Published online Feb 27, 2021. doi: 10.4240/wjgs.v13.i2.164
Peer-review started: November 24, 2020
First decision: December 20, 2020
Revised: January 2, 2021
Accepted: January 21, 2021
Article in press: January 21, 2021
Published online: February 27, 2021
Processing time: 71 Days and 15.2 Hours
Over the last decade studies reported a rising incidence of colorectal cancer (CRC) in the younger population below the age of recommended screening thresholds. Alongside a higher incidence of young-onset CRC, there is more and more evidence of advanced tumors among younger patients. Reasons for increased tumor aggressiveness are the subject of active debate. Besides genetic risk factors, environmental factors may also play a decisive role.
Several studies tried to shed more light on risk factors favoring young-onset cancer. To date, there is more speculation than strong evidence on what may lead to advanced CRC in young individuals. With our analysis of clinicopathologic parameters we intended to make a contribution to better understand the tumor biology of CRC of the young.
The purpose of this work was to compare histopathologic features of CRC diagnosed in young compared to patients over 50 years of age at our institution.
The present study is a monocentric retrospective cohort analysis from a Swiss tertiary center hospital. Patient records covering a time period of 6 year (2013–2018) were included and analyzed according to age based on current CRC screening programs (< 50 and ≥ 50 years of age). The study was approved by the responsible ethics committee.
The histopathological assessment of the CRC showed a higher proportion of locally advanced tumors in younger patients below 50 years of age. In addition, lymph node metastases were more frequent in young patients with more distant metastases diagnosed among the youngest in our center (< 40 years of age). Mutational status and behavioral risk factors depicted no difference among the groups.
Patients younger than 50 years of age suffer from more advanced CRC, and show more frequently lymphatic invasion and with more frequent lymphatic metastases than the cohort over 50 years.
Our study highlights the need to identify young individuals at risk of developing early-onset CRC. Future research should be directed towards identification of individual risk factors for colorectal carcinogenesis at young age and reasons for the early metastatic behavior of tumors in affected patients. Finally, studies such as ours question the current age limit for government-driven CRC screening programs, which may have to start before the age of 50.