patients and 25 percent in the older group (chi square p=0.72).CONCLUSION: The clinical features that we observed in young colorectal cancer patients were similar to those of earlier reports.

Histopathologic support of the 2 cm distal resection margin for rectal carcinoma

Recent evidence has shown that a five-centimeter distal margin is not required for cancers of the rectum. These findings proved significant in that selected patients with low rectal lesions can be offered curative operations that can preserve normal sphincter function, an intact route of defecation, and have a better quality of life. From August 2000 to July 2001, we began our series of examining specimens after rectal resection to determine the negative distal margin. The specimens for pathologic examination were cut at 0.5 cm intervals up to 2.0 cm from the raised distal edge of the tumor. The objective of this paper is to determine the distance of intramural tumor spread of rectal cancer from the macroscopic tumor edge. During the one-year period, a total of 11 specimens from rectal cancer patients were examined, ages of the patients ranged from 29 to 77 years. Eighty-two percent of patients had locally advanced (T3 and T4) lesions. Lymph node involvement was seen in 72 percent. Analysis of distal margins showed the following: five of 11 (45 percent) were positive for malignant cells at 0.5 cm from the tumor edge, four of 11 (36 percent) positive at 1.0 cm, one of 11 (nine percent) positive at 1.5 cm, and no malignant cells were seen at 2.0 cm distal margin. Our early results support the adequacy of a 2 cm distal resection margin for rectal cancer surgery. (Author)