Intest Res.  2017 Apr;15(2):203-207. 10.5217/ir.2017.15.2.203.

Red flag symptoms: detailed account of clinicopathological features in young-onset colorectal cancer

• Riaz R
• Masood N
• Benish A

• KMID: 2425162
• DOI: http://doi.org/10.5217/ir.2017.15.2.203

Abstract

BACKGROUND/AIMS
Colorectal cancer has long been considered disease of the West, typically occurring in old age; however, the incidence is rising in Asia. The pattern of disease is quite different in Asia, occurring at a younger age and at an advanced stage. Recognition of disease at an early stage is still a challenge for physicians. Few data are available regarding young-onset colorectal cancer in Pakistan. We conducted this study to fill this gap and provide deeper insight into clinical symptoms and histopathological features of young-onset colorectal cancer.
METHODS
We collected data regarding clinical features by directly interviewing patients and obtaining histopathological data from hospital records. Patients aged less than 50 years were included in the study. Statistical analysis was performed using IBM SPSS version 20.0.
RESULTS
Results in 105 patients showed mean age at diagnosis was 35.90±9.39, with male predominance; the majority of patients had no family history of colorectal cancer. Most patients had left-sided tumors with advance stage and intermediate grade (grade 2). Mucinous histology was common. Rectal bleeding was the first symptom for left-sided tumors, whereas most of the right-sided lesions presented with sudden obstruction.
CONCLUSIONS
Painless rectal bleeding in the early thirties should alert physicians to advise appropriate investigation, as the majority of young-onset colorectal cancer patients develop painless bleeding 2 to 3 years before appearance of other symptoms.

Keyword

Colorectal neoplasms; Early-onset; Clinicopathological features

MeSH Terms

Asia
Colorectal Neoplasms*
Diagnosis
Hemorrhage
Hospital Records
Humans
Incidence
Male
Mucins
Pakistan
Mucins

Figure

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  Fig. 1 Age versus sex distribution of colorectal cancer patients showing that the fourth age group at presentation, i.e., 41 to 50 years was the most common for male patients, whereas most female patients were aged between 31 and 40 years.

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  Fig. 2 Exact location of the tumor. The most common site was the rectum, followed by the rectosigmoid junction and the cecum.

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  Fig. 3 Clinical presentation of right-sided versus left-sided tumors. Blood in stool was the most common symptom for left-sided masses, followed by constipation, tenesmus, and weight loss; abdominal pain was the most common clinical symptom for right-sided lesions, followed by weight loss.

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