Journal of Surgical Oncology 35:52-54 (1987)

Colorectal Carcinoma in Young Adults: An Autopsy Study

DEBA P. SARMA, MD

From the Department of Pathology, Louisiana State University Medical School and Veterans Administration Medical Center, New Orleans

Autopsy records of ten patients aged 40 or younger with colorectal carcinoma were reviewed. The local and metastatic spread of the cancer was similar to that seen in colorectal cancers occurring in older people. Colorectal cancer in young people is biologically not more aggressive or virulent than that in older patients.
KEY WORDS: colorectal cancer, colorectal cancer in young people, malignancy in

young people, cancer in young patients

INTRODUCTION There has been a considerable difference in opinion as to whether colorectal carcinomas in younger patients have a poorer prognosis than those occurring in the older age groups. A large number of studies report a lower 5year survival in the young patients, indicating a biologically more aggressive cancer or a delay in diagnosis [15]. Other authors have not noted any essential difference in any respect between the young and the older groups [610]. This study is a review of the postmortem findings on ten patients aged 40 or younger who died with colorectal cancer: the aim is to identify any difference in metastatic pattern between the young and the older patients.

DISCUSSION The colorectal carcinomas occurring in this group of ten young patients did not show a highly aggressive matastatic spread (Table I). The spread of a tumor occurred by local invasion, peritoneal implantation, lymphatic spread to lymph nodes, and via vascular invasion to mainly liver and lungs. These are the usual types of spread seen in colorectal cancers, in general [11] occurring in older age groups. Findings at autopsy in the present series do not support the opinions of other authors [1,3,4] who claim that colorectal carcinomas in young people are highly aggressive and biologically virulent cancers.

MATERIALS, METHODS, AND RESULTS

ACKNOWLEDGMENTS Mrs. Roey B. Holliday provided excellent secretarial assistance.

The records of all patients autopsied over a 20-year period (from January, 1960 to December, 1979) at the REFERENCES New Orleans Veterans Administration Medical Center 1. Moore PA. Dilawari RA. Fidler WJ: Adenocarcinoma of the were reviewed. A total of 5,594 autopsies were done, colon and rectum in patients less than 40 years of age. Am Surg which included those on the bodies of 139 patients who 50:10-14, 1984. died with colorectal cancers. Among these patients ten had died at 40 years of age or younger. Complete autopsies that included brain examination were done in these Accepted for publication June 7, 1985. cases. Important findings for these cases are shown in Address reprint requests to Deba P. Sarma, MD. VA Medical Center, Table I. 1601 Perdido Street, New Orleans, LA 70146.
1987 Alan R. Liss, Inc.

Colorectal Carcinoma in Young Adults TABLE I. Colorectal Cancer in Young Adults Age/sex (years) 26/M Survival after diagnosis 12 months Location of Treatment carcinoma Colectomy Descending colon

53

Patient

I.

Tumor grade Poorly differentiated adenocarcinoma

Metastases Peritoneum, diaphragm, testis, liver, lungs Liver, peritoneum Lymph nodes, duodenum, pancreas, kidney Peritoneum, pelvis, bladder, prostate Pelvis, lymph nodes, lungs, vertebrae Liver

Comment

2. 3.

31/M 38/M

5 months 1 1 months

Abdominoperineal resection Colostomy

Rectum Hepatic flexure

Moderately differentiated adenocarcinoma Poorly differentiated adenocarcinoma

4.

39/M

15 months

Colectomy, 5-FU

Sigmoid colon

Poorly differentiated adenocarcinoma

5.

36/M

1 1 months

Colostomy 5-FU

Descending colon

Moderately differentiated adenocarcinoma

|
Clinically diagnosed as a metastatic adenocarcinoma of unknown primary site

6.

35/M

1 month

None

Sigmoid colon

Poorly differentiated adenocarcinoma

7.

36/M

7 months

Colectomy

Cecum

Poorly differentiated adenocarcinoma

8. 9.

40/M

3 days

Colostomy

Splenic flexure Cecum

37/M

See comment

None

Moderately welldifferentiated adenocarcinoma Moderately welldifferentiated adenocarcinoma

Peritoneum, pelvis, retroperitoneum. spleen, liver. pancreas, skeletal muscle Liver

Lymph nodes

Postoperative death 5-cm cecal carcinoma found at autopsy; patient died of cerebral, pulmonary. and intestinal infarcts Clinically diagnosed

10.

25/F

4 months

Methotrexate

Descending colon

Poorly differentiated adenocarcinoma

Liver, ovaries, lungs, pancreas, lymph nodes

as
metastatic adenocarcinoma of unknown primary site

54

Sarma
in Denmark, 1943-1967. Dis Colon Rectum 23:327-336, 1980. 8. Scarpa FJ, Hartmann WH, Sawyers JL: Adenocarcinoma of the colon and rectum in young patients. South Med J 69:24-27, 1976. 9. Walton WW, Hagihara PF. Griffin WO: Colorectal adenocarcinoma in patients less than 40 years old. Dis Colon Rectum 19:529-534, 1976. 10. Howard EW, Cavallo C. Hovey LM. Nelson TG: Colon and rectal cancer in the young adult. Am Surg 41:260-265, 1975. 11. DePeyster FA, Gilchrist RK: Pathology and manifestations of cancer of the colon and rectum. In Turell R (ed): "Diseases of the Colon and Anorectum." Philadelphia: WB Saunders Co, 1969, pp 428-452.

2. Lundy J, Welch JP. Berman M: Colorectal cancer in patients under 40 years of age. J Surg Oncol 24:11-14, 1983. 3. Simstein NL, Kovalcik PJ, Cross GH: Colorectal carcinoma in patients less than 40 years old. Dis Colon Rectum 21:169-171, 1978. 4. Hall A, Coffey RJ: Cancer of the large bowel in the young adult. Am J Surg 102:66-72, 1961. 5. Ezzo JA, Sullivan JF, Mack RE: Carcinoma of the colon under the age of 40. Ann Intern Med 49:321-325, 1958. 6. Ohman U: Colorectal carcinoma in patients less than 40 years of age. Dis Colon Rectum 25:209-214, 1982. 7. Bulow S: Colorectal cancer in patients less than 40 years of age

Sarma DP(1987): Colorectal carcinoma in young adults: An autopsy study. J Surg Oncol 35:52-54. PMID: 3573774 [PubMed - indexed for MEDLINE]