LITERATURE UPDATE


Early-onset colorectal cancer: an increasing healthcare issue


Historically, colorectal cancer was seen as a disease of later life. More recently, however, the increased incidence of cancer affecting the lower intestinal tract in the younger age group has been reported. Here, Pathology in Practice Science Editor Brian Nation looks at a selection of current research focusing on this emerging healthcare challenge.


The Young: Early-Onset Colon Cancer Cohen D, Rogers C, Gabre J, Dionigi B. Clin Colon Rectal Surg. 2024 Jul 2;38(3):173–8. doi: 10.1055/s-0044-1787883. eCollection 2025 May.


Early-onset colorectal cancer (EO-CRC), characterised by diagnosis before the age of 50 years, has emerged as a significant healthcare challenge with increasing global incidence. While traditional risk factors such as family history and inherited syndromes contribute to EO- CRC, a substantial proportion of cases remain sporadic, necessitating further investigation into additional aetiological factors. Molecular studies reveal heterogeneity


in EO-CRC, with distinct mutational profiles compared to late-onset CRC. Clinical management presents unique considerations, including challenges in


early detection and treatment strategies tailored to younger patients. Addressing EO-CRC requires a


multidisciplinary approach integrating epidemiological, molecular, and clinical insights to improve prevention, diagnosis, and therapeutic outcomes. Emerging research avenues explore novel biomarkers and therapeutic targets, offering promise for advancing understanding and management of this disease in contemporary oncology practice.


Colon, colorectal, and all cancer incidence increase in the young due to appendix reclassification Bleyer A, Ries LAG, Cameron DB, Mansfield SA, Siegel SE, Barr RD. J Natl Cancer Inst. 2025 Jul 1;117(7):1340–9. doi: 10.1093/jnci/djaf038.


Increases in colon and colorectal cancer


incidence among adolescents and young adults have been reported progressively. Most of the increase may be because of an artefact caused by reclassifying appendiceal carcinoids and neuroendocrine tumour (NET) as malignant. Age-adjusted incidence and survival


data were obtained from the Surveillance, Epidemiology, and End Results SEER22 database. In adolescents and young adults


during 2000–2020, appendix cancer had an average annual percent change in incidence increase that in males was 3.7 times greater than the next most increasing cancer (average annual percent change 12.8, 95% confidence interval [CI] 10.9–14.6% vs. average annual percent change 3.4 [kidney], 95% CI 2.7–3.5%) and correspondingly in females 2.9-fold greater (average annual percent change 14.6, 95% CI = 11.9–17.3% vs. average annual percent change 4.2 [pancreas], 95% CI 3.6–4.8%). From 2000–2009 to 2015–2020, appendix cancer incidence increased 17-, 6.5-, and 2.5-fold in children aged 0–14 years, adolescents and young adults aged 15–39 years, and adults aged 40–49 years, respectively. NET accounted for 95%, 90% and 80% of appendix cancer increase in the three age groups, respectively. In 3446 adolescents and young adults diagnosed during 2010–2020 with malignant appendix NET, the six-year cancer-specific survival was 99.4% (95% CI 99.0–99.6%). From 2000–2009 to 2015–2020, colon carcinoma incidence in adolescents and young adults increased 61% with the appendix included and only 11% with the appendix excluded. Reclassification of appendix NET/


Colorectal cancer, one of the most common cancers worldwide (haematoxylin and eosin [H&E] stain).


carcinoids as malignant has artefactually increased the incidence of colon, colorectum, and all cancer in children and adolescents and young adults. Appendix NET/carcinoids are rarely fatal in those younger than 40 years and should not be considered as cancer and included in


February 2026 WWW.PATHOLOGYINPRACTICE.COM 51


Shigeki Tomita, Kazuhito Ichikawa and Takahiro Fujimori CC BY 3.0 Wikimedia Commons


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