P-0213 - Colorectal cancer in patients age 40 and under: a retrospective analysis of database from the Institute of Oncology and Radiology of Serbia

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Cancer in Young Adults
Colon Cancer
Rectal Cancer
Presenter Jelena Spasic
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors J. Spasic1, D. Radosavljevic2, N. Nikolic2
  • 1Institute of Oncology and Radiology of Serbia, Belgrade/RS
  • 2Institute for Oncology and Radiology of Serbia, Belgrade/RS



Colorectal cancer (CRC) remains a notable source of morbidity and mortality worldwide. It occurs most commonly in patients over the age of 65, but the incidence in younger patients is increasing. According to some databases about 7% of all CRC patients are under the age of 45. In 2011 2.6% of all newly diagnosed patients with CRC in Serbia were age 40 or younger. Some important recent studies suggest that CRC in younger patients has a more aggressive biology and shorter overall survival.


Hospital records of patients diagnosed with CRC, age 40 or under, who were seen by the multidisciplinary tumor board (MTB) at the Institute for Oncology and Radiology of Serbia (IORS) between January 2008 and December 2013 were reviewed retrospectively. Data concerning demographic characteristics, pre-existing bowel disease, family history, histologic type of tumor, disease stage and treatment were analysed.


In this time 41 patients with CRC age 40 or under were seen, which is about 3% of all CRC patients discussed at MTBs, 20 were male (48.7%) and 21 female (51.3%), with median age at diagnosis 35 years, range 20 to 40. All patients were symptomatic at diagnosis, most common symptoms were bleeding and obstruction. First degree family history of CRC was seen in 7 patients (17%). Preoperative colonoscopy was performed in 33 patients, 8 were operated as emergency with no preoperative diagnostic procedures. Multiple colon polyposis was detected in 7 patients (17%), only one of those patients had previous diagnosis of polyposis. None of these patients were evaluated for gene mutations. In this analysis, 21 patients had tumors in the colon, and 20 in the rectum, 3 patients presented with multiple tumors. No patients had stage 1 disease, 5 patients (12,2%) had stage 2 disease, 21 patients (51,3%) had stage 3 disease and 15 patients (36,6%) presented with metastatic disease, with liver being the most common metastatic site. Only 3 patients had palliative surgery initially, the rest had definitive surgical treatment of primary tumor. Neoadjuvant chemoradiation was performed in 3 patients with rectal cancer. Adjuvant chemotherapy was administered to all stage 3 patients, 3 patients had postoperative radiotherapy. Out of the 26 patients with stage 1-3 disease, 18 patients (69,2%) relapsed to date, most with distant relapse. Chemotherapy was administered to all patients with metastatic disease at any time during this follow-up, with exception to one patient who relapsed with multiple brain metastases and was not fit for chemotherapy. Until the end of 2013 11 of these patients died from CRC, 7 patients are still receiving treatment, 4 are lost to follow-up.


CRC was observed in a fair number of young patients during this 5 year period, regardless of family history and pre-existing bowel conditions. Relapse rate in early colorectal cancer in our young patients is high, as is suggested in recent papers. A more comprehensive analysis is needed in order to find factors related to tumor biology or patient characteristics which may influence outcome of the disease.