Advanced-Stage Colorectal Cancer in Persons Younger Than 50 Years Not Associated With Longer Duration of Symptoms or Time to Diagnosis

Frank W Chen, Vandana Sundaram, Thomas A Chew, Uri Ladabaum, Frank W Chen, Vandana Sundaram, Thomas A Chew, Uri Ladabaum

Abstract

Background & aims: The incidence of colorectal cancer (CRC) is increasing in the United States among adults younger than the age of 50 years. Studies of young-onset CRC have focused on outcomes and treatment patterns. We examined patient presentation, provider evaluation, and time to diagnosis, which can affect stage and prognosis.

Methods: In a retrospective study, we collected data from patients with a diagnosis of colorectal adenocarcinoma, confirmed by pathologists, seen at the Stanford Cancer Institute from January 1, 2008, through December 31, 2014. We compared symptoms, clinical features, time to diagnosis, and cancer stage in patients with young-onset CRC (diagnosed at an age younger than 50 years; n = 253) with patients diagnosed with CRC at an age of 50 years or older (n = 232).

Results: A higher proportion of patients with young-onset CRC were diagnosed with advanced-stage tumors (72%) compared with older patients (63%) (P = .03). Larger proportions of patients with young-onset CRC also had a family history of CRC (25% vs 17% in older patients; P = .03), confirmed or probable hereditary cancer syndromes (7% vs 1% in older patients; P < .01), and left-sided disease (distal colon cancer in 41% vs 34% in older patients; P = .01; and rectal cancer in 40% vs 35% in older patients; P = .29). Patients with young-onset CRC had a significantly longer median time to diagnosis (128 vs 79 days for older patients; P < .05), symptom duration (60 vs 30 days for older patients; P < .01), and time of evaluation (31 vs 22 days; P < .05). In multivariable analyses, time to diagnosis was 1.4-fold longer for younger than for older patients (P < .01). Among younger patients, those with stage III or IV CRC had shorter durations of symptoms and evaluations than those with stage I or II CRC.

Conclusions: In a retrospective analysis of patients with CRC, we found that greater proportions of patients younger than 50 years were diagnosed with advanced-stage tumors than older patients; this difference could not be explained simply by delays from symptom onset to diagnosis. Although tumor biology may be an important determinant of stage at diagnosis, clinicians should be aware of CRC alarm symptoms, family history, and genetic syndromes, to speed evaluation and diagnosis of younger patients and potentially improve outcomes. It remains to be determined whether subgroups of persons at risk for young-onset CRC who benefit from early screening can be identified.

Keywords: Colon Cancer; Detection; Epidemiology; Work-Up.

Conflict of interest statement

Conflict of Interest Disclosure: Uri Ladabaum: Consulting Role for Medtronic, Exact Sciences, Manua Kea Technologies; Researching Funding from Exact Sciences, Myriad Genetics; Vandana Sundaram: Research Funding from The Medicines Company, Tenax. None for Frank Chen and Thomas Chew.

Transcript Profiling: Not applicable

Writing Assistance: Not applicable

Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Study cohort.
Figure 2
Figure 2
Median symptom and workup durations by age and stage.

