Characteristics of Colorectal Cancer in Elderly Patients in Comparision with Younger Patients
Hyung Suk Lee, M.D.*, Seokyoung Lee, M.D., Ji-Hyun Seo, M.D., Kyeng Kunn Kwack, M.D., Su Jin Chung, M.D., Kwang Hyuck Lee, M.D., Young-Soo Park, M.D., Jin-Hyeok Hwang, M.D., Jin-Wook Kim, M.D., Sook Hyang Jung, M.D., Nayoung Kim, M.D., Dong Ho Lee, M.D.,
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, *Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, Korea
Abstract
Background/Aims: Considering the increasing age of the general population and the incidence of colorectal cancer (CRC), this study examined the characteristics of CRC in the aged, by comparing the clinical, endoscopic and histologic findings of CRC of younger and old patients. Methods: The records of 232 patients diagnosed with CRC from March 2003 to September 2004 were reviewed retrospectively. Two cohorts based on age, under and over 65 years, were compared for the patient and tumor characteristics. Results: The bowel habit change was significant (p=0.018) and there was a high prevalence of hematochezia in the older patients. The rate of cancer detection via a routine checkup was higher in the younger patients (p=0.015). The incidence of right colon cancer increased with age, and substantially higher in females. More older patients had Dukes stage C disease (p=0.007), while more younger patients had stage D (p=0.022). The incidence of metastasis was high in those with right colon cancer (p=0.009), and significantly higher in female. In females, high-risk tumor such as mucinous or signet-ring was more common in the older patients. The older patients had significantly low CEA levels in the advanced stage. Synchronous CRC was more common in the older patients (8.1% vs. 3.4%) and was located within the adjacent segment. Conclusions: CRC must be considered when older patients present with changes in their bowel habits or hematochezia. The right colon must be examined closely in older patients, particularly in females. A metastasis should be checked in right colon cancer, particularly in females. In older patients, advanced disease should be considered even in those with a low CEA level, and synchronous CRC must be searched for in the same or adjacent segment to that of the primary cancer.
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