Original Article
Colorectal cancer in young adults in a tertiary care hospital in Chhattisgarh, Raipur Sudarshan V, Hussain N, Gahine R, Mourya J Department of Pathology, Pt. JNM Medical College, Raipur (CG), India Correspondence to: Dr. Nighat Hussain, E‑mail: [email protected]
Abstract CONTEXT: Carcinoma of the colon and rectum is a relatively uncommon malignancy in India when compared with the western world. Colorectal cancer is generally a disease affecting individuals 50 years of age and older and is much less common in persons under 40 years of age. It is also a very uncommon pediatric malignancy. AIMS: To study the age, gender, site of primary tumor, histopathological type, and pathologic stage of colorectal cancer cases with specific reference to young adults. SETTINGS AND DESIGN: Tertiary care hospital, Retrospective study. MATERIALS AND METHODS: We conducted a retrospective study of all colorectal carcinomas (CRC) which were diagnosed during the past 8 years i.e., from January 2003 to December 2010. Patients were divided in to two groups - 40 years and younger, and older than 40 years. The records were analyzed in detail for age, gender, site of primary tumor, histopathological type, and pathologic stage. The results of the two groups were compared and also with information from other centers. STATISTICAL ANALYSIS USED: Nil. RESULTS: Two hundred and thirty three patients were diagnosed to have CRC. Patients diagnosed below 40 years of age comprised 39.05% and those under age 20 comprised 4. 29%. Among those under 40 years of age, majority were males (63.73%), most occurred in the rectum (84.61%). Most of them were poorly differentiated mucin‑secreting adenocarcinomas (80.21%) and presented at advanced pathologic T stage (71.42%). This was similar to those reported in other literatures. However, the incidence of colorectal cancer in patients younger than 40 years is much more in our study when compared with reports from other places. CONCLUSIONS: CRC in our institution is more often seen in younger individuals than what is reported in population‑based cancer registries from other parts of the country. The reasons for this are not clear. Therefore, further studies are required to address the role of diet and personal habits with CRC in this region. Also, a high index of suspicion among young adults is necessary. Key Words: Adenocarcinoma, colorectal carcinoma, young adults
Introduction Colorectal cancer is the fourth most common cancer in men and the third most common cancer in women worldwide. [1] Although distributed worldwide, the incidence is higher in industrialized and western countries. [2] Many Asian countries, including China, Japan, South Korea, and Singapore, have experienced an increase of 2‑4 times in the incidence of colorectal cancer during the past few decades. The rising trend in incidence and mortality from colorectal cancer is more striking in affluent than in poorer societies and differs substantially among ethnic groups. Although changes in dietary habits and lifestyle are believed to be the reasons underlying the increase, the interaction between these factors and genetic characteristics of the Asian populations might also have a pivotal role.[3] Most cases of colorectal cancer do not have a well‑documented Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.123621 PMID: *******
Indian Journal of Cancer | October–December 2013 | Volume 50 | Issue 4
inherited component, these are referred to as sporadic cases. Such cases result from at least seven somatic mutations and take decades to evolve.[4] Carcinoma of the colon and rectum is a relatively uncommon malignancy in India when compared with the western world. The age standardized rates of colorectal cancer in India have been estimated to be 4.2 and 3.2/100,000 for males and females, respectively, compared to 35.3 and 25.7, respectively, in the USA.[5,6] Colorectal cancer is generally a disease affecting individuals 50 years of age or older. [7‑9] Age‑specific incidence of colorectal cancer in the United States appears to rise steadily from the second to sixth decade of life. [10] Adenocarcinoma is an unusual disease in patients under 40 years of age, and generally presents as advanced disease. It has been estimated that between 2 and 3% of colorectal cancers occur in patients younger than the age of 40 years.[11] Men have proportionately higher incidence of rectal cancer than women.[8,10,12] In recent years, we have observed an increased incidence of colorectal cancers in younger age group. We retrospectively reviewed the histopathology records to testify this observation. Although exact incidence rate cannot be provided by a hospital‑based study, 337
