Journal of Cancer Prevention & Current Research Rising Incidence of Rectal Carcinoma in the Young Age“Is it A Concern? An Indian Perspective Submit Manuscript | http://medcraveonline.com Volume 8 Issue 4 - 2017 Swarupa Mitra*, Parveen Ahlawat, Manoj Sharma, Inderjeet Kaur Wahi, Ruparna Khurana, Shweta Sharma, Raman Narang, Soumya Dutta, Avik Manadal Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, India *Corresponding author: Dr. Swarupa Mitra, Senior Consultant, Chief- Gastrointestinal and Genitourinary Radiation Oncology, Rajiv Gandhi Cancer Institute and research Centre, Sector 5, Rohini, Delhi 110085, India, Tel: +91 9717041602; Email: Received: June 12, 2017 | Published: August 29, 2017 Research Article J Cancer Prev Curr Res 2017, 8(4): 00284 Abstract Background: As the incidence of colorectal cancer shows a steady decline in people older than 50 years, recent studies indicate a rising incidence in young individuals. This age group presents in an advanced stage, with reportedly poorer prognosis and lower survival. Lack of screening and delay in diagnosis in this group is a serious concern all over the world and particularly in India. Aim: We aimed to study the differences between the two groups, in the tumor characteristics, responses to treatment, sphincter saving rates, recurrences and survival. Patients & Methods: 246 rectal cancer patients who were referred to the radiation department, between January 2010 and December 2015 were retrospectively analyzed from hospital data bases. Results: Young patients (52.84%) were characterized by advanced stage at diagnosis, more aggressive histology. After neo-adjuvant chemotherapy radiotherapy (NACTRT) radiological down staging in young vs old was 45.45% and 40% while pathological down staging to pT0N0 was 16.48% and 10.91%. There was a significant correlation between pathological tumor and nodal status and the radiological response to NACTRT. No difference in the disease free survival (DFS) and overall survival (OS) was found between the age groups. The overall rate of sphincter preservation was 38.2%. Carcinoembryonic Antigen (CEA) levels, nodal status and clinical stage at presentation were the factors that affected DFS and OS and not younger age. Conclusion: There was no significant differences in either DFS or OS between the younger and the older patients in our study although the radiological and pathological down staging to NACTRT was more in the young. Given the higher comorbidities and lesser likelihood of completing their treatment in older individuals, the younger patients can probably have a better survival if they are diagnosed earlier at a less advanced stage. Introduction Colorectal carcinoma, a cancer of the developed world, is one of the most common malignancies of the gastrointestinal tract. It typically affects the elderly population with over 90% of the patients affected being above 55years of age [1]. However, in the last few years, the incidence in younger adults has been on the rise. Changing lifestyle, obesity, physical inactivity, intake of diet rich in processed foods with insufficient amount of fruits and vegetables, as well as the lack of screening in the young may be some reasons for this disturbing trend. Globally, 1.4 million new cases of colorectal cancers (CRC) and almost 694,000 deaths have been estimated to have occurred in 2012, which makes it the third and second most common cancer in males and females, respectively [2]. Approximately 135,430 new cases of colon cancer are diagnosed every year in the United States, of which 95,520 are colon and the rest are rectal cancers. About 50,260 Americans die of CRC annually, which accounts for almost 8 percent of all cancer deaths [3]. Compared to the West, a higher incidence of CRC has been reported in young individuals in South and Southeast Asia [4]. In India, the burden of colorectal carcinoma has been increasing due to probably changes in dietary habits and adoption of western lifestyles. The diagnosis is often delayed due to the rarity of this disease in the young and the low index of clinical suspicion [5]. Rectal cancers in the young are characterized by presence of poorly differentiated cells, cells with mucinous and signet ring features, and are hence associated with aggressive behavior and unfavorable prognosis [6]. Screening plays a vital role in early detection [7]. In this review we will discuss the tumor features, treatment modalities and response, sphincter saving rates and survival outcomes of rectal carcinoma in the young and the old and deliver a comparison. Patients and Methods Case records were retrieved for all patients diagnosed with cancer of the rectum who were treated at the Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India, from January 2010 to December 2015. Information regarding each patient’s demography, clinical findings, treatments, and follow-up details was collected using an electronic data system (HIS VISTA).