Intest Res  
Red flag symptoms: detailed account of clinicopathological features in young-onset colorectal cancer
Ramish Riaz, Nosheen Masood, Arfa Benish
Department of Environmental Sciences (Biotechnology), Fatima Jinnah Women University, Rawalpindi, Pakistan
Correspondence to: Ramish Riaz, Department of Environmental Sciences (Biotechnology), Fatima Jinnah Women University, Mall Road, Rawalpindi, Pakistan. Tel: +923335743898, E-mail:
Received: July 29, 2016; Revised: December 26, 2016; Accepted: December 27, 2016; Published online: March 14, 2017.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background/Aims: Colorectal cancer has long been considered disease of the West, typically occurring in old age; however, the incidence is rising in Asia. The pattern of disease is quite different in Asia, occurring at a younger age and at an advanced stage. Recognition of disease at an early stage is still a challenge for physicians. Few data are available regarding young-onset colorectal cancer in Pakistan. We conducted this study to fill this gap and provide deeper insight into clinical symptoms and histopathological features of young-onset colorectal cancer. Methods: We collected data regarding clinical features by directly interviewing patients and obtaining histopathological data from hospital records. Patients aged less than 50 years were included in the study. Statistical analysis was performed using IBM SPSS version 20.0. Results: Results in 105 patients showed mean age at diagnosis was 35.90±9.39, with male predominance; the majority of patients had no family history of colorectal cancer. Most patients had left-sided tumors with advance stage and intermediate grade (grade 2). Mucinous histology was common. Rectal bleeding was the first symptom for left-sided tumors, whereas most of the right-sided lesions presented with sudden obstruction. Conclusions: Painless rectal bleeding in the early thirties should alert physicians to advise appropriate investigation, as the majority of young-onset colorectal cancer patients develop painless bleeding 2 to 3 years before appearance of other symptoms.
Keywords: Young CRC; Colorectal neoplasms; Early-onset; Clinicopathological features; Colorectal adenocarcinoma; Neoplasms; Colon

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