In my practice the biggest question is about the type of disease itself – is it sporadic or is some form of hereditary cancer syndromes, as the extent of surgery (usual resection or proctocolectomy) in these patients is an important issue, regarding the higher risk of development of metachronous cancer in the remaining bowel if the disease is genetically determined.

If the patient presents with a bleeding PR to the PCP, how long does it take and how many visits to the doctor are done before the cancer is detected?

Usually young patients are familiar that bleeding is an alarming symptom and promptly seek a medical consult. Any bleeding is an indication for endoscopy in my country and the waiting time for endoscopy is about 7 days.

We have studied colorectal cancer in young i.e.40yrs.and below and data is yet to be published.We found that most of the patients have genetic basis as an etiological factor, may be familial etc.;sphincter saving procedures are usually not feasible in rectal cancers as most present in an advanced stage at the outset;metastasis is common in them;neoadjuvant and adjuvant treatments are not that effective;and prognosis is also not that good using even the best combinations of treatment strategies available.Overall the entity has grave consequences and---------- needs to be prevented in those having a familial trend using some form of chemoprevention?????.

Dr. Julianov, what would you say is the stage of the disease at the time of the diagnosis?

Dr. Malik, what do you think in your professional opinion is the reason for advanced stages?

In my opinion,the reason for advanced stage seems to be the poorly differentiated variant of adenocarcinoma usually signet ring type that has a very high mitotic index and which grows very fast and throws early metastases.This is true with gastric cancer as well in younger individuals.

Secondly, since patients are young,they omit any presenting symptoms for long and do not seek advice particularly in developing countries.This is a fact which must have been observed by most clinicians working in developing countries.

Data from our unit suggests that we expect to see some patients between 30-40 with colorectal cancer as part of the distribution of the disease. I agree that familial factors do play a role but we have not identiifed any presentation that is common in these patients i.e. poor differentiation. Treatment in this group of patients though does appear to be more aggressive usually because they have few comorbidities and therefore tolerate treatment better, the emotional aspects of treating a younger group do affect ie young children etc. Those below 30, invariably have a variant of FAP - often unidentified due to issues of paternity. These patients are genetically interesting - tissue storage is very helpful.

The stage of disease in younger patients at our department does not differ from older patients. I join Mr. Daniels that those patients almost always had no comorbidities and are fit for more aggressive one-stage surgery even in metastatic setting. It is highly probably also part of them to be the index cases in an absence of a family history.

I agree with Dr Julianov, the issue of genetics is probably the key in these patients, but there is probably also a difference in the genetics of colonic and rectal cancer with the former having a stronger influence and hence the issue of total colectomy is different than the treatment of rectal cancer, which should be by recognised process.

As always with rectal cancer the range of treatment options calls for a dedicated staging protochol in order to optimize treatment outcome. The protochol should include Endorectal/Transrectal ultrasonography and MRI examination. Our reserach group have also demonstrated excellent results using endorectal ultrasonography based elastography.

Overstaging, especially if the tumour is located in the lower rectum, may lead to radiation therapy and permanent stoma with potential secondary infertility in cases where a local resection would sufice. On the other hand we have experienced some cases of biologically exctremely aggressive cancers in patients

Any comments on the 5 year survival of the patients?

Indian Journal of Surgical Oncology

December 2017, Volume 8, Issue 4, pp 491–498 | Cite as

Young Vs Old Colorectal Cancer in Indian Subcontinent: a Tertiary Care Center Experience

Authors

Authors and affiliations

Ashish B. PokharkarManish BhandarePrachi PatilShaesta MehtaReena EngineerAvanish P. SaklaniEmail author

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Original Article

First Online: 26 May 2017

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Abstract

This study aims to compare patient, tumor, treatment-related factors and survival between young (45 years) Indian colorectal cancer (CRC) patients. Total 778 patients of CRC were registered at tertiary cancer center in India between 1 August 2013 and 31 July 2014. Patients were followed up for median period of 27.73 months. Data regarding patient, tumor, treatment and survival-related factors were collected. Patients were divided in young (≤45 years) and old (>45 years) age groups. Statistical analysis was done with SPSS software version 23. Young age group patients presented more commonly with poor histology, node-positive disease, and rectal site. Younger age group patients received multiple lines of neoadjuvant treatment. There was no significant overall survival difference in both groups of patients. On stratified stage-wise analysis, no significant overall survival (OS) difference was found between two groups (young vs old—1- and 3-year OS: 85.2 and 61.5% vs 81.5 and 64.5%, respectively; P = 0.881). On univariate analysis, gender, performance status, site, stage, differentiation, TRG, CRM status, signet ring type, and CEA level were significant prognostic factors. In disease-free survival (DFS) analysis, it is found that there is statistically significant difference in DFS (young vs old: 1 and 3 years; 77.6 and 62.8% vs 85.8 and 74.1%, respectively; P value, 0.02), but when OS was analyzed for same group of patient, there was no statistical difference (P = 0.302). This study confirms the high incidence rates of CRC in young Indian patients. There is no OS difference between two age groups. In operated group of patients, there is higher DFS in older patients but no OS advantage at 3 years follow-up. Further long-term follow-up is required to see any OS difference.

Keywords

Colorectal cancer Disease-free survival Overall survival Young CRC