Young-Onset Colorectal Cancer

Traditionally known a condition that affects older adults, colorectal cancer has become more prevalent in people under the age of 50 since the 1990's. This shift has prompted screening recommendations to begin at the age of 45.

As Cincinnati’s exclusive Young-Onset Colorectal Cancer Center, we stand at the forefront of specialized care and research. We are committed to addressing the distinct challenges faced by younger patients. Our approach integrates leading-edge diagnostics, personalized treatment plans, and genetic counseling. Our multidisciplinary team of experts collaborates to ensure each patient receives comprehensive, tailored care throughout their journey, setting a new standard in cancer treatment and support.

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Understanding Young-Onset Colorectal Cancer

Colorectal cancer is often thought of as a condition that affects older adults, but recent trends show a startling rise in cases among young individuals.

Understanding young-onset colorectal cancer is crucial as it presents unique challenges and requires specific awareness for early detection and treatment.

This comprehensive guide delves into the symptoms, causes, and preventive measures of young-onset colorectal cancer, aiming to empower young adults with knowledge and encourage proactive health measures.

Through early detection and understanding of the risk factors, we can combat this life-threatening disease and improve outcomes for young-onset colorectal cancer patients.

What is Young Onset Colorectal Cancer?

Colorectal cancer in younger adults, commonly referred to as young-onset colorectal cancer, is an alarming healthcare concern that defies the old-age stereotype of this disease.

Defined as “colorectal cancer diagnosed in individuals under the age of 50”, it is a condition that demands attention due to its tendency to be more aggressive and often diagnosed at a later cancer stage.

Despite the advances in medical science, the incidence of colorectal cancer in younger people has been on a steady rise, prompting experts to call for a deeper investigation into its causes and advocating for earlier and more frequent screening protocols. The term "young-onset" distinguishes it from cases found in older populations, underscoring the unique aspects of its presentation and progression in younger adults.

How Common is Early-Onset Colorectal Cancer?

The prevalence of early-onset colorectal cancer is a growing health concern, with studies revealing a significant increase in cases among individuals under age 50.

This trend contrasts sharply with the declining rates of colorectal cancer observed in older adults, thanks to widespread screening efforts. According to the American Cancer Society, the rate of colorectal cancer among younger adults has nearly doubled since the 1990s.

This increase is not only a public health puzzle but also a pressing reason to amplify awareness and screening in younger populations. Young adults are not typically considered at risk, and as a result, symptoms, when present, can go unnoticed or misdiagnosed, leading to advanced stages of the disease by the time of discovery.

These statistics highlight an urgent need to re-evaluate screening guidelines and expand research to understand the underlying causes of this trend. In fact, the U.S. Preventive Services Task Force issued a new recommendation in 2021 that colorectal cancer screening for people at average risk should start 5 years sooner than it used to be (age 50) and that age is now 45. However, even this screening guideline at age 45 is missing majority of young-onset cancer and future studies may lead to further changes in screening guidelines.

Unveiling Causes and Risk Factors of Colorectal Cancer in Young Adults

Identifying the causes and risk factors for early-onset colorectal cancer is vital for prevention and early intervention. While the exact causes remain elusive, researchers have pinpointed several potential risk factors that contribute to developing this disease in young individuals.

Genetics play a crucial role; hereditary cancer syndromes like Lynch syndrome and familial adenomatous polyposis significantly increase one's risk. However, there are many young-onset colorectal cancer patients who do not have an identifiable hereditary cancer syndrome, rather the cancer can just be sporadic rather than passed on as a syndrome. Beyond heredity, lifestyle factors such as high consumption of processed meats, low-fiber diets, obesity, and lack of physical activity are implicated. The rise in environmental toxins and changes in gut microbiota might also play a part.

Other risk factors include a history of inflammatory bowel disease and type 2 diabetes. Understanding these risks is the first step toward personal risk assessment and proactive health management for young adults. Here are the factors again listed below:

Genetic Predispositions:

  • Lynch syndrome
  • Familial adenomatous polyposis (FAP)
  • Other hereditary cancer syndromes

Lifestyle Factors:

  • High intake of processed and red meats
  • Low-fiber diets
  • Sedentary lifestyle
  • Obesity

Medical Conditions:

  • History of inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
  • Type 2 diabetes

Environmental Exposures:

  • Increased interaction with environmental toxins
  • Shifts in gut microbiota possibly due to dietary changes or antibiotics

Other Considerations:

  • Age (increased risk for individuals under 50)
  • Family history of colorectal cancer
  • High alcohol consumption
  • Smoking

In addition to the risk factors previously mentioned, the rising incidence of colorectal cancer in young adults has prompted researchers to investigate other contributing factors.

