A 22-Year-Old Patient With Colorectal Cancer: The Nuances of Care

Subtotal colectomy was prioritized as the definitive surgical strategy for a 22-year-old patient presenting with a partially obstructing descending colon cancer, according to Marc Lehrer Greenwald, MD. The strategy was chosen to mitigate the elevated risk of metachronous malignancy.

During an interview with CancerNetwork®, Greenwald detailed the clinical rationale for choosing an extensive resection over a standard segmental approach in a young, microsatellite instability (MSI)–high disease.

The case involved a 22-year-old woman with no family history of colorectal cancer (CRC) who presented to the hospital with abdominal pain. Diagnostic imaging and a subsequent colonoscopy revealed a partially obstructing lesion in the descending colon. The obstruction prevented a complete evaluation of the proximal colon.

Greenwald also emphasized that for a patient in her early 20s, the primary objective extends beyond the immediate removal of the primary tumor. He highlighted several clinical imperatives, one of which was metachronous risk mitigation. By reducing the surface area of the colon, the risk of developing future colon cancers is reduced because there is less surface area for the tumor to grow.

Functionally, the patient’s recovery has been favorable. One month after surgery, Greenwald reported that her bowel function consisted of 2 to 3 semi-formed movements per day, a frequency that is expected to stabilize and improve over time.

He concluded that while the surgical choice was aggressive, it remains the most appropriate pathway for a patient with decades of life ahead. The multidisciplinary team continues to observe her closely, awaiting germline results to finalize her long-term genetic risk profile and further personalize her survivorship plan.

Greenwald is the chief of Colorectal Clinical Services and surgeon-in-chief at North Shore University Hospital.

Transcript:

CancerNetwork: What patient cases involving individuals in their 20s or 30s with colorectal cancer stand out to you?

Greenwald: One of them was a 22-year-old who just graduated from an Ivy League institution and was spending the summer working at an animal shelter because she was trying to apply to [veterinary] school. Very bright young woman. She came to the hospital with abdominal pain, and she had partially obstructing colon cancer. Now, she has no family history, and we operated on her. The issue becomes, and we discussed this—we discuss this with the oncologist, we discuss it at our tumor boards, and it's discussed in the literature—[but] it is what to do with these patients. Now, she could have been prepped, and she was. She had a colonoscopy, and they couldn't evaluate the colon proximal to the lesion, which was in the descending colon. She had bowel function where she moved her bowels every 1 to 2 days. We talked about a segmental resection, and I recommended a subtotal colectomy for a couple of reasons. One, it decreases the length of the colon so there's less surface area to develop cancers in the future; you have to presume she's at high risk for…a metachronous cancer at some point, even if she turns out to be [Lynch syndrome] negative. Also, we couldn't really look at the proximal colon because of the partial obstruction. That's my preference. That's what I offered her, and she was interested in doing that, so that's what we did.

I think it's important because surveillance is now easy. She only has maybe 30 cm or 25 cm of colon left, so it's really just a flexible sigmoidoscopy. Her bowel function is pretty good; even after a month. She's only moving her bowels about 2 or 3 times a day, and it's semi-formed. It's only going to get better. It turns out she was lymph node negative, and she was MSI high. She's going to be observed very closely. I don't know about her germline testing. I don't recall, right now, whether it's come back as [Lynch syndrome positive] or not, but if it is, she'll see the genetics team and get all the help she can in that regard as well.

Reference

Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;76(2):e70067. doi:10.3322/caac.70067