References

    1. American Cancer Society: Colorectal Cancer Facts & Figures 2014–2016. Society AC, ed
    1. Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–573.
    1. Siegel RL, Jemal A, Ward EM. Increase in incidence of colorectal cancer among young men and women in the United States. Cancer Epidemiol Biomarkers Prev. 2009;18:1695–1698.
    1. Abdelsattar ZM, Wong SL, Regenbogen SE, et al. Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening. Cancer. 2016;122:929–934.
    1. Bailey CE, Hu CY, You YN, et al. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975–2010. JAMA Surg. 2015;150:17–22.
    1. Couric K. An Unexpected Turn: My Life as a Cancer Advocate. Am J Gastroenterol. 2016;111:594–595.
    1. Quah HM, Joseph R, Schrag D, et al. Young age influences treatment but not outcome of colon cancer. Ann Surg Oncol. 2007;14:2759–2765.
    1. O’Connell JB, Maggard MA, Liu JH, et al. Do young colon cancer patients have worse outcomes? World J Surg. 2004;28:558–562.
    1. Amri R, Bordeianou LG, Berger DL. The conundrum of the young colon cancer patient. Surgery. 2015;158:1696–1703.
    1. You YN, Xing Y, Feig BW, et al. Young-onset colorectal cancer: is it time to pay attention? Arch Intern Med. 2012;172:287–289.
    1. Tezcan G, Tunca B, Ak S, et al. Molecular approach to genetic and epigenetic pathogenesis of early-onset colorectal cancer. World J Gastrointest Oncol. 2016;8:83–98.
    1. Chang DT, Pai RK, Rybicki LA, et al. Clinicopathologic and molecular features of sporadic early-onset colorectal adenocarcinoma: an adenocarcinoma with frequent signet ring cell differentiation, rectal and sigmoid involvement, and adverse morphologic features. Mod Pathol. 2012;25:1128–1139.
    1. Goel G. Evolving role of gene expression signatures as biomarkers in early-stage colon cancer. J Gastrointest Cancer. 2014;45:399–404.
    1. Limburg PJ, Harmsen WS, Chen HH, et al. Prevalence of alterations in DNA mismatch repair genes in patients with young-onset colorectal cancer. Clin Gastroenterol Hepatol. 2011;9:497–502.
    1. Vilar E, Tabernero J, Gruber SB. Micromanaging the classification of colon cancer: the role of the microRNAome. Clin Cancer Res. 2011;17:7207–7209.
    1. Ciarrocchi A, Amicucci G. Sporadic carcinoma of the colon-rectum in young patients: a distinct disease? A critical review. J Gastrointest Cancer. 2013;44:264–269.
    1. Mork ME, You YN, Ying J, et al. High Prevalence of Hereditary Cancer Syndromes in Adolescents and Young Adults With Colorectal Cancer. J Clin Oncol. 2015;33:3544–3549.
    1. Ben-Ishay O, Brauner E, Peled Z, et al. Diagnosis of colon cancer differs in younger versus older patients despite similar complaints. Isr Med Assoc J. 2013;15:284–287.
    1. Deng SX, An W, Gao J, et al. Factors influencing diagnosis of colorectal cancer: a hospital-based survey in China. J Dig Dis. 2012;13:517–524.
    1. Dozois EJ, Boardman LA, Suwanthanma W, et al. Young-onset colorectal cancer in patients with no known genetic predisposition: can we increase early recognition and improve outcome? Medicine (Baltimore) 2008;87:259–263.
    1. Esteva M, Leiva A, Ramos M, et al. Factors related with symptom duration until diagnosis and treatment of symptomatic colorectal cancer. BMC Cancer. 2013;13:87.
    1. Rahman R, Schmaltz C, Jackson CS, et al. Increased risk for colorectal cancer under age 50 in racial and ethnic minorities living in the United States. Cancer Med. 2015;4:1863–1870.
    1. A A. Categorical data analysis. Second. John Wiley & Sons, Inc;
    1. Esteva M, Ruiz A, Ramos M, et al. Age differences in presentation, diagnosis pathway and management of colorectal cancer. Cancer Epidemiol. 2014;38:346–353.
    1. Ahnen DJ, Wade SW, Jones WF, et al. The increasing incidence of young-onset colorectal cancer: a call to action. Mayo Clin Proc. 2014;89:216–224.
    1. Torring ML, Frydenberg M, Hansen RP, et al. Time to diagnosis and mortality in colorectal cancer: a cohort study in primary care. Br J Cancer. 2011;104:934–940.
    1. Bleyer A, Barr R, Hayes-Lattin B, et al. The distinctive biology of cancer in adolescents and young adults. Nat Rev Cancer. 2008;8:288–298.
    1. Ballester V, Rashtak S, Boardman L. Clinical and molecular features of young-onset colorectal cancer. World J Gastroenterol. 2016;22:1736–1744.
    1. Goldvaser H, Purim O, Kundel Y, et al. Colorectal cancer in young patients: is it a distinct clinical entity? Int J Clin Oncol. 2016
    1. Antelo M, Balaguer F, Shia J, et al. A high degree of LINE-1 hypomethylation is a unique feature of early-onset colorectal cancer. PLoS One. 2012;7:e45357.
    1. Taylor DP, Burt RW, Williams MS, et al. Population-based family history-specific risks for colorectal cancer: a constellation approach. Gastroenterology. 2010;138:877–885.
    1. Lowery JT, Ahnen DJ, Schroy PC, 3rd, et al. Understanding the contribution of family history to colorectal cancer risk and its clinical implications: A state-of-the-science review. Cancer. 2016
    1. Myer PA, Mannalithara A, Singh G, et al. Clinical and economic burden of emergency department visits due to gastrointestinal diseases in the United States. Am J Gastroenterol. 2013;108:1496–1507.

Source: PubMed

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