Colorectal Cancer in Young Adult Population in Kashmir Valley: Tertiary Care Centre Experience

  • Peerzada Umar Farooq Baba Department of Plastic Surgery, SKIMS
  • Ajaz Ahmad Malik Department of General & Minimal Access Surgery SKIMS
  • Yaqoob Hassan Department of General and Minimal Invasive Surgery, SKIMS Medical College
  • Khurshid Alam Wani Department of General Surgery, SKIMS
  • Abdul Rashid Lone Department of Medical Oncology, SKIMS
Keywords: Colorectal cancer., Young Adults., Treatment

Abstract

Background: Colorectal cancer has been defined and discussed as a disease of middle or late life. However, no age-group is exempt, and adenocarcinoma of the colon has been reported in young age. Malignant disease is frequently found in young adults in our Kashmir valley.

Objective (s): This aim was to study the clinic pathological features, diagnosis, management and outcome of colorectal cancer in young adults under the age of 40.

Material and Methods: This combined Retrospective (January 2002 to May, 2004) Prospective (June 2004 to September 2006) Observational Study was conducted in the department of General and Minimal Access Surgery, SKIMS,. Total of 62 young colorectal carcinoma patients were studied. The case records of all the patients of colorectal cancer less than 40years of age admitted in the department of General Surgery were reviewed retrospectively. In the prospective study all the patients less than 40 years of age with colorectal carcinoma admitted in our department were registered. Following the confirmation of diagnosis, the patients were subjected to exploratory laparotomy. The nature of the surgical procedure depended upon the intra-operative findings. All the patients were subjected to postoperative chemotherapy and in selected cases to postoperative chemo-radiation. The patients were followed for a period of five years .The patients were thoroughly examined and investigated on follow up to rule out any recurrence or metastasis.

Results: Most of our patients (83.9%) were admitted through outpatient department (OPD) and only 10 patients (16.1%) were admitted through emergency. In our study, the male: female ratio was 1.58: 1.The mean age in our study was 30.2 years. Bleeding per rectum was the most common (74.2%) presenting symptom followed by altered bowel habits (72.6%). Carcinoembryonic antigen (CEA) levels show significant decline after surgery/adjuvant therapy. Colonoscopy detected synchronous growths in 5.3% of patients. Rectum was the most common site of lesion (32.2%) while combined rectum and sigmoid colon (including recto sigmoid) accounted for 62.7% of lesions. Resection with intention of cure was performed in 68.3% of patients, palliative procedure in 26.7% and biopsy in 5% of patients. Postoperative complications were recorded and managed accordingly. Typical adenocarcinoma was seen in 80.6% of patients. None of our patients had Dukes stage A presentation. 13.6% of patients had local recurrence and 25.4% had metastasis on follow up.                                                

Conclusion: Colorectal cancers in young adults are quite common in Kashmir valley. Outcome of CRC in young patients is significantly related to the procedure - whether done with curative intention or for palliation. Henceforth, surgical treatment should be radical and optimized with adjuvant therapy where possible to achieve the best prognosis. The diagnosis of colorectal cancer should be done at the early and curable stage for better outcome.

Author Biographies

Peerzada Umar Farooq Baba, Department of Plastic Surgery, SKIMS

M.Ch, Associate Professor 

Yaqoob Hassan, Department of General and Minimal Invasive Surgery, SKIMS Medical College

M.S., Registrar

Khurshid Alam Wani, Department of General Surgery, SKIMS

M.S.

