Presentation and outcomes of patients aged 30 years and younger with colorectal cancer: a 20-year retrospective review

Age may influence the clinicopathological characteristics and outcome of colorectal cancer. The aim of this study is to retrospectively review the characteristics and outcomes of patients diagnosed at age 30 years and younger. All patients diagnosed with colorectal adenocarcinoma at age 30 years or younger, referred to the British Columbia Cancer Agency between 1985 and 2005, were identified. Abstracted data included demographics, presenting symptoms, risk factors, stage at presentation, treatment received and overall survival. Survival analysis was by the method of Kaplan-Meier. From 16,732 patients with colorectal cancer, 78 (0.47%) were younger than or equal to 30 years of age. Sufficient data were available for 62 patients. Twenty-three patients (37%) had a rectal primary, and 52% of colon primaries were proximal. Seventeen patients (27%) presented with metastatic disease. The stage distribution among the 45 patients with localized disease was stage I 9%, stage II 42% and stage III 49%. A positive family history was reported in 27% of patients. Pain and bleeding were the most common symptomatic presentations. Five-year overall survival was 44% in the entire cohort; 54% in stage I-III disease and 12% in stage IV disease. Very young patients with colorectal cancer represent < 0.5% of all referred cases in British Columbia. The majority presented without a positive family history. The 5-year survival for patients in our young cohort with localized disease appears inferior to that expected, although 5-year survival among patients with stage IV disease was observed to be higher than expected.