High incidence of prolonged rectal bleeding and advanced stage cancer in early-onset colorectal cancer patients

Background: We examined characteristics of early-onset colorectal cancer (CRC) patients to identified factors, which may lead to earlier diagnosis. Materials & methods: This is a retrospective study with inclusion criteria: CRC diagnosed between 2012 and 2018 and age at diagnosis <50 years. Results: A total of 209 patients were included (mean age 41.8 years). Of those patients 42.5% had rectal cancer and 37.8% were stage IV at initial diagnosis. Of patients with data available for rectal bleeding history (n = 173), 50.8% presented with rectal bleeding and median time from onset of bleeding to diagnosis was 180 days (interquartile range 60–365), with longer duration noted in advanced cancer. Conclusion: Prolonged rectal bleeding history was noted in a significant proportion of early-onset CRC patients, with longer duration of rectal bleeding noted in stage IV patients. Patients and primary care physicians should be made aware of this finding in order to facilitate timely referral for diagnostic workup.

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A model-based assessment of the cost–utility of strategies to identify Lynch syndrome in early-onset colorectal cancer patients

BMC Cancer ◽

10.1186/s12885-015-1254-5 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 24

Author(s):

Tristan Snowsill ◽

Nicola Huxley ◽

Martin Hoyle ◽

Tracey Jones-Hughes ◽

Helen Coelho ◽

...

Keyword(s):

Colorectal Cancer ◽

Lynch Syndrome ◽

Cancer Patients ◽

Early Onset ◽

Cost Utility ◽

Model Based ◽

Colorectal Cancer Patients ◽

The Cost ◽

Early Onset Colorectal Cancer

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Clinical features and survival among patients with standard-onset versus early-onset colorectal cancer by age groups.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.3614 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 3614-3614

Author(s):

Ana Acuna Villaorduna ◽

Nishi Shah ◽

Sanjay Goel

Keyword(s):

Colorectal Cancer ◽

Clinical Features ◽

Early Onset ◽

Task Force ◽

Age Groups ◽

Stage Iv ◽

Early Screening ◽

Cancer Society ◽

Crc Screening ◽

Early Onset Colorectal Cancer

3614 Background: Colorectal cancer (CRC) incidence is increasing in patients younger than 50 years old. Currently, there are discordant recommendations regarding CRC screening: while the American Cancer Society favors to start at age 45, the National Comprehensive Cancer Network and the US Preventive Task Force suggest starting at age 50. This study is aimed to compare the incidence, clinical characteristics and survival of patients diagnosed with standard-onset CRC (SO) versus early-onset colorectal cancer by age-groups. Methods: Patients diagnosed with CRC at ages older than 35 were identified using the SEER registry and categorized into four groups based on age at diagnosis. EO1 (35-39), EO2 (40-44), EO3 (45-49) and SO (>50) years, respectively. Incidence, clinical features and survival were compared among groups. Results: 178 678 patients were identified. 9.2% were diagnosed before 50 years. Of these, 1.4%, 2.8% and 5.1% were EO1, EO2 and EO3; respectively. Patients with early-onset CRC (EO) had higher frequency of Hispanics (13.9% vs. 8.4%, p<0.01), stage IV (24.8% vs. 17.3%, p<0.01), left-sided tumors (74.1% vs. 56.9%, p<0.01) and better survival compared to SO. Among EO groups, the frequency of poor/anaplastic grade was inversely proportional to age; stage IV was similar between EO2 and EO3 and lower in EO1. Black race, grade and stage were predictors of mortality for all EO groups; laterality was a mortality predictor in EO2 and EO3. Conclusions: EO-CRC and SO-CRC have different pathological features that should be considered for CRC screening. Higher rates of stage IV disease are encountered in patients between 40-49 years old; hence early screening should be considered. Given higher rates of left-sided tumors, sigmoidoscopy might be an adequate tool for most patients with EO-CRC. [Table: see text]

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Abstract 4909: The role of CpG island methylator phenotype 2 (CIMP2) in early onset colorectal cancer patients

10.1158/1538-7445.am10-4909 ◽

2010 ◽

Author(s):

Carmen Li ◽

Siu Tsan Yuen ◽

Anthony ◽

Kin Wang Chan ◽

Wendy Wai Yin Tsui ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Early Onset ◽

Cpg Island ◽

Cpg Island Methylator Phenotype ◽

Methylator Phenotype ◽

Colorectal Cancer Patients ◽

Early Onset Colorectal Cancer

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Identification of candidate predisposing copy number variants in familial and early-onset colorectal cancer patients

International Journal of Cancer ◽

10.1002/ijc.25821 ◽

2011 ◽

Vol 129 (7) ◽

pp. 1635-1642 ◽

Cited By ~ 48

Author(s):

Ramprasath Venkatachalam ◽

Eugène T.P. Verwiel ◽

Eveline J. Kamping ◽

Eveline Hoenselaar ◽

Heike Görgens ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Early Onset ◽

Copy Number ◽

Copy Number Variants ◽

Colorectal Cancer Patients ◽

Early Onset Colorectal Cancer

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Use of Molecular Tumor Characteristics to Prioritize Mismatch Repair Gene Testing in Early-Onset Colorectal Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.04.671 ◽

2005 ◽

Vol 23 (27) ◽

pp. 6524-6532 ◽

Cited By ~ 139

Author(s):

Melissa C. Southey ◽

Mark A. Jenkins ◽

Leeanne Mead ◽

Jonathan Whitty ◽

Melanie Trivett ◽

...

Keyword(s):

Colorectal Cancer ◽

Family History ◽

Protein Expression ◽

Cancer Patients ◽

Gene Mutation ◽

Early Onset ◽

Amsterdam Criteria ◽

Colorectal Cancer Patients ◽

Early Onset Colorectal Cancer ◽

Mmr Proteins

Purpose The relationships between mismatch repair (MMR) protein expression, microsatellite instability (MSI), family history, and germline MMR gene mutation status have not been studied on a population basis. Methods We studied 131 unselected patients with colorectal cancer diagnosed younger than age 45 years. For the 105 available tumors, MLH1, MSH2, MSH6, and PMS2 protein expression using immunohistochemistry (IHC) and MSI were measured. Germline DNA was screened for hMLH1, hMSH2, hMSH6, and hPMS2 mutations for the following patients: all from families fulfilling the Amsterdam Criteria for hereditary nonpolyposis colorectal cancer (HNPCC); all with tumors that were high MSI, low MSI, or that lacked expression of any MMR protein; and a random sample of 23 with MS-stable tumors expressing all MMR proteins. Results Germline mutations were found in 18 patients (nine hMLH1, four hMSH2, four hMSH6, and one hPMS2); all tumors exhibited loss of MMR protein expression, all but one were high MSI or low MSI, and nine were from a family fulfilling Amsterdam Criteria. Sensitivities of IHC testing, MSI (high or low), and Amsterdam Criteria for MMR gene mutation were 100%, 94%, and 50%, respectively. Corresponding positive predictive values were 69%, 50%, and 75%. Conclusions Tumor IHC analysis of four MMR proteins and MSI testing provide a highly sensitive strategy for identifying MMR gene mutation–carrying, early-onset colorectal cancer patients, half of whom would have been missed using Amsterdam Criteria alone. Tumor-based approaches for triaging early-onset colorectal cancer patients for MMR gene mutation testing, irrespective of family history, appear to be an efficient screening strategy for HNPCC.

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