|Ahead of print publication
Increased incidence of young age presentation of colorectal carcinoma: A tertiary cancer hospital study
Pandu Ranga Kumari Motepalli1, Rajya Lakshmi Nukala2
1 Department of Radiotherapy, Kurnool Medical College, Affiliated to Dr. NTR University of Health Sciences, Kurnool, Andhra Pradesh, India
2 Department of Radiotherapy, Siddhartha Medical College, Affiliated to Dr. NTR University of Health Sciences, Vijayawada, Andhra Pradesh, India
Pandu Ranga Kumari Motepalli,
Kumari Motepalli, Kurnool Medical College, Cancer Ward No. 38, Kurnool - 518 002, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Colorectal cancer is relatively uncommon malignancy in India when compared with the Western world, disease affecting individuals above 40 years of age and is rare below 40 years of age. However, now there is an increase in young age presentation globally and India.
Materials and Methods: We conducted a retrospective study of all colorectal carcinomas colorectal cancer (CRC) that were diagnosed during the past 6 years, i.e., from January 2011 to December 2016. Patients were divided into two groups – below 40 years and above 40 years. The records were analyzed in detail for age, gender, site of primary tumor, and histopathological type. The results of the two groups were compared and in turn compared with population-based cancer registry (PBCR) of Delhi, Mumbai, Kolkata, Chennai, and Bengaluru.
Results: Two hundred and twenty-three patients were diagnosed to have CRC. Patients diagnosed below 40 years of age comprised 39.5% (88) compared with PBCR of Delhi (19.75%, P value significant at <0.05), Mumbai (10.9%), P value significant at <0.05), Kolkata (13.1%, P value significant at <0.05), Chennai (8.6%, P value significant at <0.05), and Bengaluru (13.6%, P value significant at <0.05). Among patients below 40 years of age, majority were males (56.8%), most occurred in the rectum (75%). Poorly differentiated, mucin-secreting, signet ring type adenocarcinomas are most frequent (35.2%) and presented at advanced stage (33%). This was similar to those reported in other literatures.
Conclusions: Study shows that there is a rise in younger age presentation in our institution with rectal site predominance, advanced stage, and poor histopathological variants.
Keywords: Colorectal cancer, increased incidence, poor prognosis, young age presentation
| > Introduction|| |
Colorectal cancer (CRC) is the third-most common cancer in men and the second in women worldwide. It is the fourth-most common cause of death, with significant geographical, racial, and ethnic variation in its incidence rate and pattern.
CRC incidence and distribution correlates with human developmental indices usually common cancer in the Western world and high-income countries due to high-fat diet and low fiber intake. Now it is increasing in developing countries, and low- and medium-income countries due to adopting Western lifestyles, ongoing socio-economic development; stabilizing or decreasing trends tend to be seen only in highly developed countries due to early screening methods.
The incidence of rectal cancer in India is lower than that in the Western countries. Colon cancer ranks 8th and rectal cancer ranks 9th among men. For women, rectal cancer does not figure in the top 10 cancers, whereas colon cancer ranks ninth.
Usually, colorectal cancers present in old age with peak after 60 years of age, its occurrence below 40 years of age is rare, but now the American Cancer Society Studies have shown a sharp rise in colorectal cancers in young adults with rising death rates.,
Even several individual studies conducted in various parts of India documented younger age presentation of colorectal cancers with different histopathological patterns,,,, with mean age around 40–45 years
The aim of this study is to see any change in pattern of presentation of colorectal cases in my institute.
| > Materials and Methods|| |
We did a retrospective study in the oncology department of Viswabharathi Medical College and General Hospital, which is one of the major cancer centers in Andhra Pradesh, which treats patients from four districts of Rayalaseema, that is, Kurnool, Cuddapah, Anantapur, Chittoor and a few patients from Bellary of Karnataka.
Our objective was to investigate if any discrepancy in colorectal cancers presentation and to identify the associated clinicopathological features.
All patients diagnosed with colorectal carcinoma from January 2011 to December 2016 were included in the study. Data of histopathological proven colorectal patients were collected retrospectively from hospital records.
Two hundred and twenty-three patient's data were collected and analyzed regarding age, sex, stage of disease, and histology type and differentiation and treatment given.
