FREQUENCY OF SIGNS AND SYMPTOMS PRECEDING DIAGNOSIS OF NON-HEREDITARY YOUNG ONSET COLORECTAL CANCER PATIENTS AND ITS IMPACT ON SURVIVAL

Introduction: Over the last several decades, the incidence of patients under fifty years of age diagnosed with non-hereditary colorectal cancer has steadily increased. While some risk factors associated with the development of young onset colorectal cancer have been elucidated in literature, others such as gastrointestinal symptoms preceding cancer diagnosis have not been clearly defined. Knowledge of potential heralding signs and symptoms prior to young colorectal cancer diagnosis is important, as this could lead to earlier screening and diagnosis at a more favorable stage. Aims: We aimed to assess the frequency of gastrointestinal and non-gastrointestinal signs and symptoms preceding the diagnosis of colorectal cancer in young patients and assess its impact on survival. Methods: In this retrospective observational study, we randomly selected young patients ≤ fifty years old with histopathologic diagnosis of non-hereditary colorectal adenocarcinoma at Carilion Clinic, Roanoke, from 2002 to 2017. Patients with a history of inflammatory conditions including inflammatory bowel disease and those with predisposing genetic syndromes such as Lynch Syndrome and Familial Adenomatous Polyposis Syndrome were excluded. Patient demographics, reported gastrointestinal symptoms, procedures (index colonoscopy), and mortality were obtained from the electronic medical record. The cumulative risk of mortality among symptomatic patients was estimated using Kaplan Meier curves. Results: One hundred and thirty-nine patients (Mean age, 41.6±6.9 years; 53.2% males) with non-hereditary colorectal cancer were identified. The presenting signs and symptoms were rectal bleeding (45.3%), abdominal pain (36.0%), diarrhea (23.0%), constipation (18.7%), weight loss (17.3%), nausea with vomiting (10.8%), rectal pain (2.2%), bloating (2.2%), microcytic anemia (17.3%), and other symptoms (12.9%). The diagnosis of cancer was made after a mean of 4.5±11.4 months and rectal cancer was the most common site (31.4%), followed by sigmoid colon cancer (25.4%). Twenty-eight patients (20.1%) were asymptomatic at the time of diagnosis, 95 (68.5%) had between 1 to 3 signs or symptoms, and 16 (11.5%) had more than 3 signs or symptoms at initial evaluation. Interestingly, roughly 17% of the patients presented with advanced disease (stage 4); the majority of them (94.4%) had 1 to 3 signs or symptoms. The median survival was lower in patients with more signs and symptoms (>3) on initial presentation (P=0.046). Conclusion: Non-hereditary colorectal cancer diagnosis was delayed in young patients by four and a half months, and rectal bleeding was the most common presenting symptom. The survival of patients with more signs and symptoms was decreased compared to patients with less signs and symptoms. Diagnostic colonoscopy should be offered early for patients with signs or symptoms to improve survival.