COLORECTAL-CANCER IN PATIENTS YOUNGER THAN 40 YEARS OF AGE

The records of the General Surgery Department of the Cerrahpasa Medical Faculty of 10 years duration (1981-1991) were studied retrospectively to determine prognostic factors in colorectal cancer patients younger than 40-year old. Fifty patients between the ages of 10-39 were identified. The family history was positive in 7 of the 50 patients. We found Hematochezia (60%), abdominal pain (64%), alterations in bowel movements (60%) among the presenting symptoms. The pathologic examination revealed no patients in Dukes Stage A, 14 patients in stage B (28%), 36 patients in stage C and D (72%). Distant metastases were present in 10%. Mucinous adenocarcinoma was found in 40% of the patients in whom an histological differentiation could be made. The 5-year survival rate was 25.7% and the 5-year disease free survival rate was 17.1% in the patients who were followed up. The mean survival was 30 months. Poor prognostic factors were Dukes Stages C and D, sex, age, mucinous/nonmucinous histology, tumour differentiation and grade. Patients presenting with one or more of the symptoms above should be carefully examined for colorectal cancer regardless of age because of the importance of delay and presentation with progressive disease on survival. Colorectal cancer is the second leading cause of cancer in the U. S. A. (21). Although colorectal cancer is a disease of older group of patients, the incidence of colorectal cancer in younger patients is being increasingly reported. The importance of this subject derives from the fact that 4 to 18 per cent of the colorectal cancer is found in patients younger than 40-year old (17, 23) and that these patients have a special prognosis. The survival rates have been reported to be between 20 and 40% (3, 4, 22, 23). In our study we reviewed 332 patients operated in the General Surgery Department of the Cerrahpasa Medical Faculty between the years 1981-1991, among which were patients younger than 40-year old and their response to surgery and the poor prognostic factors shortening the survival rate.