Rates of advanced-stage colorectal cancer are climbing in young patients, marking a need for increased vigilance, according to data presented during the American Academy of Pediatrics 2026 National Conference & Exhibition (Abstract 02-204).
Investigators retrospectively examined the medical files of 84 patients aged 21 years or younger who were diagnosed with colorectal cancer between 2012 and 2023. Patients with a known colorectal cancer predisposition syndrome (including genetic syndromes as well as inflammatory bowel disease) before colorectal cancer diagnosis were excluded.
Data showed that while only 20% of those diagnosed had first- or second-degree family history of colorectal cancer, almost all patients (96.8%) had aggressive forms of the disease—either stage III or IV. The median age at diagnosis was 16.5 years (interquartile range [IQR] = 14.0–19.0 years), and 56.0% (n = 47) were male.
The authors stated that the research further emphasizes concerns about the growing rates of colorectal cancer in young people along with the advanced stage of disease at presentation. Signs and symptoms such as lower back and abdominal pain, changes in bowel habits, weight loss, and rectal bleeding are often overlooked due to low rates of this type of cancer in young people.
The most common presenting symptoms included back/abdominal pain (73.8%, n = 62), change in bowel habits (45.2%, n = 38), weight loss (42.9%, n = 36), and rectal bleeding (38.1%, n = 32). The median duration of symptoms prior to diagnosis was 12 weeks ([IQR] = 2.0–24.0 weeks), and median time to colonoscopy was 13 weeks (IQR = 6.0–32.0 months).
“Colorectal cancer is, unfortunately, becoming more common in adolescents and young adults, and represents a different disease than colorectal cancer diagnosed in older adults,” said study author and pediatric surgery research fellow Erica Arnold, MD. “When diagnosed, it is often aggressive, presenting with late-stage disease and associated with high rates of disease relapse and mortality.”
Researchers found that these delays in diagnosis, on top of the aggressive tumor behavior, ultimately can lead to poor long-term outcomes. Thirty-one patients (36.9%) experienced relapse at a median of 11 months (IQR = 10.0–21.0 months). Patients who experienced relapse were more likely to have positive lymph nodes (90.3% vs 50.9%, P = .0004), poorly differentiated histology (64.5% vs 28.3%, P = .0047), and signet ring features (61.3% vs 17.0%, P = .0002) than those who did not experience relapse. At the end of the study period, 38 (45.2%) patients died.
The authors emphasized serious consideration of symptoms like unexplained weight loss or rectal bleeding when present in younger patients. As early-onset adult cancers are seen in younger and younger patients, the logistical considerations of adult and pediatric care teams and carefully tailored treatment regimens are paramount.
DISCLOSURE: For full disclosures of the study authors, visit aapexperience26.eventscribe.net.
