Ruesch Center for the Cure of Gastrointestinal Cancers, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Road NW, Washington, D.C, 20007, USA.
Curr Oncol Rep. 2019 Jan 18;21(1):3. doi: 10.1007/s11912-019-0756-8.
The recent rise of young individuals under age 50 with colorectal cancer (CRC) is a startling trend in need of greater focus and research. The etiology of young-onset CRC is unexplained as efforts to blame obesity or diabetes as causative factors are simplistic and inadequate.
We describe the epidemiologic shifts of CRC incidence and mortality across age groups as well as the differences in clinicopathologic, molecular, treatment, and survival characteristics between young and older patients. Novel studies of the microbiome may elucidate bacterial causes of CRC carcinogenesis in younger individuals. Moving up the colonoscopy screening to age 45 in normal-risk individuals should prove beneficial in detecting more patients with early-onset CRC. We favor the development of risk-adaptive screening decision algorithms and flexible sigmoidoscopy screening at age 40 given the predilection for left-sided primaries in this age group. More awareness and attention to young-onset CRC will be critical to improve outcomes in this patient population.
50 岁以下年轻人结直肠癌（CRC）发病率的上升是一个值得关注和研究的惊人趋势。年轻人 CRC 的病因尚不清楚，将肥胖或糖尿病归咎于病因的做法过于简单和不充分。
我们描述了结直肠癌发病率和死亡率在各年龄段的流行病学变化，以及年轻和老年患者在临床病理、分子、治疗和生存特征方面的差异。肠道微生物组的新研究可能阐明了年轻个体 CRC 癌变的细菌原因。将结肠镜筛查提前到 45 岁的正常风险人群，应该有助于发现更多的早期 CRC 患者。鉴于该年龄段左半结肠癌的倾向，我们赞成开发风险适应筛查决策算法和 40 岁时的软性乙状结肠镜筛查。提高对年轻起病 CRC 的认识和关注，对于改善该患者群体的预后至关重要。
