Analysis Of Clinical Characteristics And Pathological Features Of Young Patients With Colorectal Cancer

Background:Colorectal Cancer (CRC) ranks the third among the most common cancers for male and ranks the second among the most common cancers for female. Furthermore, CRC ranks the fourth among all the cancers that are relevant to death. According to statistics, in developed countries, the morbidity and the death rates caused by CRC have already reached a stable status and even lowered. However, for the undeveloped regions, the morbidity and the death rates remain increasing with the young patients taking a higher ratio. Analysis suggests the morbidity of CRC in China is undergoing an upward trend, and the young patients (≤40 years old) makes up the majority.Currently, most documents define the upper limit of the age for the young CRC patients to 40 years old. CRC encountered by the young people is usually categorized as the sporadic CRC with the exact cause remaining unclear. Nevertheless, at present, the increase of CRC among young people is mainly attributed to unhealthy diet, excessive consumption of red meat, lack of exercise and obesity. Young patients often show less specific clinical characteristics, while the majority of them suffer from change of bowel habit, hematochezia, change of property of stool and weight loss, etc.The most common sites of colorectal cancer for young patients are sigmoid colon and rectum, with poor pathological differentiation and a high degree of malignancy. Because of the delay in seeing the doctor or the doctor’s failure to link the above symptoms of the young patients to CRC, usually such cases get neglected. Thus in order to improve the detection rate of young patients with colorectal cancer in early period, to reduce mortality and to improve the prognosis, young patients should pay more attention to the symptoms concerning digestive system such as abdominal pain, hematochezia etc.Objectives:This paper retrospectively analyzes the data about the colorectal cancer patients in the nearly last 20 years of Peking Union Medical College Hospital, to evaluate the incidence of the young people. By exploring the clinical characteristics and pathological features of the 280 patients in the last 10 years, this paper aims to highlight the attention of people to the clinical symptoms of the digestive tract. In addition, doctors should raise their awareness to young people belonging to the high risk group and notice the earliest symptoms of the colorectal cancer in order to lower the death ratio and improve the prognosis of the CRC patients.Methods:By gathering the total number of the patients in PUMC, the total number of the colerectal cancer patients in PUMC and the number of the colerectal cancer patients not above the age of 40 from January 1995 to December 2004 and from January 2005 to December 2014, the incidence is analyzed.The retrospective analysis is conducted among 280 young colerectal cancer patients (≤40 years old) in the PUMC from January 2005 to December 2014 who have detailed clinical and pathological data which include gender, age, clinical symptoms, lab test results, endoscopy results and pathological features. By analyzing and comparing these data, the clinical characteristics and pathological features are summarized.Results:From January 1995 to December 2004, the hospitalization rate of the patient suffering from the colorectal cancer was 0.74%, and patients with colorectal cancer not above 40 years old takes up 0.0640% of the total number of the patients in PUMC and 8.67% of the total colorectum patients, among which the male to female ratio is 1.54:1; From January 2005 to December 2014, the hospitalization rate of the patient suffering from the colorectal cancer was 0.84%, which was higher than that of ten years before, and patients with colorectal cancer not above 40 years old takes up 0.0463% of the total number of the patients in PUMC and 5.52% of the total colorectum patients, among which the male to female ratio is 1.16:1. No statistical difference has been found in the male to female ratio with respect to the colorectum patients who were aged at 40 or below in recent 20 years.A total of 280 patients, who were aged from 14 to 40, have been analysed in this study. Their average age is 33.6±5.7. Among the patients,150 are male and the other 130 are female (with a male to female ratio as 1.15:1).10 cases out of the young patients with familial adenomatous polyposis have developed into carcinoma, accounting for 3.57% of the young patients with colorectal cancer.6 patients suffered from cancers in multiple locations, accounting for 2.1%.58 patients have the tumour on the right colon, accounting for 21.96% of patients with single-site colorectal cancer. Among these 58 cases, the ratios of ileocecal tumor, cecum cancer, ascending colon cancer were 2.65%,1.89% and 17.42% respectively.20 cases are transverse colon cancer, taking up 7.58%; 19 cases are descending colon cancer, taking up 7.20% and 167 cases are sigmoid colon and rectum cancer, which account for 63.26%.No special symptom is discovered for colorectal cancer. Change of bowel habit (172/280,61.43%), hematochezia (167/280,59.64%), change of property of stool (161/280,57.50%), abdominal pain (138/280,49.29%), and the loss of weight(121/234, 51.71%) are the most common symptoms. Rectal touch was abnormal in 114 patients (40.71%); 33 patients are positive for abdominal tenderness (11.79%) and 29 patients are with abdominal mass (10.36%). The period from the starting of the clinical symptoms to the definite diagnosis takes from 2 days to 11 years, and 88 patients should take more than 6 months.In lab tests,184 patients (184/209,88.04%) are tested with positive result of feces occult blood,96 (96/248,38.71%) with anemia,79 (79/215,36.74%) with CEA rising and 57 (57/123,46.34%) with hsCRP rising. Compared with the serum CEA inspection, the fecal occult blood test has a higher rate to discover the colorectal cancer(P<0.001), and compared with the distant colon cancer, near colon cancer has a higher potential to cause anemia (P<0.001).Pathological properties:Among 234 cases of adenocarcinoma,167 are high and moderately differentiated adenocarcinoma, taking up 59.64%, and 67 are poorly differentiated adenocarcinoma taking up 23.93%. In addition, there are 30 cases of mucinous adenocarcinoma taking up 10.72% and 10 cases of signet-ring cell carcinoma taking up 3.57%.2 cases just returned the result of metastatic adenocarcinoma (unaware of the differentiated degree) taking up 0.71%,4 cases are other unusual types (1 malignant mesenchymoma,1 malignant solitary fibroustumor,1 malignant gastrointestinal stromal tumor,1 melanoma) taking up 1.43%.Clinical stage (Dukes stage):273 patients have clear clinical stage,71 cases are at stage A, taking up 26%,35 at B, taking up 12.82%,101 at C, taking up 37% and 66 at D, taking up 24.18%.Factors related to Dukes stage:Logistic Regression Analysis reveals that CEA and hsCRP are proved by Logistic Multivariate Regression Analysis to be related with Dukes stage. Risk of a late stage of patient with abnormal CEA is 4.45 times higher than that of the patients with a normal CEA level. Besides, Risk of a late stage of patient with abnormal hsCRP is 3.08 times higher than that of the patients with a normal hsCRP level.