A Prospective Observational Study of Demographic Profile and Clinicopathological Aspects in Young Patients with Colorectal Cancer.

[BACKGROUND] Colorectal Cancer (CRC) is generally considered a disease of older age; however, there is a rising trend among younger individuals worldwide. There is limited data regarding the demographic profile and clinicopathological aspects of young individuals in South India. This study aimed to evaluate the clinicopathological profile of young patients with CRC.

[METHODS] This prospective observational study was conducted in the Department of Surgical Oncology, Nizams Institute of Medical Sciences, Telangana, from January 2024 to March 2025. Patients aged less than 50 years were included in the analysis. Demographic details, clinical presentation, tumour marker levels, histopathological details were collected. Associations between age, gender, family history, tumour site, histology, grade, metastasis were analysed. Statistical analysis was performed using SPSS version 23.0 with p value 0.05 considered statistically significant.

[RESULTS] Among 163 Early Onset (EO-CRC), 71.46% belongs to 41-50 years age group, with a mean age of 42.46 years. Males constituted 64.4% of patients, and the majority were from Hyderabad district. Family history was observed in 8.5% of patients. The most common tumour location was the rectum (44.9%), followed by the ascending colon (25.3%). Colon cancer patients most commonly presented in stage IV (38.8%), while rectal cancer patients commonly presented in stage III (42.2%). The most common sites of metastasis were the peritoneum (15.3%) and liver (14.1%), followed by the lung (6.7%). A very weak, positive, non-significant correlation was observed between AJCC stage and tumour size and CEA levels. Signet ring (8.64%) and mucinous (7.4%) types were less common than adenocarcinoma. LVSI and PNI were present in 55% and 35% respectively. MSI-high tumours were observed in 18.57%. Higher burden of signet ring tumours was noted in patients aged < 30 years, while mucinous type were more common in the 31-40 years age group. No gender predilection for tumour site was observed; however, signet ring carcinoma was more common in females. Patients with a family history presented at earlier stages, with poorly differentiated carcinoma as the predominant histology. Mucinous tumours, poorly differentiated carcinomas and grade 3 tumours were more common in right colon.

[CONCLUSION] Younger patients present with advanced stages and aggressive tumour variants, underscoring the importance of a high index of suspicion and increased awareness in Indian population.