A study on presentation and behavior of colo-rectal carcinoma in young Indian patients.

ABSTRACT

Background: Colorectal cancer is rare in younger age group. Most cases occur in the second decade of life and are clinically aggressive. The prognosis of these patients is generally poor. This is a retrospective study in which data of Indian patients was compared to standard literature. Methods: Data on 32 young patients with colorectal cancer between ages of 10-25 years treated between January 2000 and December 2006 was reviewed. Clinical presentation, natural history and response to therapy were evaluated. Results: Studied cases comprised 9.9% of the total number of colorectal cancer patients. The median age of presentation was 21.5 years. Four-fifths of the cases presented in late stage. Nodal involvement was seen in 38% cases and metastatic disease in 12% cases. The rectum was the most commonly involved site. A majority of the patients presented with pain (81%), altered bowel habits (72%) and bleeding per rectum (78%). Surgery was done in 16 cases; radiotherapy in 16 patients; while chemotherapy was used in 19 cases. Responses at completion of treatment were seen in 28% cases; while 1 year post treatment only 12% cases were alive and only 6% at 2 years. Conclusions: Colorectal cancer in younger age is rare and a high level of suspicion is necessary to diagnose it at an early and curable stage. Rectal bleeding therefore should not be ignored but evaluated further with at least a digital rectal examination and a sigmoidoscopy. Failure to do so results in late presentation with consequent dismal survival rates.