Carcinoma of the colon in patients 35 years of age and younger.

Of 705 patients who were treated at the Vanderbilt University and Metropolitan Nashville General Hospitals from 1973 to 1984 for carcinoma of the colon, 45 (6.3%) were 35 years of age or younger at the time of diagnosis. There were 25 men and 20 women; the average age was 29.3 years. Twenty-six patients (57.7%) presented with pain, 19 reported a change in bowel habits, and 18 had gastrointestinal bleeding which led to diagnostic investigation. At the time of diagnosis, only two patients had lesions which could be classified as Dukes' A, eight were Dukes' B, 28 were Dukes' C, and the remaining seven had Dukes' D lesions with distant metastasis. Nineteen patients had poorly differentiated tumors; survival in this group averaged 1 year. In the 19 patients who had well or moderately well-differentiated tumors, survival averaged 4.3 years. Fifteen patients had unresectable tumors at the time of initial treatment, and survival in this group has averaged 1.5 years. Thirty patients had tumors which were considered to be resectable by the operating surgeon, and nine of these 30 patients are alive without evidence of recurrence for an average of 5.6 years. The prognosis of carcinoma of the colon in the young has been poor, with the major factors being the unfavorable histologic features of these tumors and the advanced disease at the time of presentation in these patients. Those few patients who present early in the course of their disease respond well to radical resection.