International Journal of Colorectal Disease

, Volume 29, Issue 4, pp 519–527 | Cite as

Do young patients have different clinical presentation of colorectal cancer causing delay in diagnosis?

  • João Batista de Sousa
  • Caio Simões Souza
  • Maria Bianca Fernandes
  • Leonardo de Castro Durães
  • Romulo Medeiros de Almeida
  • Antônio Carlos Nóbrega dos Santos
  • Eduardo Freitas da Silva
  • Paulo Gonçalves de Oliveira
Original Article



The incidence of colorectal cancer is increasing among young patients. In these patients, colorectal cancer is believed to have a poorer prognosis because it is more aggressive and diagnosed at later stages; however, the behavior of these tumors in young patients remains to be elucidated. We investigated the impact of time interval between onset of symptoms and diagnosis (TISD) at the pathologic stage of colorectal cancer in young patients.


The medical records of 215 patients with colorectal adenocarcinoma were reviewed. Patients were divided into two groups according to age. The young group (age < 50 years) consisted of 66 patients, and the older group (age ≥ 50 years) of 149 patients. Clinical variables, TISD, pathologic stage, operative mortality, and oncologic outcomes were compared between groups.


The older group had less abdominal pain (74.0 vs. 56.0 %, p = 0.0129). In multivariate analysis, the following variables were independently associated with tumor pathologic stage: personal history of inflammatory bowel disease (p < 0.0001), family history of familial adenomatous polyposis (p = 0.00100), and smoking (p = 0.0070). Both groups had similar rates regarding pathologic stage (I, 15 vs. 22 %; II, 22 vs. 24 %; III, 27 vs. 16 %; IV, 37 vs. 38 %, p = 0.3380). There was no difference in overall survival [45 (69 %) vs. 84 (61 %), p = 0.2482] and cancer-free survival [36 (63 %) vs. 83 (62 %), p = 0.9218] between groups.


Young patients with colorectal cancer had clinical and pathological presentation similar to that of older patients.


