The Increasing Incidence of Young-Onset Colorectal Cancer: A Call to Action
The Increasing Incidence of Young-Onset Colorectal Cancer: A Call to Action
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DOI：
10.1016/j.mayocp.2013.09.006
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发表时间：
2014-02-01
影响因子：
8.9
通讯作者：
You, Y. Nancy
中科院分区：
文献类型：
--
作者：
Ahnen, Dennis J.;Wade, Sally W.;You, Y. Nancy
在美国，结直肠癌（CRC）是第三大最常见和第二大致命的癌症。超过十分之一的结直肠癌病例（11%的结肠癌和18%的直肠癌）是年轻发病（即发生在50岁以下的个体中）。在50岁以上的所有年龄组中，结直肠癌的发病率和死亡率都在下降，但在筛查使用有限且关键症状可能未被识别的年轻人中，结直肠癌的发病率和死亡率却在上升。家族性综合征约占年轻发病crc的20%，其余为典型的微卫星稳定癌症，与老年人的类似肿瘤相比，这种癌症更常见为二倍体。年轻起病的crc更可能发生在远端结肠或直肠，分化较差，具有粘液和印戒特征，并在晚期出现。然而，早发性结直肠癌患者的分期特异性生存率与晚发性癌症患者相当。初级保健医生有一个重要的机会来识别高风险的年轻人进行筛查，并及时评估结直肠癌的症状。风险调整、有针对性的筛查和预防性手术可能有利于有易感遗传综合征或疾病（如炎症性肠病）或有结直肠癌或晚期腺瘤性息肉家族史的个体。当明显的平均风险年轻人出现crc样症状（例如，不明原因的持续性直肠出血、贫血和腹痛）时，内镜检查可以加快诊断。高危人群的早期筛查和有症状的年轻人的彻底诊断检查可能改善年轻发病的CRC趋势。(C) 2014年梅奥医学教育与研究基金会
In the United States, colorectal cancer (CRC) is the third most common and second most lethal cancer. More than one-tenth of CRC cases (11% of colon cancers and 18% of rectal cancers) have a young onset (ie, occurring in individuals younger than 50 years). The CRC incidence and mortality rates are decreasing among all age groups older than 50 years, yet increasing in younger individuals for whom screening use is limited and key symptoms may go unrecognized. Familial syndromes account for approximately 20% of young-onset CRCs, and the remainder are typically microsatellite stable cancers, which are more commonly diploid than similar tumors in older individuals. Young-onset CRCs are more likely to occur in the distal colon or rectum, be poorly differentiated, have mucinous and signet ring features, and present at advanced stages. Yet, stage-specific survival in patients with young-onset CRC is comparable to that of patients with later-onset cancer. Primary care physicians have an important opportunity to identify high-risk young individuals for screening and to promptly evaluate CRC symptoms. Risk modification, targeted screening, and prophylactic surgery may benefit individuals with a predisposing hereditary syndrome or condition (eg, inflammatory bowel disease) or a family history of CRC or advanced adenomatous polyps. When apparently average-risk young adults present with CRC-like symptoms (eg, unexplained persistent rectal bleeding, anemia, and abdominal pain), endoscopic work-ups can expedite diagnosis. Early screening in high-risk individuals and thorough diagnostic work-ups in symptomatic young adults may improve young-onset CRC trends. (C) 2014 Mayo Foundation for Medical Education and Research