Changes in diet and physical activity patterns over recent decades have been implicated in this increase. The Western diet, characterized by high consumption of red and processed meats and low in fiber-rich fruits and vegetables, is particularly under scrutiny.

Furthermore, the obesity epidemic and increased sedentary lifestyles are contributing to not just colorectal cancer but various diseases in younger populations.

Environmental factors, such as exposure to carcinogens, and the potential role of gut microbiota alterations due to antibiotic use and dietary changes, are also being explored. Understanding these trends is critical for developing targeted prevention strategies and modifying screening guidelines to address the alarming rise in early-onset colorectal cancer.

Recognizing Young-Onset Colorectal Cancer Symptoms

Recognizing the symptoms of young-onset colorectal cancer is critical for early detection. Young adults should be particularly vigilant about persistent changes in bowel habits, such as diarrhea or constipation, and any signs of rectal bleeding or blood in the stool.

Constipation can present with perianal concerns like a fissure or hemorrhoid flare, although most often these are unrelated to cancer. Abdominal discomfort, including frequent cramps or aches, and systemic symptoms like unexplained weight loss, fatigue, and nausea, can also be warning signs, although again these are often unrelated to cancer.

Anemia, with its telltale fatigue and paleness, may also be a symptom. These signs often go unnoticed as they can be easily mistaken for less serious conditions, making it imperative for individuals, especially those with additional risk factors, to seek medical evaluation promptly.

Early detection of young-onset colorectal cancer hinges on recognizing its symptoms and screening those who are at increased risk early. Unfortunately, these signs can be subtle or mimic other common ailments, leading to delays in diagnosis. Here's what young adults should be vigilant about:

Changes in Bowel Habits:

  • Persistent diarrhea or constipation
  • A feeling that your bowel doesn't empty completely
  • Frequent gas pains, bloating, fullness, or cramps

Rectal Symptoms:

  • Rectal bleeding with bright red blood
  • Blood in the stool, which might make it look dark brown or black

Abdominal Discomfort:

  • Persistent abdominal pain or discomfort, such as cramps or aches

Systemic Symptoms:

  • Unexplained weight loss
  • Fatigue or weakness
  • Nausea or vomiting


  • Symptoms caused by a decrease in healthy red blood cells, leading to paleness and additional fatigue

It is crucial for anyone experiencing these symptoms persistently to consult with a healthcare provider. While these symptoms can be indicative of less serious conditions, it's important to rule out colorectal cancer as a cause, particularly in individuals with risk factors for the disease.

Diagnosis: Identifying Early Onset Colorectal Cancers

For those presenting with symptoms, early diagnosis is crucial and is achieved through a simple yet comprehensive diagnostic process.

It begins with a detailed review of the patient's medical history and a physical examination, focusing on symptom discussion and family history.

Diagnostic colonoscopy, which allows for visualization and biopsy of suspicious areas, is the most important first study when there is a concern for colorectal cancer. For screening purposes, if no symptoms and concerns, then there are options ranging from fecal occult blood tests, such as FIT or gFOBT, to colonoscopy which remains the gold standard test.

In cases with strong family history indications, genetic counseling and testing become instrumental in identifying hereditary cancer syndromes as well as actionable mutations.

Further evaluation may include blood tests to check for anemia and other cancer indicators, as well as advanced imaging tests like MRI or CT scans to determine the cancer's spread. Access to these diagnostic services is critical, and for those with a suspected diagnosis, referral to a specialized center can provide a multidisciplinary approach to treatment. For example, not all CT scans are the same and if not done at an expert center for the indication of cancer staging versus non-cancer reasons, patients can end up with inadequate cancer imaging and staging which could impair treatment decision-making.

Early diagnosis of young-onset colorectal cancer can significantly improve treatment outcomes, making awareness of the diagnostic process crucial. For young adults presenting with symptoms, the diagnostic journey typically involves the following steps listed again:

Initial Evaluation:

  • Medical history review and physical examination
  • Discussion of symptoms and risk factors, including family history

Diagnostic Tests:

  • Colonoscopy, the most comprehensive diagnostic method, allows for direct visualization and biopsy of suspicious areas

Genetic Counseling and Testing:

  • Assessment for hereditary cancer syndromes when a strong family history or specific symptoms are present
  • Genetic testing for mutations in genes associated with increased cancer risk

Further Evaluation:

  • Blood tests to check for anemia and other signs that might indicate cancer
  • Additional imaging tests, such as MRI or CT scans, to assess the extent of the disease

Timely access to these diagnostic services is essential. If colorectal cancer is suspected, a referral to a specialized young-onset colorectal cancer center can provide patients with access to a multidisciplinary team experienced in treating this disease in younger populations.

