Inra Jennifer A, Syngal Sapna
Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA,
Dig Dis Sci. 2015 Mar;60(3):722-33. doi: 10.1007/s10620-014-3464-0. Epub 2014 Dec 6.
The incidence and mortality rates of colorectal cancer (CRC) have been decreasing in adults over 50 years of age, however, these rates have been increasing in adults under 50. The majority of CRC in young adults is sporadic, and is likely due to behavioral and environmental causes, however the exact etiology still remains unclear. The minority of CRC in this population is due to inherited CRC syndromes. Young adults with CRC are often symptomatic (abdominal pain, rectal bleeding), and diagnosis is often delayed due to reasons such as under-utilized health care services, and physicians attributing symptoms to diagnoses other than CRC. Young adults with CRC often have more aggressive tumor characteristics, but they tend to have better survival rates when compared with older adults when matched for stage. Treatment is the same for young patients with CRC, however there are issues that arise in this population that do not necessarily affect older adults, such as the negative effect of chemotherapy/radiation on fertility. It is not clear that screening individuals for CRC at ages under 50 is beneficial or cost-effective. Further studies are needed regarding this topic.
50岁以上成年人的结直肠癌（CRC）发病率和死亡率一直在下降，然而，50岁以下成年人的这些比率却在上升。年轻成年人中的大多数结直肠癌是散发性的，可能是由于行为和环境原因，但确切病因仍不清楚。该人群中少数结直肠癌是由遗传性结直肠癌综合征引起的。患有结直肠癌的年轻成年人通常有症状（腹痛、直肠出血），由于医疗服务利用不足以及医生将症状归因于结直肠癌以外的诊断等原因，诊断往往会延迟。患有结直肠癌的年轻成年人通常具有更具侵袭性的肿瘤特征，但与年龄较大的成年人在分期匹配时相比，他们的生存率往往更高。患有结直肠癌的年轻患者的治疗方法相同，然而，该人群中出现的一些问题不一定会影响老年人，例如化疗/放疗对生育能力的负面影响。目前尚不清楚对50岁以下的人进行结直肠癌筛查是否有益或具有成本效益。关于这个主题需要进一步的研究。
