Changing Trends of Colorectal Carcinoma in Nepalese Young Adults


Introduction: Colorectal carcinoma (CRC) is the most common gastrointestinal malignancy in the olderpopulation, but it is also quite frequent among young adults in developing countries. The aim of this studywas to update the trends of clinicopathological features of CRC in young Nepalese.
Methods: A retrospectivecomparative study on the data retrieved from the surgical records of all patients between 20 to 39 years of agewith CRC was carried out for periods of 5 years each from 1999 to 2003 (early) and 2004 to 2008 (recent), treatedat Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Results: The number of young adults withCRC increased from 28 to 34. However, the proportion of young patients in both groups was 28% of all CRCpatients. The mean ages were 34±4.7 and 31.8±5.1 years in early and recent 5 years, respectively, and the malefemale ratio changed from 2:3 to 4:3. Abdominal pain as the most common presenting symptom was replacedby bleeding per rectum in recent years. The mean duration from onset of symptoms to seeking medical advicedecreased from 7.8 months to 5.6 months in recent years. More patients (85.3%) were subjected to endoscopicexamination in recent years than early years (60.7%) and right colonic cancer increased from 10.7% to 26.5%.However, the rectum was the commonest site in both early (71.4%) and recent (50%) groups. CRC was detectedsignificantly at an earlier stage (7.1% vs 32.4%) in recent years with large proportion of modified Dukes B stage.Poorly differentiated adenocarcinoma was the predominant histology in both groups (50% vs 60.7%). Curativeresection had risen in recent years (39.3% vs 73.6%).
Conclusion: CRC among Nepalese young adults accountsfor a high incidence (28%) of all CRC cases. Although right sided colonic cancer has been increasing, rectum isthe commonest site. There is also an increasing trend for diagnosis at earlier stages of the disease which can betreated with curative intent.