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Jump to Key Points SAN DIEGO — Colorectal cancer (CRC) is becoming more common in young people. A new multicenter study finds those aged up to 21 years are often diagnosed with advanced disease at 3 or more months after the development of symptoms. In addition, the mortality rate is high.
Among 84 patients diagnosed from 2012 to 2023, the median duration of symptoms before diagnosis was 12 weeks, reported Erica Arnold, MD, a pediatric surgical oncology research fellow at Nationwide Children’s Hospital, Columbus, Ohio, and colleagues at the American Academy of Pediatrics (AAP) 2026 National Conference.
Almost all patients presented with stage III (51%) or stage IV (29%) disease, and 5-year overall survival was 47%.
“Our findings add additional data that support that CRC diagnosed in adolescents and young adults through age 21 is a distinct disease from colorectal cancer diagnosed in older adults,” Arnold said in an interview.
- CRC in age ≤21 often diagnosed late: median symptoms-to-dx 12 weeks.
- 80% presented stage III/IV; 5-year OS only 47%.
- Common presenting symptoms: abdominal/back pain, bowel habit change, weight loss, rectal bleeding.
- Relapse 36.9% at median 11 months; CRC death 45.2% during study.
- Family history present in 20.2%; symptoms should prompt expedited work-up.
The results also highlight the importance of recognizing that bowel symptoms could be a sign of the disease in young people, she said.
What We Know About CRC Rates in the Young
From 1999 to 2020, CRC cases increased 333% in 15- to 19-year-olds and 185% among 20- to 24-year-olds, reported a study presented at Digestive Disease Week in 2024. But the overall numbers remained small, accounting for 1 in 77,000 teens in 2020.
However, in an interview, gastrointestinal oncologist Kimmie Ng, MD, MPH, of Harvard Medical School and Dana-Farber Cancer Institute, Boston, said it’s not definitive that cases are on the rise in this population, “partly due to the rarity of the disease in this age group, as well as the potentially different coding methodologies that are used across studies.”
Still, “as treating oncologists, we definitely feel that we’re seeing more and more young adults and adolescents than we used to,” said gastrointestinal oncologist Andrea Cercek, MD, of Memorial Sloan Kettering Cancer Center, New York City, in an interview. Neither Ng nor Cercek took part in the new study.
It’s Not Clear Why Cases May Be Rising
If cases are rising in the younger population, it’s likely that factors such as diet and lifestyle are responsible, Ng said.
“The critical window of susceptibility to these exposures is thought to be in early life,” Ng said. According to her, obesity, sedentary behavior, and consumption of sugar-sweetened beverages and ultraprocessed foods have all been linked to young-onset CRC. And her own research has, surprisingly, linked CRC to breastfeeding.
“However, we all take care of young patients who have none of these risk factors,” she said. “Therefore, research efforts are also looking at other novel environmental exposures, including pesticides and microplastics.”
Methodology and Findings
For the study, researchers tracked 84 patients at 34 institutions in the Pediatric Surgical Oncology Research Collaborative, which includes 60 institutions in North America. Patients were excluded if they had a known CRC predisposition syndrome.
The median age of diagnosis was 16.5 years, and two patients were below the age of 10; 56.0% were male; 64.3% were White, 14.3% Hispanic/Latino/Latina, 9.5% Black, 6.0% Asian, and 1.2% multiracial, and the rest unknown.
The most common symptoms were back/abdominal pain (73.8%), change in bowel habits (45.2%), weight loss (42.9%), and rectal bleeding (38.1%). Treatments included upfront resection (73.8%), neoadjuvant chemotherapy (17.9%), attempted resection with only ostomy creation due to unresectable disease (4.8%), and definitive chemoradiation (3.6%).
Among the patients, 20.2% had a first- or second-degree relative with CRC. More than a third (36.9%) relapsed at a median of 11 months, and 45.2% died due to CRC during the time of the study. The 5-year event-free survival rate was 42%.
Lessons from the Findings
The study highlights that “in adolescents and young adults presenting with back/abdominal pain, change in bowel habits, weight loss, and rectal bleeding, practitioners should include colorectal cancer as a potential underlying cause,” Arnold said. “In order to avoid delays in diagnosis and potential worsening of disease, these symptoms should prompt an expedited work-up to determine the cause.”
Ng noted that “it is striking that studies consistently report more advanced stages of diagnosis, more aggressive histologies, and shorter survival among pediatric patients with colorectal cancer.”
Moving forward, she said, “this highlights the need for deep molecular and genomic profiling studies to better understand the biological distinctions between the youngest patients and older patients with the hope of advancing strategies for prevention, early detection, and treatment.”
The study received no funding, and the authors had no disclosures.
Cercek reported relationships with multiple pharmaceutical and other companies including AbbVie, Amgen, GSK, Janssen, Merck, and Pfizer. Ng had no disclosures.