The patients were divided into two groups - a younger group of below 40 years of age and above 40 years. The results of the two groups were compared and in turn compared with population-based cancer registry (PBCR) of Delhi, Mumbai, Kolkata, Chennai, and Bengaluru.
| > Results|| |
Two hundred and twenty-three patients were diagnosed to have CRC. Mean age of presentation is 47 years and range 11–70 years. Detailed age, sex, site, stage, and histopathological distribution in age groups are shown in [Table 1].
Patients diagnosed below 40 years of age comprised 39.5% (88), majority were males 56.8% (50) compared using Chi-square test with PBCR of Delhi (19.75%, P value significant at <0.05) Mumbai (10.9%, P value significant at <0.05), Kolkata (13.1%, P value significant at <0.05), Chennai (8.6%, P value significant at <0.05), and Bengaluru (13.6%, P value significant at <0.05) shown in [Table 2] and [Chart 1].
There is high incidence of rectal cancers compared to colon cancers in age group below 40 years of age which is in correlation with PBCR of Delhi, Mumbai, Kolkata, Chennai, and Bengaluru, and as the age increases there is also an increase in colon cancers compared to rectal cancers shown in [Table 3] and [Chart 2], [Chart 3] with P value significant at <0.05.
In age below 40 years of age that poorly differentiated, mucin-secreting, signet ring type adenocarcinomas are most frequent (35.2%) and presented at advanced stage (33%) [Table 4] and [Chart 4].
| > Discussion|| |
In our study, there is an increase in incidence of colorectal cases in age group <40 years of age (39.5%) the rise is significant with PBCR of Delhi (19.75%, P value significant at <0.05), Mumbai (10.9%, P value significant at <0.05), Kolkata (13.1%, P value significant at <0.05), Chennai (8.6%, P value significant at <0.05), and Bengaluru (13.6%, P value significant at <0.05), correlated with many institutional studies done in India like Kumari et al. Laskar et al., Sudarshan et al. (39.5), Pal study, and Gupta et al.
The study also showed it is more of male predominance in both groups. Younger patient presents with more of rectal site compared to elder age where colon cancers are more predominant, which is similar to PBCR of Delhi, Mumbai, Kolkata, Chennai, and Bengaluru.
Younger patients present with advanced stage and poor histopathological variants. This was similar to those reported in other literature as:
Kumari et al. studied on 1096 patients in that 24.17% were below 40 years of age, out of them 60.37% were male, 66% were in stage IV.
Laskar et al. studied on 144 patients in that 48.61% were below 40 years, 55.7% presented with poor histopathological variants and 35.5% presented with stage IV disease.
Sudarshan et al. studied on 223 patients in that 39.05% were below 40 years, out of them 63.73% were male, 84.61% occurred in the rectum, poorly differentiated mucin-secreting adenocarcinomas were 80.21% and presented with advanced pathologic T-stage (71.42%). My study is very close to this study.
Madhumay Pal et al. study showed there is proportionately higher incidence in young presentation >20% for both sexes.
Gupta et al. studied on 305 patients with a ratio of 0.64 between patients below 40 years to patients above 40 years, 60% were in advance stage and 50% with poor histopathological variants.
The main concern of our study is due to the poor prognosis of colorectal cancer affecting young population ≤40 years age. To know whether the rise in India is a false interpretation due to high young population in India or there is a change in pattern of occurrence in India too, if so whether its due to adopting western lifestyle by Indians such as high fat diet, more red meat consumption, low fiber diet, smoking and chronic constipation or due to any genetic changes.
The above data suggest:
- Early investigation is needed for young patients presenting with colorectal symptoms
- Lifestyle modifications
- Cancer awareness programs periodically
- Need for screening in India also, especially in high-risk individuals.
All these measures may improve young-onset CRC prognosis.
| > Conclusions|| |
The study showed that there is a rise in young age presentation with rectal site predominance, advanced stage, and poor histopathological variant presentation.
Although exact incidence rate cannot be provided by a hospital-based study, the information would be useful in showing that young-onset CRCs cases exhibit more aggressive pathologic characteristics, delay in diagnosis and advanced stage at presentation and poor prognosis.
Further studies with large number of patients are required to come to a conclusion.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]