Current Treatments for Young-Onset Colorectal Cancer Patients

Treatment for young-onset colorectal cancer is personalized and may involve a combination of therapies depending on the stage and spread of the disease.

Surgical options range from advanced endoscopy, like endoscopic mucosal resection (EMR), for pre-cancerous lesions, to transanal minimally invasive surgery for early-stage rectal cancers to more extensive, yet often minimally invasive procedures like partial colectomy which can often be performed laparoscopically or robotically. Chemotherapy may be administered to shrink tumors before surgery or to address any remaining cancer cells afterward.

For rectal cancer, radiation therapy is often used in conjunction with chemotherapy to maximize efficacy. Advances in medical science have introduced targeted therapy, which utilizes drugs to home in on specific cancer cell abnormalities, sometimes in combination with chemotherapy.

Immunotherapy, a treatment that harnesses the body's immune system to combat cancer, has shown effectiveness, particularly for cancers that exhibit certain genetic markers. Clinical trials also offer access to cutting-edge treatments, providing hope for new ways to combat this disease.

Once a diagnosis of young-onset colorectal cancer is confirmed, a personalized treatment plan is developed, considering the stage of cancer and the patient's overall health. Here are the primary treatments listed once more:

Surgical Interventions:

  • Polypectomy during a colonoscopy for early-stage cancers for select cancers that could be fully removed with adequate margins at the time of colonoscopy and the pathology did not harbor high-risk lesions
  • Advanced endoscopic techniques like endoscopic mucosal resection (EMR) for large precancerous lesions that cannot be removed with conventional colonoscopy.
  • Transanal minimally invasive surgery (TaMIS) for large rectal polyps or very early rectal cancers.
  • Partial colectomy to remove part of the colon when there is a true cancer that is growing into the bowel wall.
  • An ostomy is a temporary or permanent measure depending on the extent of the disease and the patient’s baseline comorbidity burden. Most patients with colorectal cancer do not need an ostomy.


  • Utilized to shrink the tumor before surgery if needed or to eliminate remaining cancer cells post-surgery
  • Can be used as the main treatment if surgery isn't an option

Radiation Therapy:

  • Often combined with chemotherapy (chemoradiation) for rectal cancer
  • Can be used to reduce tumor size before surgery or to target cancer cells that remain afterward

Targeted Therapy:

  • Drugs designed to target specific abnormalities within cancer cells
  • Can be used alone or in combination with chemotherapy


  • Employs the body's immune system to fight cancer
  • Particularly effective for cancers with certain genetic markers

Clinical Trials:

  • Access to new treatments or treatment paradigms that are being tested for effectiveness.

Supportive care:

  • Social workers
  • Fertility specialists who can talk you about fertility preservation options before treatment if needed.
  • Genetic counselors
  • Registered Dieticians
  • Integrative medicine who can take a holistic approach to your wellness during cancer care
  • Oncology primary care

Each treatment strategy is tailored to the individual, and decisions are made collaboratively by a team of specialists, including oncologists, surgeons, and other healthcare providers. Treatment plans for young patients also consider factors such as the impact on fertility, quality of life, and long-term health.

Prevention: Reducing Your Risk of Colorectal Cancer

While the genetic factors influencing young-onset colorectal cancer cannot be controlled, adopting healthy lifestyle changes can significantly mitigate risk.

A diet rich in fiber from fruits, vegetables, and whole grains, with limited red meat and processed foods, is foundational. Regular physical activity, ideally 30 minutes of moderate to vigorous exercise most days, is also recommended.

Maintaining a healthy weight is key, as obesity is linked to an increased risk of colorectal and other cancers. Reducing alcohol consumption and eliminating smoking are further crucial steps for prevention. For those with a family history or other risk factors, early and regular colorectal cancer screening is essential. Awareness of one's family health history can inform personal risk and screening timelines.

Collectively, these preventive strategies serve not only to lower the risk of developing colorectal cancer but also to promote overall health, which can be beneficial should cancer treatment become necessary.

Preventing young-onset colorectal cancer is not always possible, especially when genetic factors are at play. However, adopting certain lifestyle changes can help reduce the risk. Here's what our experts suggest, listed once-more:

Dietary Modifications:

  • Increase fiber intake from fruits, vegetables, and whole grains.
  • Limit red meat and processed foods.
  • Incorporate more fish and lean poultry into your diet.

