Colorectal cancer (CRC) is the second leading cause of cancer
related death in the UK. According to the office of national statistics in
2013, CRC is the eighth leading cause of death in 35-49 year olds and the
fourth in 50-64 year olds. 11% of Colon and 18% of rectal cancers occur in
patients below the age of 50 years.
Risk stratification, lifestyle modification, early screening and
prophylactic surgery are helpful in patients with hereditary components to
their disease. However little is available to diagnose the younger patient
without a known predisposition to CRC. Literature has indicated that the
incidence of CRC has been rising in people below the age of 40 years. Since the
1990s Bowel cancer incidence in the UK has increased for most age groups, but
it has remained stable in people aged between 50-59 and 60-69. The largest
increase in incidence has been in people aged between 25-49 European age
specific incidence rates increased by 34% between 1993-1995 and 2012-2014.
CRC has been considered an older age disease often leading to
delayed screening and referrals in younger patients with colonic symptoms. Average
risk screening is now recommended in the United Kingdom to commence after the
age of 55 years old, data had shown that there is an increasing trend towards
younger patients developing CRC. This study aims to confirm whether this trend
is reflected in local population and establish whether younger patients are
presenting with more aggressive tumours.
It is well established that poorly differentiated histological
features such as mucinous and signet ring features are common in younger
patients and associated with a poorer prognosis in CRC. The increasing
incidence is a younger working population will have significant impact on risk
stratification and screening as well as a change in the traditional mind-set
that CRC is a disease of the elderly.
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