Colorectal carcinoma: do elderly patients present differently?

A cohort of patients with a histological diagnosis of colorectal carcinoma was enrolled prospectively. All subjects were interviewed by one observer using a structured questionnaire. One hundred and fifty 'young' (under 70 years) and 123 'elderly' (70 years or more) subjects formed the study sample. The elderly patients did not present more frequently as emergencies than the young, but were more often referred to medical or geriatric rather than surgical units (p < 0.01). There was no difference in median overall delay from symptom onset to histological diagnosis between the age groups (19.5 weeks in each). Symptomatic anaemia and nonspecific symptoms were more often the presenting complaint in the elderly subjects (p < 0.05). On direct questioning, there were no differences in symptom reporting with respect to age group for subjects with colonic cancer. For rectal cancer the following symptoms were more common in the young group: tenesmus (odds ratio 4.2; 95% confidence intervals 2.0-10.0), abdominal or rectal pain (4.0; 1.9-10.6), change in flatus production (2.6; 1.3-5.8), passage of mucus per rectum (2.2; 1.1-4.8). Anorexia was more common in the elderly patients (0.4; 0.1-0.8). This study suggests that symptomatic presentation of rectal cancer is different in the elderly but does not necessarily lead to greater delays in diagnosis nor higher rates of non-elective presentation.