Colorectal cancer in young patients under 40 years of age. Comparison with old patients in a well defined Jordanian population

OBJECTIVE: To determine the incidence of colorectal cancer (CRC) in young Jordanians and to compare the clinical and pathological characteristics with those in older patients and with those in high risk populations.

METHODS: Clinical and pathological data of all the patients with CRC managed at Princess Basma Teaching Hospital, Irbid, Jordan over a 10 year period (January 1990 through December 1999) were recorded. The patients were divided according to age into group one (those <40 years) and group 2 (> 40 years). The 2 groups were compared regarding sex, predisposing conditions, tumor stage at presentation, tumor differentiation, mucin secretion, tumor invasion, presentation with complications and tumor location. The data were compared with those of "high risk" Western populations and with the few reports coming from "low risk" populations, mainly from Kingdom of Saudi Arabia and Egypt.

RESULTS: Out of 202 patients evaluated, 4 were excluded. Group1 constituted 20.2% of the patients, 17.5% of them have predisposing conditions. Comparison between group 1 and 2 revealed the following: female sex (65% versus 50.6%, p=0.104), advanced stages at presentation (65% versus 41%, p=0.005), rectal tumors (50% versus 39.2%) and right side tumors (15% versus 29.1%) (p=0.18). Mucinous and signet ring tumors (30% versus 15.8%, p=0.04), poor tumor differentiation (20% versus 18.3%, p=0.78) and presentation with complications (21% versus 22.2%, p=0.96).

CONCLUSION: The incidence of CRC in young Jordanians was much higher than high risk populations. Half of the tumors were rectal. Young patients have more advanced stage and more mucin secreting tumors. The relative high frequency and frequency of predisposing conditions calls for family screening and surveillance in the presence of predisposing conditions.