References

1. Dobre M, Dinu DE, Panaitescu E, Bîrlă RD, Iosif CL, Boeriu M, et al. KRAS gene mutations prognostic factor in colorectal cancer? Rom J Morphol Embryol 2015; 56:671-8.
2. Calva AM, Acevedo Tirado MT. Revisión y actualización general en cancer colorrectal. Revista de Radiología México. 2009; 1:99-115.
3. Siegel RL, Miller K, Jemal A. Cancer Statistics, 2015. CA Cancer J Clin. 2015; 65:5-29.
4.Smith RET, Renaud RC, Hoffman E. Colorectal cancer market. Nat Rev Drug Discov. 2004;3:471-2.
5.Cancer Facts & Figures 2016 [Internet]. Cancer.org; 2016 [17 May 2016]. Available from: http://www.cancer.org/acs/groups/content/ @research/documents/document/acspc-04- 7079.pdf.
6.Ferlay J, Soerjomataram I, Ervik M. Globacon 2012 v1.0. Cancer Incidence and Mortality Woridwide: IARC No. 11. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://www.globacon.iarc.fr. [Last accessed on 2013 Dec 23].
7.BFactSheetsbyPopulation-CRCIndiaASRs.^[Online].Available: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx
8. Safford KL, Spebar MJ, Rosenthal D. Review of colorectal cancer in patients under age 40 years. Am J Surg 1981;142:767-769.
9. Kern WH, White WC. Adenocarcinoma of the colon in a 9-month old infant: Report of a case. Cancer 1958;11:855-857.
10. Walton WW, Hagihara PF, Griffen WO. Colorectal adenocarcinoma in patients less than 40 years old. Dis Colon Rectum 1976;19:529-534.
11. Steele GD Jr. The national cancer data base report on colorectal cancer. Cancer 1994; 74:1979‑89.
12.Laishram RS, Kaiho N, Shimray R, Devi SB, Punyabati P, Sharma DC. Histopathological evaluation of colorectal carcinomas status in Manipur, India. Int J Pathol 2010;8:5‑8.
13. Cohen AM, Minsky BD, Schilsky RL. In: De Vita TV, Hellman S, Rosenberg SA, et al. editors. Cancer: Principles and Practice of Oncology. 4th ed. Philadelphia: J.B. Lippincott Company; 1993. p. 931.
14. Goh KL, Quek KF, Yeo GT, Hilmi IN, Lee CK, Hasnida N, et al. Colorectal cancer in Asians: A demographic and anatomic survey in Malaysian patients undergoing colonoscopy. Aliment Pharmacol Ther 2005; 22:859‑64.
15.Singh LJ, Moirangthem GS, Debnath K. Colorectal cancer in younger patients. Trop Gastroentrol 2002; 23:144-145.
16. Soliman AS, Bondy ML, Levin B, Hamza MR Ismail K, Ismail S, Hammam HM, El-Hattab OH, Kamal SM, Soliman AGA, Dorgham LA, McPherson RS, Beasley RP. Colorectal cancer in Egyptian patients under 40 years of age. Int J Cancer 1997;71:26-30.
17. Umpleby HC, Williamson RCN. Carcinoma of the large bowel in the first four decades. Br. J Surg 1984;71:272-277
18 Jarvinen HJ. Time and type of prophylactic surgery for familial adenomatosis coli. Ann Surg 1985; 202:93-97.
19. Adloff M, Arnaud JP, Schloegel M, Thibaud D, Bergamaschi R. Colorectal cancer in patients under 40 years of age. Dis Colon Rectum 1986;29:322-325.
20. Recalde M, Holyoke ED, Elias EG. Carcinoma of the colon, rectum and anal canal in young patients. Surg Gynecol Obstet 1974;139:909- 913.
21. Singh LJ, Moirangthem GS, Debnath K. Colorectal cancer in younger patients. Trop Gastroentrol 2002;23:144-145.
22. Chung YFA, Eu KW, Machin D, Ho JMS, Nyam DCNK, Leong AFPK, Ho YH, Seow-Choen F. Young age is not a poor prognostic marker in colorectal cancer. Br J Surg 1998;85:1255-1259.
