Adenocarcinoma of the colon and rectum in patients less than 40 years of age.

Sixty-two patients less than 40 years of age were admitted with adenocarcinoma of the colon and rectum between 1967 and 1981 at the Methodist Hospitals of Memphis. These represented 3.2 per cent of a total of 1909 patients with the disease during the same time period. Eighty-one per cent presented less than 6 months after onset of symptoms; pain and bleeding being the most common complaints. Inflammatory bowel diseases and polyposis were uncommon. Fifty-eight per cent of the lesions were within reach of the sigmoidoscope. Localized disease was present in 37.9 per cent, with one-third presenting with distant metastases. Sixty-five per cent were considered curable at initial laparotomy. Only 2 per cent of the lesions were well differentiated, and mucin production was noted in 32.3 per cent of the specimens compared to 8.6 per cent in the total group. Vascular invasion was noted in 24 per cent and perineural invasion in 11 per cent. Five-year survival was only 17.6 per cent, although this increased to 33 per cent in those undergoing curative resection. Survival in the total group of 1909 patients was 35.5 per cent at 5 years. The poorer survival in the young patients does not seem to be on the basis of delay in diagnosis, premalignant states, or distribution of lesions, but rather it reflects an inherently more virulent lesion. This impression is supported by a greater incidence of mucinous tumors (a poor prognostic indicator) and higher incidence of advanced disease, especially in the second and third decades.