Colorectal cancer in young patients: A case report
Clinical and Biomedical Research
Colorectal cancer is the third most common malignant neoplasm worldwide, predominantly affecting the elderly population. However, in recent decades, there has been an increase in its incidence in patients under 50 years of age, who currently represent 7-26% of the diagnosed cases 1-3 . In this age group, the clinical presentation is similar to that of patients over 50. A previous prevalence study with young patients showed that the most common symptoms are rectal bleeding (57%), abdominal pain
... 31%), change in bowel habits (21%), weight loss (11%), and anemia (11%) 1 . Younger patients present a clinically more advanced and biologically more aggressive disease. The most commonly found histologic type is mucinous adenocarcinoma with poorly differentiated signet ring cells 1,3-5 . A retrospective review involving 180 patients younger than 50 years showed that, at the time of diagnosis, 37 (21%) patients were in stage I, 47 (26%) in stage II, 70 (39%) in stage III, and 26 (14%) in stage IV 1 . The majority of cases are sporadic tumors, as much in younger patients as in older; however, mutation analysis of younger patients, particularly for Lynch syndrome, the most common form of hereditary colorectal cancer, should be performed. In this report, we present the case of a patient diagnosed with colorectal cancer at the age of 17. Cases like this are rare in the literature; however, they support the statistics that show an increase in the incidence of this type of cancer in young patients. CASE REPORT A 17-year-old male patient, born and raised in Porto Alegre, arrived at the emergency room of Hospital de Clínicas de Porto Alegre complaining of abdominal pain and distension associated with nausea and vomiting for 1 month, weight loss (5 kg in 1 month), and diarrhea for 5 days without associated pathology. There was no family history of colorectal cancer. The patient was an alcoholic (1 L of vodka/day) for 1 year and a daily user of marijuana. Physical examination revealed a body mass index of 16 kg/m 2 , distended abdomen, and shifting dullness but with no other abnormalities. Laboratory tests showed normocytic and normochromic anemia. Serological tests for HIV and hepatitis B and C were negative. Abdominal ultrasound confirmed voluminous ascites without changes in structure or hepatic vessel flow. Paracentesis was performed and 3.7 L of a citrine-colored liquid were removed. Cellularity was lymphocyte predominant and cytopathology was negative. Computed tomography (CT) of abdomen was performed and identified a 5.9 cm-long stenotic lesion in transverse colon causing upstream colonic distension; thickening of the ileocecal valve and of the walls of the terminal ileum; ileal and jejunal distension; and densification of greater omentum, transverse mesocolon and parietal peritoneum associated with ascites (figure 1). Colonoscopy revealed a vegetating intraluminal lesion occupying 95% of the transverse colon cavity. Biopsies gave a histopathological diagnosis of ulcerated adenocarcinoma with poorly differentiated signet ring cells (figure 2).