Bladder carcinoma in patients age 40 years or younger

The records of 26 men and nine women aged 40 years or younger, with transitional cell carcinoma of the bladder, were reviewed. Twenty-eight of the patients presented with gross painless hematuria, and 30 were regular smokers. Twenty-two patients presented with noninvasive disease, five with superficial invasion and eight with deep invasion. The risk of the disease progressing to invasion increased with the grade of the tumor, rising from 24% with Grade 1 to 75% with Grade 3. The patients younger than 30 years presented with a lower grade and a lower stage disease than those older than age 30. Transitional cell carcinoma of the bladder in young adults has a natural history similar to that seen in older patients.     

Lung cancer in patients younger than 40 years of age

The records of 52 patients younger than 40 years of age who had bronchogenic carcinoma diagnosed between 1965 and 1985 were reviewed. The preponderance of adenocarcinoma (54%), the lower male-female ratio in this age group compared with patients age 40 or older (2:1), the importance of cigarette smoking as a causative factor (80% of patients), the long mean duration of symptoms (5 months), and the high incidence of advanced stage at diagnosis (77% Stages III and IV) in these patients are findings similar to those reported in other published series. There was no significant difference in resectability (23% versus 19%), median survival length (5.3 months versus 6.9 months), median survival length of patients who had surgical resection (10.5 months versus 10.8 months), and 5-year survival rate (11.5% versus 6.3%) in these patients compared with a randomly selected group of 260 patients with lung cancer who were age 40 or older.     

Gastric carcinoma in patients younger than age 36 years

The clinical and pathologic features of 18 patients with gastric carcinoma younger than age 36 years were studied. Of these patients, 36.8% were Hispanics of Mexican origin. Eighteen percent of the Mexican population with gastric carcinoma were younger than 36 years as compared to 2.8% of the overall population (P less than 0.05). Fifty percent of the gastric ulcers in the Mexican population were malignant as compared to 6% in the non-Mexican population (P less than 0.05). In addition, a subset of aggressive carcinomas were found. Patients presenting with symptoms of less than 6 months' duration had a survival of less than 6 months, compared to the less aggressive subset, in which patients had symptoms for greater than 6 months and survived longer than 6 months. Racial, environmental influences, or selection bias may account for the differences in gastric carcinoma in the Mexican and non-Mexican population. Factors contributing to a more aggressive form of carcinoma are unclear and require further study.     

Lung carcinoma in patients age younger than 30 years

BACKGROUND: To the authors' knowledge, no study regarding lung carcinoma patients age <30 years has been published. Therefore, this study was undertaken to define the characteristics of lung carcinoma patients age <30 years. METHODS: Information regarding 26 patients with primary lung carcinoma who were age <30 years was obtained from 10 medical institutions and reviewed retrospectively. For comparison, 304 patients age > or = 30 years who were admitted to the First Department of Internal Medicine at Toyama Medical and Pharmaceutical University between 1980-1996 were studied. RESULTS: Among the characteristics observed in the group of lung carcinoma patients age <30 years was a high incidence of female gender, no history of smoking, so-called "low grade malignancy," American Joint Committee on Cancer Stage I disease, and previous surgical resection. In addition, a low incidence of squamous cell carcinoma was noted, and a more favorable prognosis was observed. CONCLUSIONS: The current study noted clinical features that could be defined clearly in lung carcinoma patients age <30 years.     

Lung cancer in patients younger than 40 years of age.

