COLORECTAL-CANCER IN PATIENTS UNDER AGE 45

Colo-rectal cancer in young patients is a subject of interest for many reasons. Various studies are devoted to this subject but controversies regarding the stages, the evolution and the prognosis still remains. We present intermediate results, of an ongoing study, which is directed to those particular aspects of colon cancer of the patients less than 45 years of age in a region where the global incidence of the disease is one of the highest in the world. In the past five years, we have observed 602 patients with colon cancer. 23 of them (4%) were less than 45 years old. The age at diagnosis was 38+/-6 years. Two-thirds of the subjects were male. 13% had had predisposing conditions for colon cancer such as FAP, ulcerative colitis or Turcot sydrome; 50% had a positive familial history for cancer. Symptoms lasted for less than 3 months in two thirds of the patients. 15% had a right sided tumor, 38% were located in the sigmoid and 28.5% in the rectum. At diagnosis, the tumors were classified as follows: 32% Dukes B. 23% Dukes C and 40% were disseminated disease. Most of them were located in the rectum, but 43% of Dukes B lesions were located in ascending or transverse colon. Grading reveal moderately to poorly differentiated tumors in 3/4 of cases. 30% of patients received an adjuvant therapy. After two years, 70% of the patients were alive. None of them with Dukes A or B but one of the patients with Dukes C were dead. Muciparity of tumors is associated with a poor prognosis: 25% of living patients presented such differenciation compared to 42% of the death (p<0.001). Symptoms for more than six months were present in 43% of death patients, but in none of the survivors (p<0.001). Colo-rectal cancer in young patients is rare. The disease often presents with advance stages at time of diagnosis. The intrinsic tolerance and resistance to modifications induced by the tumor in young subject may lead to the late onset of symptoms. This may explain the failure to correlate the stages of the disease and the duration of symptoms in many studies and it does not support the hypothesis of a more aggressive disease in patients less than 45 years of age.