Carcinoma colon in young adults: An institutional experience

ABSTRACT Introduction: Carcinoma of colon is predominantly disease of elderly. In the recent times, its incidence is increasing in young adults (age <40 years). The data on colon cancer in young adults is scant. The present study is done to analyze the clinicopathological profile and outcomes of colon cancer in young adults. Objectives: The aim was to study the clinical and pathological treatment and outcomes in young adults with carcinoma of colon. Materials and Methods: Between 2016 and 2021, a total 75 patients with colon cancer, aged between 18 and 40, were retrospectively analyzed. Survival analysis was done by plotting Kaplan Meier curves. Results: A total of 516 colon cancer patients were seen between 2016 and 2021 of which, 75 (14.5%) patients were aged less than 40 years. The median age at presentation was 34 years (range, 18-40). Fifty-three (70.7%) patients were males and 22 (29.3%) were females. Abdominal pain (80%) is the most common symptom at presentation, followed by loss of weight (41.3%), obstruction (40%), and loss of appetite (38.7%). The median duration of symptoms was 3 months (range, 1-24 months). Left sided tumors (48%) were more common than the right-sided tumors (37.3%). Poorly differentiated tumors were seen in 40% of patients. Carcinoembryogenic antigen (CEA) elevation was seen in 24 (32%) patients and the median CEA was 6.565 (range, 0-447). Of 75 patients, 51 (68%) patients had localized disease and 24 (32%) patients had metastatic disease at presentation. The most common site of metastases was liver (41.7%) followed by peritoneum (37.5%) and omentum (16.7%). Among 51 patients with localized disease, stage II and III were seen in 16 (31.4%) and 23 (45.1%) patients respectively. All patients with localized disease underwent hemicolectomy. Adjuvant chemotherapy regimens used were capecitabine and oxaliplatin (CAPOX) (33.3%), fluorouracil and oxaliplatin (mFOLFOX6) (25.5%) and single agent capecitabine(11.8%). Of 24 patients with metastatic disease, 8 (33.3%) patients received CAPOX and 5 (20.8%) patients received mFOLFOX6. In patients with localized disease, at a median follow up of 20 months, overall survival (OS) was 81.5%. OS among patients with right sided tumors and left sided tumors were 78.6% and 84.6% respectively. The median OS in patients with metastatic disease was 16 months (range, 6-25 months). Conclusion: Unfavorable outlook for young adult with colon cancer highlights the need for the systematic study of these patients. Future studies should explore the genetic and biological features of these individuals and therapeutic options to bring out best outcomes.