Incidence of de novo Early-Onset Colorectal Adenocarcinoma in Southern Alabama

摘要

Purpose: The authors analyzed the incidence of de novo early-onset colorectal adenocarcinoma (age<= 45 years) among the patient population that this institution served in southern Alabama between 1988-2002.Methodology: A retrospective analysis of data compiled by the Cancer Data System/Tumor Registry of the University of South Alabama was conducted and compared to data compiled by the Alabama Statewide Cancer Registry. Demographic information, clinical symptoms and signs, diagnostic modalities, therapeutic interventions, and outcome data were assessed. The American Cancer Staging and End-Results Reporting criteria (Commission on Cancer/American College of Surgeons) were utilized to stratify patients.Results: Between 1988-2002, 42 of a total of 252 patients (17%) were diagnosed with de novo early-onset colorectal adenocarcinoma (<= 45 years of age). The symptoms and signs that patient cohort manifested were non-specific. Serum carcinoembryonic antigen determinations ranged widely at the time of initial diagnoses. Fifty-seven percent (57%) of that patient cohort underwent curative resectional therapy; the remaining 43% underwent palliative therapy, because of advanced stagedisease. Twenty-one patients (21/42; 50%) were alive without disease; 9/42 (21%) were alive with disease; and 12/42 (29%) were dead at a mean follow-up duration of 6.2 years (range 0.5-12.0 years).Summary: The data reported herein suggest that the incidence rates of de novo colorectal adenocarcinoma among young adults (<= 45 years) in southern Alabama is substantial. Seventeen (17) percent of the patients diagnosed with colorectal adenocarcinoma as recorded in the Cancer Data System/Tumor Registry of the University of South Alabama between 1988-2002 were <=45 years of age. Of that patient cohort 43% initially presented with advanced stage disease. Life-style and environmental issues have been implicated pathoetiolog-ically, but remain speculative and unproven. Since the laity has demonstrated only modest compliance with salutary life-styles and currently available screening protocols, more intensive educational efforts are rational. Any recommendation to institute currently available screening protocols at an earlier age is problematic in terms of effort-yield and cost-benefit analyses.