BACKGROUND AND OBJECTIVES: We investigated whether the clinicopathologic characteristics and prognosis of lung cancer in younger patients differ from those of older patients. METHODS: Among 2,763 lung cancer patients treated during the period from April of 1972 to April of 1997, we retrospectively investigated the clinical features and prognosis of 53 patients under 40 years of age (young group) and compared them with the findings of 1,886 patients with 60 years of age or older (elderly group). RESULTS: The proportion of female patients in the younger group was significantly higher than that in the elderly group (39.6% vs. 24.1%). The young group had a significantly higher proportion of adenocarcinoma (75.5% vs. 44.8%) and stage III-IV disease (73.6% vs. 59.2%) and a significantly lower proportion of squamous cell carcinoma (3.8% vs. 32.1%). Regarding the selection of therapy, in the young group, a significantly lower proportion of patients underwent surgical therapy (35.8% vs. 41.5%) and a significantly higher proportion of those (37.7% vs. 16.4%) received chemotherapy. The overall survival between the young and elderly groups was not significantly different. Moreover, the 5-year survival rate of the patients undergoing a surgical resection was 56.1% in the young group and 44.8% in the elderly group (P = 0.0615). CONCLUSIONS: This study suggests that the prognosis of young patients with lung cancer is at least equivalent to that of older patients; therefore, they should be managed according to the general therapeutic guidelines.     

Colorectal carcinoma in patients younger than 40 years of age. Montpellier Cancer Institute experience with 78 patients

During an 18-year period, 2600 patients were treated for colorectal carcinoma in the Montpellier Cancer Institute. Of the 93 patients younger than 40 years of age (3.6%), 78 records were retrospectively studied. The overall 5-year survival rate was 30%. Their survival was not significantly affected by the site of the primary tumor, the degree of tumor differentiation, or sex. The only significant parameter was Dukes' staging at presentation (P less than 0.0001). An analysis of sites of recurrence revealed the frequency of liver metastasis, ovarian metastasis in women, and local recurrence of rectal cancer. Although the high failure rate in these areas clearly justifies aggressive combined therapy, the high frequency of inaugural Stage D patients (27%) and their short mean survival time (5 months), underline the crucial importance of early detection. However, it is unfortunate that colorectal cancer screening in young patients is difficult because of the low rates of precancerous states (4%).     

Characteristics and outcome of endometrial carcinoma patients age 45 years and younger

Recent reports have suggested that the pathologic features of young patients with endometrial cancer are less favorable than previously thought. We retrospectively reviewed the characteristics and outcome of young patients with endometrial cancer at our institution. A total of 457 surgically staged patients were divided in 2 groups: Group A (age < or =45 years, n = 41) and B (age >45, n = 416). Groups A and B had a similar distribution of tumor stage, grade, histology, lymphovascular invasion, synchronous ovarian primaries, and positive cytology. Although group A tumors had less myometrial invasion (MI) (p = 0.004) and were lower grade (p = 0.06), a trend to more frequent nodal involvement was seen in group A women (p = 0.09). Adverse pathologic features, in particular deep MI, were more common in group A patients older than age 40. Group A patients had a disease-free (p = 0.56) and cause-specific (p = (0.26) survival that was similar to that of group B patients. Young patients with endometrial cancer have a distribution of most pathologic features and equivalent outcome similar to that of older women. However, adverse features are not equally distributed in young women. A discordance may also exist between MI, grade, and nodal involvement.     

Rare ductal adenocarcinoma of the pancreas in patients younger than age 40 years

BACKGROUND: Pancreatic ductal adenocarcinomas (PDACs) are extremely rare before age 40 years. The objective of the current study was to determine whether the features of PDACs in patients age < 40 years differ from those in older patients. The authors reviewed the literature and their own files. METHODS: The cases reported in the literature were evaluated to determine their precise diagnoses and characteristic features. In a series of 439 PDACs from the authors' files, tumors in patients age < 40 years were identified, and their clinicopathologic features and certain genetic features were compared with those in a selected group of patients age > 40 years. RESULTS: Of 71 pancreatic carcinomas reported in patients age < 40 years, only 20 fully qualified as PDACs. The remaining tumors represented malignancies other than PDACs, such as pancreatoblastoma, solid-pseudopapillary neoplasms, acinar cell carcinomas, and endocrine tumors. PDACs in patients age < 20 years were the absolute exception and commonly were associated with risk factors such as Peutz-Jeghers syndrome, hereditary pancreatic cancer syndrome, and preceding radiotherapy. In the authors' series of patients, there were 6 PDACs and 4 PDAC variants in patients age < 40 years (0.2%), all in male patients. These tumors compared well with the PDACs in patients age > 40 years in their pathologic and molecular findings. Three patients were age < or = 20 years, and 2 of those patients had a mucinous component with MUC2 positivity. CONCLUSIONS: The incidence of PDACs in patients age < 40 years was approximately 0.3%, and the incidence in patients age < 20 years was 0.1%. Their clinicopathologic findings were comparable to those in patients age > 40 years, but they seemed to include more variants, particularly mucinous carcinomas. In addition, PDACs in younger patients frequently appeared to be associated with genetic factors.     

