Early-onset colorectal cancer: A separate subset of colorectal cancer

Abstract

Colorectal cancer (CRC) has a great impact on the world population. With increasing frequency, CRC is described according to the presenting phenotype, based on its molecular characteristics. Classification of CRC tumors according to their genetic and/or epigenetic alterations is not only important for establishing the molecular bases of the disease, but also for predicting patient outcomes and developing more individualized treatments. Early-onset CRC is a heterogeneous disease, with a strong familial component, although the disease is sporadic in an important proportion of cases. Different molecular alterations appear to contribute to the apparent heterogeneity of the early-onset population and subgroups can be distinguished with distinct histopathologic and familial characteristics. Moreover, compared with late-onset CRC, there are characteristics that suggest that early-onset CRC may have a different molecular basis. The purpose of this review was to analyze the current state of knowledge about early-onset CRC with respect to clinicopathologic, familial and molecular features. Together, these features make it increasingly clear that this subset of CRC may be a separate disease, although it has much in common with late-onset CRC.

Keywords: Chromosomal instability, CpG island methylator phenotype, Early-onset colorectal cancer, Lynch syndrome, Microsatellite instability

Core tip: Early-onset colorectal cancer is a heterogeneous disease with various molecular alterations, in which different subgroups with different histopathologic and familial characteristics can be distinguished. Classification of colorectal cancer tumors according to their genetic alterations is important for establishing the molecular bases of the disease, as well as for predicting patient outcomes and developing more individualized treatments.