COLORECTAL-CARCINOMA IN THE 1ST 3 DECADES OF LIFE

Cases [16] of colorectal adenocarcinoma in patients 30 yr of age and younger were treated at the University of Virginia Medical Center [USA] between 1957 and 1977. Ten patients (63%) were black and 7 patients (44%) were black females. The high incidence of this tumor in young blacks in the patient population appears to be a recent development, becoming clinically manifested since 1965. Pain was the major presenting symptom, and bleeding was a constant finding in the patients with rectosigmoid lesions. Most (86%) had metastases at the time of diagnosis despite a short duration of symptoms. Five yr survival in 11 patients with mucinous adenocardinoma was 18%, while the 3 patients with well-differentiated glandular carcinoma had a 5 yr survival of 33%. Material was unavailable for histologic review in 2 cases. Fourteen of 16 patients eventually died of their carcinoma, and 1 patient died of malignant lymphoma. Additional factors which correlated with length of survival were resectability, extent of bowel wall invasion and the presence of lymph node capsular invasion. Nodal capsular invasion is an especially sensitive marker for short-term survival and has not been previously reported in colonic tumors.