Incidence of chemotherapy-induced, long-term amenorrhea in patients with breast carcinoma age 40 years and younger after adjuvant anthracycline and taxane

BACKGROUND: Twenty-five percent of all women with breast carcinoma are premenopausal and are at risk for chemotherapy-induced menopause with long-term side effects. Although there is considerable documentation of the rates of chemotherapy-induced amenorrhea with classic adjuvant regimens, there are inadequate data that address the impact of taxanes on menstrual function in this setting. The objective of this analysis was to determine the incidence of long-term amenorrhea (> or = 12 mos) in women with breast carcinoma age 40 years and younger after adjuvant anthracycline and taxane-based chemotherapy, with or without subsequent tamoxifen. METHODS: The authors identified 235 premenopausal women with breast carcinoma age 40 years or younger who were treated with adjuvant anthracycline and taxane-based chemotherapy at Memorial Sloan-Kettering Cancer Center from January 1997 to June 2003. RESULTS: One hundred sixty-six patients met all eligibility criteria and had sufficient follow-up for evaluation. The median age of patients at diagnosis was 36 years (range, 27-40 yrs). All patients had regular pretreatment menses, 25 patients (15%) developed long-term amenorrhea, and 141 patients (85%) resumed menstruation. Eighty-two patients (49%) also received tamoxifen: The incidence of amenorrhea among them was 17%. There was a statistically significant association between age and the development of amenorrhea, with older women at higher risk (P < 0.01). CONCLUSIONS: The sequential addition of a taxane to standard adjuvant anthracycline-based chemotherapy did not appear to produce a high rate of chemotherapy-related amenorrhea compared with historic controls. To increase the information available to assist young patients who are considering adjuvant therapy, prospective studies should incorporate menstrual function ascertainment by patient-reported history and assays of ovarian function.     

40岁以下膀胱移行细胞癌非职业相关因素的调查分析

目的:探讨≤40岁膀胱移形细胞癌患者的患病相关因素。方法:采用以人群为基础的1∶1病例对照研究。病例组为≤40岁膀胱移行细胞癌患者82例,选取≤40岁正常人82名为对照组。单因素分析采用χ2检验,多因素分析采用非条件Logistic回归分析。结果:多因素非条件Logistic回归分析显示,≤40岁膀胱癌患者与文化程度(OR=0.010,95%CI:0.000~0.403)、日吸烟量(OR=9.905,95%CI:1.837~53.411)、饮食不规律(OR=6.117,95%CI:1.079~34.685)、食用奶制品(OR=0.031,95%CI:0.002~0.544)、睡眠习惯(OR=5.360,95%CI:1.580~18.190)和服用抑酸剂(OR=3.418,95%CI:1.155~10.111)有关。结论:吸烟量大、饮食不规律、睡眠不规律和常服用抑酸剂可能为≤40岁膀胱癌患者发病的危险因素,文化程度高和常食用奶制品可能为≤40岁膀胱癌发病的保护因素。     

Safety of bevacizumab in patients younger than 4 years of age

Purpose

Limited data exist regarding the safety and efficacy of bevacizumab in pediatric patients under the age of 4 years. Here, we report a large cohort of pediatric patients under 4 years of age treated with bevacizumab.

Methods

The primary objective was to document adverse events with a possible relationship to bevacizumab. Patients (n = 16) were identified through retrospective chart review and harbored a variety of conditions (44 % central nervous system (CNS) tumors, 31 % vascular anomalies, 13 % neuroblastoma, 12 % other).