23. Bulow S. Colorectal cancer in patients less than 40 years of age in Denmark, 1943-1967. Dis Colon Rectum 1980;23:327-336.
24. Heys SD, O’Hanrahan TJ, Brittenden J, Eremin O. Colorectal cancer in young patients: a review of the literature. Eur J Surg Oncol 1994;20:225-231.
25. Umpleby HC, Williamson RCN. Carcinoma of the large bowel in the first four decades. Br. J Surg 1984;71:272-277.
26. Pitluk H, Poticha SM. Carcinoma of the colon and rectum in patients less than 40 years of age. Surg Gynecol Obstet 1983; 157:335-337.
27. Simstein NL, Kovalcik PJ, Cross GH Colorectal carcinoma in patients less than 40 years of old. Dis Colon Rectum 1978;21:169-171.
28. Hall A, Coffey RJ. Cancer of the large bowel in the young adult. Am J Surg 1961;102:66-72.
29. Cusack JC, Giacco GG, Cleary K, Davidson BC, Izzo F, Skibber J,Yen J, Curley SA. Survival factors in 186 patients younger than 40 years old with colorectal adenocarcinoma. J Am Coll Surg 1996;183:105-112.
30.Iqbal QM, Abdul M. Ganai , Gul M. Bhat, et al. Pattern and magnitude of various cancers registered at regional cancer centre of a tertiary care institute in north India, Int J Community Med Public Health. 2016 Jun;3(6):1672-1680
31. Lee PY, Fletcher WS, Sullivan ES, Vetto JT. Colorectal cancer in young patients: characteristics and outcome. Am Surg 1994;60:607- 612.
32. Ezzo JA, Sullivan JF, Mack RE. Carcinoma of the colon under the age of 40. Ann Intern Med 1958;49:321-325.
33. Miller FE, Liechty RD. Adenocarcinoma of the colon and rectum in persons under thirty years of age. Am J Surg 1967;113:507-510.
34. Johnson JW, Judd ES, Dahlin DC. Malignant neoplasms of the colon and rectum in young persons. Arch Surg 1959;79:365-372.
35. Domergue J, Ismail M, Astre C, Saint-Aubert B, Joyeux H, Solassol C, Pujol H. Colorectal carcinoma in patients younger than 40 years of age. Montpellier cancer Institute experience with 78 patients. Cancer 1988;61:835-840.
36. Martin EW, Joyce S, Lucas J, Clausen K, Cooperman M. Colorectal carcinoma in patients less than 40 years of age: pathology and prognosis. Dis Colon Rectum 1981;24:25-28.
37. Alici S, Aykan NF, Sakar B, Bulutlar G, Kaytan E, Topuz E. Colorectal cancer in young patients: characteristics and outcome. Tohoku J Exp Med 2003;199:85-93.
38. Lin JT, Wang WS, Yen EC, Liu JH, Yang MH, Chao TC, Chen PM, Chiou TJ. Outcome of colorectal carcinoma in patients under 40 years of age. J Gastroenterol Hepatol 2005;20(6):900-905
39. Smith C, Butler JA. Colorectal cancer in patients younger than 40 years of age. Dis Colon Rectum 1989;32:843-846.
40. Ohman U. Colorectal carcinoma in patients less than 40 years of age. Dis Colon Rectum 1982;25:209-214.
41. Abdulla HS. Early postoperative morbidity and mortality of colorectal cancer surgery. JSP International 2003;8(3).
42. Simona A, Giuseppe N, Giulia T, Carlo F, Antonio Z, Enzo P,Paolo C. Early and late outcome after surgery for colorectal cancer: elective versus emergency surgery. Tumori 2003; 89(1):36-41
Published
2019-05-31
How to Cite
1.
Baba PUF, Malik AA, Hassan Y, Wani KA, Lone AR. Colorectal Cancer in Young Adult Population in Kashmir Valley: Tertiary Care Centre Experience. jms [Internet]. 2019May31 [cited 2019Jul.19];22(1):58-6. Available from: http://jmsskims.org/index.php/jms/article/view/412
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Original Articles