Sudarshan, et al.: Colorectal cancer in young adults in a tertiary care hospital in Chhattisgarh, Raipur
the information would be useful in showing patterns of malignancies in our region. The present study was therefore designed to report age, gender, site of primary tumor, histopathological type, and pathologic stage in patients with colorectal carcinomas (CRC) with special reference to young adults. The need for early detection is emphasized. Materials and Methods This retrospective observational study was conducted in the Department of Pathology. Histopathological records of all cases of malignant tumor which were received and diagnosed during last 8 years i.e., from January 2003 to December 2010 were studied. Patients diagnosed to have CRC by histopathology were analyzed for demographic information, such as age and gender and site of primary tumor. The slides of all patients with CRC were reviewed for typing of malignancy and pathologic staging. Only carcinomas were included in the study. All young patients (defined as those 40 years old or younger) were studied separately. Cancer of the anus was not included. Clinical details were obtained from case records. As the histopathology section of the Pathology department, receives biopsy specimens from the whole region, urban as well as rural, the data from this institute, although not an absolute representation, may still be considered a fair indicator of trends in distribution of colorectal cancer and may be taken as representative of this part of the country. Since we did not have any previous data of cancer patients in this region, our data were analyzed on the same lines as that of colorectal cancers registered in population‑based cancer registries (PBCR)[5] from Bangalore, Barshi, Bhopal, Chennai, Delhi, Mumbai, Ahmedabad, and Kolkata in 2004‑2005 to estimate any deviation in any parameter if at all. Results A total of 233 cases were diagnosed to have CRC. Demographics
The median age at diagnosis was 43 years and age range was 9‑70 years. The detailed age distribution of CRC patients is shown in Table 1. A total of 91 (39.05%) patients of age 40 years or younger were diagnosed. Three cases were diagnosed in the pediatric (defined as 40 year age group, 84.61% in
Colorectal cancer in young adults in a tertiary care hospital in Chhattisgarh, Raipur Sudarshan V, Hussain N, Gahine R, Mourya J Department of Pathology, Pt. JNM Medical College, Raipur (CG), India Correspondence to: Dr. Nighat Hussain, E‑mail: [email protected]
Abstract CONTEXT: Carcinoma of the colon and rectum is a relatively uncommon malignancy in India when compared with the western world. Colorectal cancer is generally a disease affecting individuals 50 years of age and older and is much less common in persons under 40 years of age. It is also a very uncommon pediatric malignancy. AIMS: To study the age, gender, site of primary tumor, histopathological type, and pathologic stage of colorectal cancer cases with specific reference to young adults. SETTINGS AND DESIGN: Tertiary care hospital, Retrospective study. MATERIALS AND METHODS: We conducted a retrospective study of all colorectal carcinomas (CRC) which were diagnosed during the past 8 years i.e., from January 2003 to December 2010. Patients were divided in to two groups - 40 years and younger, and older than 40 years. The records were analyzed in detail for age, gender, site of primary tumor, histopathological type, and pathologic stage. The results of the two groups were compared and also with information from other centers. STATISTICAL ANALYSIS USED: Nil. RESULTS: Two hundred and thirty three patients were diagnosed to have CRC. Patients diagnosed below 40 years of age comprised 39.05% and those under age 20 comprised 4. 29%. Among those under 40 years of age, majority were males (63.73%), most occurred in the rectum (84.61%). Most of them were poorly differentiated mucin‑secreting adenocarcinomas (80.21%) and presented at advanced pathologic T stage (71.42%). This was similar to those reported in other literatures. However, the incidence of colorectal cancer in patients younger than 40 years is much more in our study when compared with reports from other places. CONCLUSIONS: CRC in our institution is more often seen in younger individuals than what is reported in population‑based cancer registries from other parts of the country. The reasons for this are not clear. Therefore, further studies are required to address the role of diet and personal habits with CRC in this region. Also, a high index of suspicion among young adults is necessary. Key Words: Adenocarcinoma, colorectal carcinoma, young adults