Results

The median age was 34.3 months (range 4.9–47.3), including five patients <2 years of age. Patients received bevacizumab for a median duration of 6.2 months, alone or with chemotherapy, and a median dose of 9.25 mg/kg (range 7.0–11.8). Partial responses were seen in 19 % of patients, and clinical improvements were seen in 69 %. Adverse events known to be associated with bevacizumab occurred in 37 %. Outcomes observed in this population resemble those reported for bevacizumab in older pediatric patients. The overall pattern and frequency of adverse events observed was similar to those seen in reports of older pediatric patients with a variety of conditions. The highest level of efficacy observed was seen among patients with vascular malformations or with low-grade CNS tumors.

Conclusions

Our results suggest that the use of bevacizumab is safe for the youngest children.

     

Increasing incidence of rectal cancer in patients aged younger than 40 years

BACKGROUND:

The incidence of rectal cancer in the United States in young patients is considered to be low. Underestimating this incidence may result in a failure to diagnose younger patients with rectal cancer in a timely manner.

METHODS:

The authors conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) cancer registry data. A total of 7661 patients with colon, rectal, and rectosigmoid cancer who were diagnosed at age <40 years were identified between 1973 and 2005. The change in incidence over time for colon and rectal/rectosigmoid cancer was calculated and the annual percent change for anatomic subsites of colorectal cancer compared.

RESULTS:

SEER data demonstrated an increase in the incidence of rectal cancer without any increase in colon cancer (annual percent change of 2.6% vs ?0.2%). The difference was statistically significant and extended to rectosigmoid cancer, but not cancer of the sigmoid colon or descending colon (annual percent change of 2.2% vs 0.4% and ?2.8%, respectively). Joinpoint analysis of the slope of the curve of rectal and rectosigmoid cancer incidence identified the beginning of the increase to be 1984. All races and both sexes demonstrated similar statistically significant increases in the incidence of rectal and rectosigmoid cancer.

CONCLUSIONS:

The incidence of rectal and rectosigmoid cancer appears to be increasing in patients aged <40 years. Patients presenting with rectal bleeding or other alarming signs or symptoms should be evaluated with this finding in mind. Cancer 2010. © 2010 American Cancer Society.     

Breast carcinoma at the extremes of age: a comparison of patients younger than 35 years and older than 75 years

We assessed the prognosis of patients with breast carcinoma at the extremes of the age distribution of the disease. The groups examined were 166 women 35 years or less and 169 at least 75 years old. Analysis of recurrence and survival showed no significant difference between the groups as a whole or when they were stratified by nodal status. Life expectancy of elderly women with breast carcinoma was significantly reduced when compared with a "normal" age-matched population. Medullary carcinoma was more frequent in young women while a relatively higher proportion of colloid and invasive lobular carcinoma occurred in elderly women. Bilateral carcinoma was found with nearly equal frequency in both age groups. However, elderly women were more likely to have been treated previously for contralateral carcinoma while young women tended to develop asynchronous, subsequent carcinoma.     

Rhabdomyosarcoma in patients older than 40 years of age

The original diagnosis of rhabdomyosarcoma (RM) was critically evaluated by histology, immunohistochemistry, and electron microscopy in a retrospective series of 25 patients older than 40 years of age. Only two of the 25 patients (8%) were verified to have RM by strict criteria. By light microscopy, the true RM had a spindle or round cell appearance and were subtyped as embryonal RM, although some pleomorphism was present. Sarcomeric differentiation was revealed by electron microscopy, and desmin and muscle actin by immunohistochemistry. Both of these tumors arose in the urogenital organs, one in the urinary bladder and the other in the prostatic region. Both patients died within 3 months of the diagnosis. The other tumors not verified as RM were pleomorphic or spindle cell sarcomas (n = 17), ten of which were considered to represent malignant fibrous histiocytoma, or had desmin and/or muscle actin, and were verified as leiomyosarcomas by electron microscopy (n = 2). There were single cases of undifferentiated carcinoma, probable neuroendocrine carcinoma, extraskeletal osteosarcoma, and pleomorphic liposarcoma. The average survival for the non-RM tumor patients was 32 months. The results show that true RM do occur in the elderly, but they are very rare. Such tumors may have clinicopathologic properties similar to embryonal RM in children both in regard to the site of origin and to the histologic picture. True RM seems to carry a worse prognosis than other pleomorphic sarcomas, and this emphasizes the need for accurate diagnosis.     