Regular Exercise:

  • Engage in at least 30 minutes of moderate to vigorous activity most days of the week.
  • Reduce sedentary time and include strength training exercises.

Weight Management:

  • Strive for a healthy weight to lower the risk of various cancers, including colorectal cancer.

Limit Alcohol and Avoid Smoking:

  • Keep alcohol consumption to moderate levels.
  • Quit smoking, as it's linked to an increased risk of many cancers.

Colorectal Cancer Screening and Surveillance:

  • Adhere to screening guidelines, especially if you have a family history of the disease.
  • Discuss with your doctor the right age to begin screening, which may be earlier than the general population if you have additional risk factors.

Awareness of Family History:

  • Know your family's health history and discuss it with your healthcare provider to assess your personal risk.

Preventive strategies are not only about lowering the risk of developing cancer but also about improving overall health, which can contribute to better outcomes if cancer does occur.

The Importance of Colorectal Cancer Screening in Younger Age Groups

With the noticeable increase in young-onset colorectal cancer, early and effective screening is more crucial than ever. Screening provides the best chance for early detection when the cancer is most treatable and survival rates are highest.

The American Cancer Society has adjusted its guidelines, now recommending screening begin at age 45 for those at average risk, with earlier screening for those with additional risk factors. A range of screening tests, from colonoscopies to non-invasive stool DNA tests, offers options tailored to individual needs and circumstances. Colonoscopy has significant advantages in that it can catch the simplest of polyps which are removed at the same procedure and don’t have the chance to become troublesome. However, challenges remain, particularly in access to and awareness of screening for younger individuals.

Advocacy efforts are intensifying to improve screening rates and to secure necessary research funding, ensuring that early detection remains a key component in the strategy to combat colorectal cancer.

The rise in young-onset colorectal cancer has prompted a reevaluation of screening guidelines. Early detection is pivotal, as it often leads to more effective treatment and better outcomes. Here's why screening is essential for younger individuals:

Early Detection Saves Lives:

  • Screening can detect cancer before symptoms develop when it's most treatable.
  • Precancerous polyps can be found and removed during colonoscopy before they turn into cancer.

Updated Screening Guidelines:

  • The American Cancer Society now recommends that individuals at average risk start regular screening at age 45.
  • Those with a family history or other risk factors may need to start screening even earlier, for example, if a close family member was diagnosed younger than age 55 then colonoscopy is offered 10 years prior to their age of diagnosis.

Understanding the Options:

  • A variety of screening tests are available, including colonoscopy, FIT, and gFOBT.
  • Non-invasive tests like stool DNA tests can be initial options for those at average risk but it lacks the advantage of removing early polyps before they become troublesome that colonoscopy affords.

Challenges and Considerations:

  • Access to screening can be a barrier for some younger individuals.
  • Awareness campaigns are needed to educate on the importance of early screening.

Advocacy for Change:

  • Organizations and advocates are pushing for policy changes to improve screening rates among younger populations.
  • Increased funding for research on young-onset colorectal cancer is also being sought.

Screening not only has the potential to detect cancer early but also serves as a preventive measure against the development of cancer.

Collaborative Efforts in Combatting Early-Onset Colorectal Cancer

The fight against young-onset colorectal cancer is a collaborative endeavor, with significant contributions from national organizations and local institutions alike. The American Cancer Society (ACS) leads with preventive screening guidelines and patient support resources, advocating for individuals to begin colorectal cancer screenings at age 45. Their efforts are complemented by the National Cancer Institute (NCI), which provides a wealth of research, educational materials, and access to clinical trials. The NCI's guidelines and resources offer invaluable support to healthcare providers, enhancing the quality of care and informing public health policies.

A local beacon in this effort is the University of Cincinnati Cancer Center, which plays a pivotal role in advancing care and research for colorectal cancer. Our specialized programs and services focus on the unique needs of young patients, including genetic counseling, advanced diagnostic technologies, and access to the latest treatment options. Our center's multidisciplinary approach brings together experts from various fields to offer comprehensive care and to support patients through every step of their journey, from diagnosis to treatment and beyond.

These organizations' collective mission is not only to treat cancer but also to empower patients and providers with the knowledge and tools to prevent it. Through education, advocacy, and research, they aim to understand the rising rates of early-onset colorectal cancer and to develop targeted strategies to reduce its impact. The involvement of local centers like the University of Cincinnati Cancer Center ensures that patients have access to high-quality care and the support they need closer to home.

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