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What Is Early-Onset Colorectal Cancer?

Colorectal cancer is the uncontrollable growth of cells in the colon (the bowel or large intestine) or rectum (the final section of the large intestine connecting to the anus).

Early-onset colorectal cancer refers to colon and rectal cancers that develop in people before age 50.

While colorectal cancer mostly occurs among people age 50 and older, the number of younger people getting the illness has dramatically climbed over the past few decades.

Researchers now estimate that 10 percent of all new colorectal cancer diagnoses are in people younger than 50.

As more people in their prime get this illness, scientists are searching for the reasons why and investigating the best ways to recognize, treat, and prevent this potentially life-threatening, but treatable, disease.

Signs and Symptoms of Early-Onset Colorectal Cancer

Because young people don’t expect to get colorectal cancer, they may ignore symptoms early on when the cancer is most treatable, says John Marshall, MD, the director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University in Washington, DC.

“We all need to be more aware of the symptoms so we take them seriously right away,” says Dr. Marshall, who also serves as chief medical consultant for the Colorectal Cancer Alliance.

Common symptoms of early-onset colorectal cancer include:

Blood in your stool
Abdominal pain
Bowel movement changes
Fatigue and weakness (often caused by an iron deficiency)
Unexplained weight loss
Loss of appetite

Causes and Risk Factors of Early-Onset Colorectal Cancer

Some factors that put a person at risk of colorectal cancer cannot be changed, such as:

Genetic Conditions Inherited physical problems such as Lynch syndrome and familial adenomatous polyposis (which can produce hundreds of polyps in the colon) increase the chances of developing colorectal cancer, especially at a young age.

The Global Colon Cancer Association estimates that 16 to 25 percent of early-onset cases are related to a genetic syndrome, whereas only up to 10 percent of regular colorectal cases are related to genetics.
Racial and Ethnic Background American Indian and Alaska Native people have the highest rates of colorectal cancer in the United States, followed by Black men and women. Jews of Eastern European descent (Ashkenazi Jews) also have a high risk compared to other ethnic groups; about 6 percent carry a specific gene mutation that increases their risk of developing colorectal cancer by two times.
Other Health-Related Issues Certain health-related conditions may contribute to colorectal cancer risk, including a family history of the disease, a personal history of radiation to the abdomen or pelvis area, a personal history of inflammatory bowel disease (Crohn’s or ulcerative colitis), and having had the gallbladder removed (cholecystectomy).
Toxins in the Environment Researchers are studying whether exposure to chemicals may play a role in colorectal cancer. Chemical exposures (from air and water pollution, chemicals in soil and food, and pesticide use) may damage the DNA of intestinal cells leading to cancer-causing mutations.

Modifiable Risk Factors

According to two research studies, one-third to one-half of all early-onset colorectal cancer cases are attributable to modifiable risk factors, including:

Obesity Early-onset colorectal cancer is linked to having obesity, although the exact mechanism is not yet fully understood.

Excess fat has been linked to inflammation, which may raise the likelihood of developing cancer. Obesity is also connected to insulin resistance and diabetes, increased production of the hormone leptin, and gut hormone imbalance — all factors tied to greater cancer risk.

Unhealthy Diet Colorectal cancer has been linked to the consumption of red meats (such as beef, pork, lamb, or liver) and processed meats (like hot dogs and some lunch meats). Research has also found that sugar-sweetened drinks may be a culprit.

Lack of Exercise Research has shown that physical inactivity and sedentary behavior are well-established risk factors for colorectal cancer. Insufficient exercise may contribute to weight gain, insulin resistance, and inflammation.

Smoking A study involving more than 700 adults younger than 55 with colorectal cancer found that former smokers had a 139 percent higher risk of developing colorectal cancer than nonsmokers in the same age group. For current smokers, that risk was 150 percent greater.

Alcohol Use Moderate to heavy alcohol consumption is a known risk factor for colorectal cancer. Alcohol consumption can damage the intestinal lining, allowing bacteria and toxins to enter other tissue in the body. A scientific investigation looking at more than 8,000 colorectal cancer patients between ages 20 and 49 found that the risk increased in relation to how much a person drank. Compared with nondrinkers, those who had one to two drinks weekly had a 7 percent higher risk. For those having three to four drinks per week, the risk was 14 percent higher, while five drinks or more equaled a 27 percent greater risk.

How Is Early-Onset Colorectal Cancer Diagnosed?

In addition to looking for symptoms, a doctor will identify early-onset colorectal cancer through screening and diagnostic tests.

Colorectal Cancer Screenings

For people at average risk of colorectal cancer, the American Cancer Society recommends regular screenings beginning at age 45.

If someone younger than 45 is exhibiting symptoms, however, a colonoscopy may be warranted. In additional to colonoscopies, these are types of screenings done for colorectal cancer:

Fecal Immunochemical Test (FIT) This screening detects blood in feces that may not be visible. This test is done once a year.
Guaiac-Based Fecal Occult Blood Test (gFOBT) Like the FIT, this test looks for blood in feces that may be hidden and should be done annually.
Fecal DNA Test This test looks for signs of genetic mutations and blood in feces. It should be performed every three years.
Shield Blood Test Approved by the FDA in the summer of 2024 for use in people 45 and older, this test looks for the presence of specific changes to DNA floating freely in the blood, which indicate the presence of a tumor or precancerous growths in the colon.
Flexible Sigmoidoscopy This uses a flexible scope to see inside the lower colon and rectum.
Virtual Colonoscopy An X-Ray exam

Colonoscopy

A colonoscopy is the most common method of screening for colorectal cancer, and for people at average risk it should be performed once every 10 years.