Introduction Colorectal cancer is the fourth most common cancer in men and the third most common cancer in women worldwide. [1] Although distributed worldwide, the incidence is higher in industrialized and western countries. [2] Many Asian countries, including China, Japan, South Korea, and Singapore, have experienced an increase of 2‑4 times in the incidence of colorectal cancer during the past few decades. The rising trend in incidence and mortality from colorectal cancer is more striking in affluent than in poorer societies and differs substantially among ethnic groups. Although changes in dietary habits and lifestyle are believed to be the reasons underlying the increase, the interaction between these factors and genetic characteristics of the Asian populations might also have a pivotal role.[3] Most cases of colorectal cancer do not have a well‑documented Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.123621 PMID: *******
Indian Journal of Cancer | October–December 2013 | Volume 50 | Issue 4
inherited component, these are referred to as sporadic cases. Such cases result from at least seven somatic mutations and take decades to evolve.[4] Carcinoma of the colon and rectum is a relatively uncommon malignancy in India when compared with the western world. The age standardized rates of colorectal cancer in India have been estimated to be 4.2 and 3.2/100,000 for males and females, respectively, compared to 35.3 and 25.7, respectively, in the USA.[5,6] Colorectal cancer is generally a disease affecting individuals 50 years of age or older. [7‑9] Age‑specific incidence of colorectal cancer in the United States appears to rise steadily from the second to sixth decade of life. [10] Adenocarcinoma is an unusual disease in patients under 40 years of age, and generally presents as advanced disease. It has been estimated that between 2 and 3% of colorectal cancers occur in patients younger than the age of 40 years.[11] Men have proportionately higher incidence of rectal cancer than women.[8,10,12] In recent years, we have observed an increased incidence of colorectal cancers in younger age group. We retrospectively reviewed the histopathology records to testify this observation. Although exact incidence rate cannot be provided by a hospital‑based study, 337
Sudarshan, et al.: Colorectal cancer in young adults in a tertiary care hospital in Chhattisgarh, Raipur
the information would be useful in showing patterns of malignancies in our region. The present study was therefore designed to report age, gender, site of primary tumor, histopathological type, and pathologic stage in patients with colorectal carcinomas (CRC) with special reference to young adults. The need for early detection is emphasized. Materials and Methods This retrospective observational study was conducted in the Department of Pathology. Histopathological records of all cases of malignant tumor which were received and diagnosed during last 8 years i.e., from January 2003 to December 2010 were studied. Patients diagnosed to have CRC by histopathology were analyzed for demographic information, such as age and gender and site of primary tumor. The slides of all patients with CRC were reviewed for typing of malignancy and pathologic staging. Only carcinomas were included in the study. All young patients (defined as those 40 years old or younger) were studied separately. Cancer of the anus was not included. Clinical details were obtained from case records. As the histopathology section of the Pathology department, receives biopsy specimens from the whole region, urban as well as rural, the data from this institute, although not an absolute representation, may still be considered a fair indicator of trends in distribution of colorectal cancer and may be taken as representative of this part of the country. Since we did not have any previous data of cancer patients in this region, our data were analyzed on the same lines as that of colorectal cancers registered in population‑based cancer registries (PBCR)[5] from Bangalore, Barshi, Bhopal, Chennai, Delhi, Mumbai, Ahmedabad, and Kolkata in 2004‑2005 to estimate any deviation in any parameter if at all. Results A total of 233 cases were diagnosed to have CRC. Demographics
The median age at diagnosis was 43 years and age range was 9‑70 years. The detailed age distribution of CRC patients is shown in Table 1. A total of 91 (39.05%) patients of age 40 years or younger were diagnosed. Three cases were diagnosed in the pediatric (defined as 40 year age group, 84.61% in