MR shoulder arthrography in patients younger than 40 years of age: Frequency of rotator cuff tear versus labroligamentous pathology

The purpose of this study was to compare the frequency of rotator cuff pathology versus labroligamentous pathology in patients younger than 40 years and to determine whether routine MR arthrography is justified in all patients in this age group, regardless of the clinical symptoms. The MR arthrography was carried out on 332 patients 40 years of age and younger. Two hundred and forty‐three patients had clinical history of instability and possible labroligamentous pathology. Eighty‐nine patients had no history or physical signs of instability and were referred for reasons other than instability, such as assessment for rotator cuff tear. In the 243 patients younger than 40 years with clinical history of potential labral pathology, 39% (95/243) showed a labral tear and 2.1% (5/243) had a full‐thickness rotator cuff tendon tear. In the 89 patients with no history suggesting labral pathology, 19% (17/89) showed an unsuspected labral tear and 4.5% (4/89) had a full‐thickness rotator cuff tear. These findings suggest that, regardless of the clinical indication for referral, patients aged 40 and less referred for shoulder MRI should be imaged using MR arthrography because of the significant risk that symptoms are related to unsuspected labral pathology.     

Laryngeal carcinoma in a boy of twelve years

A case of laryngeal carcinoma in a boy of twelve who had history of excessive tobacco-smoking since early childhood is reported. Initially he received full irradiation but his symptoms recurred and a total laryngectomy was done, on clinical grounds, 10 months after completion of radiotherapy. The surgically removed specimen was subjected to serial sectioning and was studied in detail. Viable tumour foci were observed histologically at the primary site. Patient was doing well for 4 years after surgery without any recurrence.     

Endometrial carcinoma in women under 40 years of age: incidence of ovarian carcinoma and ovarian metastasis

Background. Patients under 40 years of age with endometrial carcinoma were compared with patients aged 40 years or more in terms of clinical and histopathological characteristics. Methods. One hundred and fifty-three patients with endometrial carcinoma who had their initial treatment in our hospital between 1980 and 1996 were divided into two groups; those under 40 years of age (group A) and those 40 years or more (group B). They were compared in terms of clinical stage, histological differentiation, degree of myometrial invasion, existence of lymph-vascular invasion, incidence of ovarian carcinoma with endometrial carcinoma, incidence of ovarian metastasis, treatment methods, and prognosis. Results. Fourteen patients (9.2%) were in group A and 139 patients (90.8%) in group B. There were no significant differences in the proportion of stage I patients in the two groups, but the proportion of stage IV patients was significantly higher in group A (P < 0.005). There were no significant differences in histological differentiation, degree of myometrial invasion, and the existence of lymph-vascular invasions. The incidence of ovarian carcinoma with endometrial carcinoma was 21.4% for group A and 2.2% for group B, being significantly higher in group A (P < 0.005). The incidence of simultaneous ovarian carcinoma with endometrial carcinoma was 14.2% for group A and 1.4% for group B, being significantly higher in group A (P < 0.05). The incidence of ovarian metastasis of endometrial carcinoma in groups A and B was 14.2% and 2.9% respectively, showing no significant difference. The incidence of either ovarian carcinoma with endometrial carcinoma or ovarian metastasis of endometrial carcinoma was significantly higher in group A (35.7%) than in group B (5%; P < 0.0005). There were no significant differences in the 5-year survival rates. Conclusion. Women aged under 40 years had a significantly higher incidence of ovarian carcinoma associated with endometrial carcinoma and a significantly higher incidence of either ovarian carcinoma with endometrial carcinoma or metastasis of endometrial carcinoma to the ovary than women aged 40 years or more. The 5-year survival rate showed no difference between the groups. Received: June 17, 1999 / Accepted: November 26, 1999