It can also be used to diagnose colorectal cancer. This is an examination of the colon, rectum, and anus using an endoscope (a flexible tube with a tiny lighted camera on the end that’s inserted through the rectum).

A colonoscopy can reveal if a person has any suspicious swollen or irritated tissue, internal bleeding, or polyps that may be indicative of cancer. (Early-onset colorectal cancer is more commonly found in the rectum or the left side of the colon.)

Colonoscopies are associated with lower risk of death from colorectal cancer. An analysis of medical records from more than 5,200 adults revealed that a screening for colorectal cancer may reduce the risk of dying by 67 percent.

Other Diagnostic Tests

Diagnostic tests to confirm the presence of cancer include:

Complete blood count
Comprehensive metabolic panel, a routine test to assess 14 substances in the blood, including electrolytes, blood sugar, cholesterol, and liver enzymes
Carcinoembryonic antigen (CEA) assay, a test that measures CEA, a protein found in the blood that may be elevated in people with cancer
Computed tomography (CT) scan
Magnetic resonance imaging (MRI) scan
Positron emission tomography (PET) scan
Ultrasound
Biopsy

Treatment for Early-Onset Colorectal Cancer

Diagnostic tests help clinicians determine what stage of cancer a patient may have. Younger people tend to be diagnosed when the cancer is at an advanced stage.

Depending on stage, a doctor will determine the appropriate treatment, which may include one or more of the following:

Endoscopic Treatment Some polyps may be removed during a colonoscopy.
Surgery Removal of cancerous tissue and possibly reconstructing the bowel
Chemotherapy Drugs that travel through the bloodstream and destroy cancer cells
Immunotherapy Drugs that help the body’s immune system recognize and kill cancer cells
Targeted Therapies Treatment that targets the genetic changes or mutations that turn healthy cells into cancer cells
Radiation Therapy High-energy rays (such as X-rays) that shrink or eliminate tumors

Disparities and Inequities in Early-Onset Colorectal Cancer

American Indian and Alaska Native people have the highest rates of colorectal cancer in the United States, followed by Black men and women.

Some research has shown that patients with early‐onset colorectal cancer are more likely to be Black or Hispanic and to have stage 4 cancer. A study in Cancer Medicine noted that these two groups are more likely to experience socioeconomic barriers and health disparities in cancer care.

Evidence indicates that a significant portion of these populations may not have access to adequate healthcare nor adequate health insurance.

The disparity is reflected in the survival rates. A study published in 2023 looking at more than 33,700 patients with early-onset colorectal cancer found that 57.6 percent of Black patients met the five-year survival mark while 69.1 percent of white patients met it.

Lifestyle Changes and Prevention of Early-Onset Colorectal Cancer

The Centers for Disease Control and Prevention (CDC) recommend that people at average risk of colorectal cancer get a colonoscopy every 10 years starting at age 45.

Screening tests like colonoscopy may identify precancerous polyps, which a doctor can remove to reduce cancer risk.

In addition to screening, young adults can reduce their colorectal cancer risk by adopting healthy lifestyle habits.

Claire Saxton, the executive vice president of insights and impact with the Cancer Support Community, recommends the following lifestyle changes:

Increase physical activity.
Maintain a healthy weight.
Eat a diet low in animal fats and high in fruits, vegetables, and whole grains.
Limit alcohol (two drinks or fewer a day for men, one drink or fewer a day for women).
Avoid tobacco, or get help to quit.
Limit sugar-sweetened drinks.
Limit fast food, processed foods, and foods high in fat, starches, or sugars.

Prognosis of Early-Onset Colorectal Cancer

Colorectal cancer is highly treatable when it hasn’t spread beyond the bowel.

While every case is different, and statistics don’t predict how long you’ll live, some scientists estimate that those with early-stage colorectal cancer generally have a favorable prognosis, with a five-year survival rate of 90 percent. The survival rate is 71 percent for stage 3 colorectal cancer, and 14 percent for advanced disease.

Unfortunately, compared with older adults, people under the age of 50 are up to 75 percent more likely to be diagnosed with late-stage disease, according to a review of 29 research studies.

One large analysis looking at more than 26,000 patients indicated that 29 percent with early-onset had recurrence at five years, versus 21 percent with late-onset.

A large research study found that individuals with early-onset colorectal cancer had a lower 10-year survival rate compared with those diagnosed at ages 51 through 55.

But it’s noted that compared with individual stages, early-onset patients had better survival rates.

Complications of Early-Onset Colorectal Cancer

Possible complications from early-onset colorectal cancer include:

Blockage of the colon: This prevents food, liquid, gas, and stool from passing through the intestines.
Cancer returning in the colon: When cancer comes back, it can be more aggressive.
Metastasis: When the cancer spreads to other organs or tissues.
Development of a second primary colorectal cancer: This is development in a new location in the colon, distinct from any recurrence of the original tumor.
Chronic diarrhea: Some cancer survivors have long-lasting bowel issues.

Treatments for this cancer, such as chemotherapy and radiation, can have a range of side effects, including fatigue, nausea, diarrhea, constipation, and pain. Additionally, peripheral neuropathy (a tingling or numbness in fingers or toes) can affect some patients after having been treated with chemotherapy.