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Colon carcinoma in adolescents and young adults, not so rare: Experience from an Indian cancer center
Background
The rise of colorectal carcinoma in adolescents and young adults (AYA) is a growing global concern. Limited studies are available which have focused on colon cancer in this population. We aimed to assess clinicopathologic features and outcomes of colon carcinoma in this population.
Methods
We conducted a retrospective study including patients with colon carcinoma aged 13 to 30 years who presented to Tata Medical Center between 1 Jan 2012 and 31 Dec 2020. Information extracted from electronic medical records (EMR) included demographics, risk factors, stage at presentation, pathologic information, treatment, and follow-up details. Rectal primaries were excluded. Overall survival (OS) was estimated with the Kaplan-Meier method and Cox proportional hazard model was used to identify factors associated with survival.
Results
2845 patients with colon cancer were registered in the hospital during this period. A total of 148 (5.8%) patients belonged to the age group of AYA, with the majority being males (58%). A family history of cancer was present in 36% of cases. Hereditary cancer syndrome was present in 26 (17.6%) patients (Lynch syndrome 10.1%, familial adenomatous polyposis 5.4%, and others 2%). The most common presenting features were bleeding (45.9%) and altered bowel (41.2%). The most common site was sigmoid colon in 76(51.4%) cases, while tumors arising from descending, transverse, and ascending colon were 12.2%, 16.9%, and 19.6%, respectively. The majority of them had signet ring morphology (58%). Sixty-two (49.1%) patients initially presented with metastatic disease. The distribution of patients in stages I, II, III were 4.1%, 16.2%, and 37.8%, respectively. At a median follow-up of 44 (95% confidence interval [CI] 33.8- 61.5) months, 5-year OS was 37.2% (95% CI 31.8-42.8) in the entire cohort. Five-year OS for stages I, II, III, and IV were 100%, 53%, 26%, and 16%. Adverse histology (p=0.001) and higher stage at presentation (p < 0.001) were associated with poorer survival.
Conclusions
The proportion of AYA patients with colon carcinoma was more than expected, and they presented with advanced stages and poorer histology. Most patients had sporadic cancers. Five-year OS for stages II-IV was worse than those reported in older patients.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