Colorectal cancer Young patients Colorectal cancer in young patients Diagnosis Clinical presentation TNM staging 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Braet F, Nagatsuma K, Saito M, Soon L, Wisse E, Matsuura T (2007) The hepatic sinusoidal endothelial lining and colorectal liver metastases. World J Gastroenterol 13(6):821–825PubMedGoogle Scholar
  2. 2.
    Estimativa 2012: incidência de câncer no Brasil (2011) Accessed December 2011
  3. 3.
    Atkin WS, Cuzick J, Northover JM, Whynes DK (1993) Prevention of colorectal cancer by once-only sigmoidoscopy. Lancet 341(8847):736–740PubMedCrossRefGoogle Scholar
  4. 4.
    Siegel RL, Jemal A, Ward EM (2009) Increase in incidence of colorectal cancer among young men and women in the United States. Cancer Epidemiol Biomarkers Prev 18(6):1695–1698. doi: 10.1158/1055-9965. EPI-09-0186 PubMedCrossRefGoogle Scholar
  5. 5.
    You YN, Xing Y, Feig BW, Chang GJ, Cormier JN (2012) Young-onset colorectal cancer: is it time to pay attention? Arch Intern Med 172(3):287–289. doi: 10.1001/archinternmed.2011.602 PubMedCrossRefGoogle Scholar
  6. 6.
    O’Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY (2003) Rates of colon and rectal cancers are increasing in young adults. Am Surg 69(10):866–872PubMedGoogle Scholar
  7. 7.
    O’Connell JB, Maggard MA, Livingston EH, Yo CK (2004) Colorectal cancer in the young. Am J Surg 187(3):343–348. doi: 10.1016/j.amjsurg.2003.12.020 PubMedCrossRefGoogle Scholar
  8. 8.
    Ganapathi S, Kumar D, Katsoulas N, Melville D, Hodgson S, Finlayson C, Hagger R (2011) Colorectal cancer in the young: trends, characteristics and outcome. Int J Colorectal Dis 26(7):927–934. doi: 10.1007/s00384-011-1174-z PubMedCrossRefGoogle Scholar
  9. 9.
    Shemesh-Bar L, Kundel Y, Idelevich E, Sulkes J, Sulkes A, Brenner B (2010) Colorectal cancer in young patients in Israel: a distinct clinicopathological entity? World J Surg 34(11):2701–2709. doi: 10.1007/s00268-010-0748-1 PubMedCrossRefGoogle Scholar
  10. 10.
    Li M, Li JY, Zhao AL, Gu J (2011) Do young patients with colorectal cancer have a poorer prognosis than old patients? J Surg Res 167(2):231–236. doi: 10.1016/j.jss.2010.10.040 PubMedCrossRefGoogle Scholar
  11. 11.
    Al-Barrak J, Gill S (2011) Presentation and outcomes of patients aged 30 years and younger with colorectal cancer: a 20-year retrospective review. Med Oncol 28(4):1058–1061. doi: 10.1007/s12032-010-9639-4 PubMedCrossRefGoogle Scholar
  12. 12.
    Schellerer VS, Merkel S, Schumann SC, Schlabrakowski A, Fortsch T, Schildberg C, Hohenberger W, Croner RS (2012) Despite aggressive histopathology survival is not impaired in young patients with colorectal cancer: CRC in patients under 50 years of age. Int J Colorectal Dis 27(1):71–79. doi: 10.1007/s00384-011-1291-8 PubMedCrossRefGoogle Scholar
  13. 13.
    Ghazi S, Lindforss U, Lindberg G, Berg E, Lindblom A, Papadogiannakis N (2012) Analysis of colorectal cancer morphology in relation to sex, age, location, and family history. J Gastroenterol 47(6):619–634. doi: 10.1007/s00535-011-0520-9 PubMedCrossRefGoogle Scholar
  14. 14.
    Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn. Wiley, New YorkCrossRefGoogle Scholar
  15. 15.
    Barros AJ, Hirakata VN (2003) Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 20(3):21. doi: 10.1186/1471-2288-3-21 CrossRefGoogle Scholar
  16. 16.
    Botteri E, Iodice S, Bagnardi V, Raimondi S, Lowenfels AB, Maisonneuve P (2008) Smoking and colorectal cancer: a meta-analysis. JAMA 300(23):2765–2778. doi: 10.1001/jama.2008.839 PubMedCrossRefGoogle Scholar
  17. 17.
    Liang PS, Chen TY, Giovannucci E (2009) Cigarette smoking and colorectal cancer incidence and mortality: systematic review and meta-analysis. Int J Cancer 124(10):2406–2415. doi: 10.1002/ijc.24191 PubMedCrossRefGoogle Scholar
  18. 18.
    da Fonseca LM, da Luz MM, Lacerda-Filho A, Cabral MM, da Silva RG (2012) Colorectal carcinoma in different age groups: a histopathological analysis. Int J Colorectal Dis 27(2):249–255. doi: 10.1007/s00384-011-1299-0 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • João Batista de Sousa
    • 1
    • 2
    • 5
  • Caio Simões Souza
    • 1
  • Maria Bianca Fernandes
    • 3
  • Leonardo de Castro Durães
    • 1
  • Romulo Medeiros de Almeida
    • 1
    • 2
  • Antônio Carlos Nóbrega dos Santos
    • 1
  • Eduardo Freitas da Silva
    • 4
  • Paulo Gonçalves de Oliveira
    • 1
    • 2
  1. 1.Coloproctology Service, Hospital Universitário de BrasíliaUniversidade de Brasília, Center of Surgical ClinicsBrasíliaBrazil
  2. 2.Division of Surgery, School of MedicineUniversidade de BrasíliaBrasíliaBrazil
  3. 3.State Department of Health of the Federal DistrictBrasíliaBrazil
  4. 4.Department of Statistics, Institute of Exact SciencesUniversidade de BrasíliaBrasíliaBrazil
  5. 5.Secretaria do Centro de Clínicas CirúrgicasHospital Universitário de BrasíliaBrasíliaBrazil

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