Colorectal Cancer (Crc) In The Young: A Comparative Study Of Crc In Young Vs Old

IntroductionIncidence of CRC in the young are increasing and it is defined when a diagnosis is made in individuals younger than 50 years of age. There is plethora of data on incidence and tumour characteristics in young. However, there is limited literature available regarding clinical presentation and tumour behaviour in young CRC. Aim is to assess the clinical presentation, tumour characteristics, management and mortality in young and to compare between older individuals.MethodologyIt is a retrospective review of prospectively collected data. We reviewed all CRC diagnosed at our hospital between 2014 – June 2019. Data were retrieved from trust cancer database, endoscopy reports, electronic clinical records and pathology reporting systems.ResultsA total of 12983 colonoscopies were performed during this period. 547 (age range 30–98 years) cases of CRC were diagnosed, 54% of them were males and 48 (8.7%) were less than 50 years of age. Clinical presentation and other characteristics were compared between young and old illustrated in table 1. Most common clinical presentations in young were; Anaemia (40%) Rectal bleeding(40%), change in bowel habits-CIBH (12%) while older patients were presented with anaemia(22%), CIBH (19%), rectal bleeding (21%) and abnormal imaging(19%). Significant proportion of young patients showed thrombocytosis when compared to older individuals (23% vs 14%, p=0.03). Most common sites were rectum and SC in both cohorts. In older population 43% of CRC were in proximal colon while only 14% in young had a proximal CRC (p=0.01) Majority of the CRC were adenocarcinoma (90%), and the remainder were anal squamous, neuro endocrine. 4.7% of cancers were not confirmed by histology. Significant proportion of patients were diagnosed at an advanced stage (3 and above) 31% and 32% in older and younger age group respectively. 59% of our cohort had elective or emergency surgery while the rest were treated with a palliative intent. One year mortality was 12.5% and 19% for young and older cohort respectively. 5 year survival rate was higher in young patients than older (77.8% vs 69.2%).ConclusionsIn our cohort younger CRCs presented with anaemia and rectal bleeding while older cohort with CIBH and anaemia/rectal bleeding. Thrombocytosis was a distinct feature in young CRCs. Even through significant proportion of younger CRCs presented with advanced disease, 5 year survival rate was higher in young.