Objective:

To describe disease stage, symptoms, tumor characteristics, recurrence, and outcomes among patients aged 21 or younger diagnosed with colorectal cancer.

Approach:

• Study design: Researchers retrospectively reviewed records for 84 patients diagnosed from 2012 to 2023 at 34 institutions.
• Participants: Patients with previously diagnosed hereditary cancer predisposition syndromes or inflammatory bowel disease were excluded; median age at diagnosis was 16.5 years.

Key Findings:

• At diagnosis, 80% had stage III or IV disease; 20% reported a first- or second-degree relative with colorectal cancer.
• Common symptoms included abdominal or back pain (74%), changes in bowel habits (45%), weight loss (43%), and rectal bleeding (38%). Median symptom duration was 12 weeks, and median time to colonoscopy was 13 weeks.
• About 42% had poorly differentiated tumors, one-third had signet ring features, and 39% had mucinous features.
• Disease recurred in 37% of patients, typically within 11 months. Recurrence was associated with lymph node involvement, poor differentiation, and signet ring features.
• During the study period, 45% died from colorectal cancer. Germline testing identified variants involving mismatch repair genes, TP53, and APC among tested patients.

Interpretation:

The study authors emphasize investigating persistent gastrointestinal symptoms in younger patients, including those without known hereditary predisposition, and note the relevance of histopathological assessment and genetic evaluation.

Limitations:

• The retrospective study cannot establish whether colorectal cancer incidence is increasing or determine the causes of delayed diagnosis.

Conclusion:

The authors highlight the need for timely investigation and coordinated pediatric and adult oncology care.

Sources:

• Article context