WASHINGTON--Colorectal cancers in patients younger than age 40 are reputed
to behave more aggressively than similar lesions in persons over 40, resulting
in poorer survival. Younger patients have also been reported to present
with a higher tumor stage.
A new study suggests that delay in seeking treatment among younger patients,
rather than a delay in diagnosis after help is sought, may account for
much of the difference in prognosis.
At their poster presentation during Digestive Disease Week 1997, G.
Wilcox, MD, and colleagues, of Baylor College of Medicine and Methodist
Hospital, Houston, described their study, which began with a review of
the tumor registry files of Methodist Hospital, Houston, between 1984 and
The researchers found 34 patients diagnosed with colorectal carcinoma
at 40 years of age or younger. Kaplan-Meier survival analysis was performed
on 27 patients from this group and 27 patients who had been diagnosed with
colorectal cancer between ages 45 and 55. The two groups were matched for
gender, histologic subtype, stage, grade and treatment.
Colorectal cancer in younger persons is often poorly differentiated
and includes a higher proportion of signet ring cell types. These two conditions
may contribute to the less favorable prognosis in this subset of patients.
However, in this study, five-year survival in younger and older patients
was identical when the two groups were matched for tumor stage, histologic
subtype, and treatment.
The study found that younger patients characteristically delay longer
than older patients before seeking medical attention. Eleven of 33 younger
patients (33%), compared with one of 29 older patients (3%), sought medical
attention one year or more after the onset of symptoms (most frequently,
pain and bleeding from the rectum).
Delay in diagnosis of six months or more after initial presentation
was about the same in both groups: five of 31 younger patients and three
of 32 older patients.
Positive family history was more likely to be obtained in younger patients
(10/30, 30%) than in older patients (1/24, 4%).
"The study showed a significant difference between older and younger
people in the time elapsed between initial symptoms and seeking medical
attention, which may explain the reported poorer prognosis," Dr. Wilcox
said. "However, younger and older people with colorectal cancer have
similar prognosis when matched for stage, grade, and treatment."
The researchers urged that younger persons be educated to seek immediate
medical attention for gastrointestinal symptoms, especially if they have
a positive family history for the disease.