Colorectal carcinoma in young patients.

Utilizing Tumor Registry records dating from 1935 to 1988, 50 patients diagnosed with colorectal adenocarcinoma at the age of 40 years or younger were retrospectively studied with respect to sex, race, family history, delay in diagnosis, primary tumor location, tumor differentiation, mucin production, stage at presentation, and the effect of these factors on 5-year survival. This younger group of patients was compared to a computer-generated, randomly selected group of 50 patients 40 years of age or older. There was no difference with respect to sex, racial distribution, family history, symptoms at presentation, or expediency of physician diagnosis between the two groups. Younger patients waited significantly longer to seek medical attention than did their older counterparts. However, those patients who delayed presentation had no higher incidence of advanced disease than those patients who presented earlier. Younger patients had a higher incidence of poorly differentiated, advanced, right-sided tumors. This is in contrast to a predominance of well-differentiated, less advanced, rectosigmoid lesions in the older patients. There was no age-related difference in the incidence of mucin-producing tumors. Overall 5-year survival was 75% in older patients, in contrast to only 51% in younger patients (P = 0.01). We conclude in this study that it is advanced stage at presentation that is the most significant prognostic indicator in patients of all ages. The high incidence of poorly differentiated, right-sided tumors is responsible for the majority of young patients presenting with advanced disease, resulting in their poorer prognosis.