LITERATURE UPDATE
colorectal cancer analyses. To the extent that the appendix artefact occurs in adults aged 40-49 years, recommendations for starting colorectal cancer screening earlier may be affected.
Early-onset Colon Cancer Shows a Distinct Intestinal Microbiome and a Host-Microbe Interaction Adnan D, Trinh JQ, Sharma D, Alsayid M, Bishehsari F. Cancer Prev Res (Phila). 2024 Jan 4;17(1):29–38. doi: 10.1158/
1940-6207.CAPR-23-0091.
The incidence rate of colorectal cancer in younger adults has been rising in developed countries. This trend may be atributed to environmental exposures as a result of lifestyle changes. Many of the lifestyle factors that promote colorectal cancer can also affect the gut microbiome, which may be associated with colorectal cancer risks. The role of the microbiome in the ongoing rise of early-onset colorectal cancer is unknown. Here, the authors aimed to
investigate age-related differences in the gut microbiome of patients with colorectal cancer and healthy individuals by examining both the faecal and tumour microbiomes. They utilised the publicly accessible data on faecal shotgun metagenomics from CuratedMetagenomeData and TCGA via the GDC Data Portal. Comparison of 701 colorectal cancers and 693 controls revealed that microbial features were age dependent, with a significant difference in species enrichment between early-onset (<50 years) and late-onset (>65 years) patients with colorectal cancer. Analysis of the tumour-associated microbiome in a separate dataset of 85 patients with colorectal cancer verified age-specific differences in taxon abundance between early- and late-onset patients with colorectal cancer. Finally, using host gene expression
data, the authors found a stronger microbe-host interaction in early versus late-onset colorectal cancers. Altogether, these findings indicate that microbial features were age-dependent with stronger microbial-host interactions at the tumour site in early-onset colorectal cancers, suggesting a direct role of microbes in tumourigenesis via interaction with cancer-related pathways in this age group. Early-onset colorectal cancer is on the
rise, presumably because of changes in environmental exposures. Lifestyle changes may contribute to colorectal cancer via alterations in gut microbes. Here, the authors show that microbial association with colorectal cancer is age-dependent, and microbe interactions with tumour
pathways are stronger in young versus older colorectal cancers.
Lymphatic spread paterns in young versus elderly patients with stage III colon cancer Song J, Kataoka K, Inoue M et al. BJS Open. 2024 May 8;8(3):zrae036. doi: 10.1093/bjsopen/zrae036.
The anatomical patern of lymph node spread differs between young (aged 45 years or younger) and elderly (aged 80 years or older) patients with stage III colon cancer and is poorly investigated. Two groups of patients (young and elderly) with stage III colon cancer who underwent upfront extensive (D3) lymphadenectomy at eight Japanese centres between 1998 and 2018 were retrospectively analysed. The primary endpoint was the proportion of positive central lymph nodes. The lymph nodes spreading patern and its prognostic impact on recurrence-free survival and overall survival in the two groups were also compared. Two hundred and ten young patients
and 348 elderly patients were identified and compared. The total number of lymph nodes harvested and the total number of invaded lymph nodes were significantly higher in younger patients compared with elderly patients (median 31.5 [3–151] versus 21 [3–116], P<0.001, and median 3 [1–21] versus 2 [1–25], P<0.001, respectively). The proportion of positive central lymph nodes were higher in younger patients than in elderly patients (9.52% [95% CI 6.24–14.2%] versus 4.59% [95% CI 2.84–7.31%], P=0.012). In multivariate models for recurrence-free survival, central lymph node invasion was identified as a poor prognostic factor in younger patients (HR 5.21 [95% CI 1.76– 15.39]) but not in elderly patients (HR 1.73 [95% CI 0.80–3.76]). Young patients with stage III colon
cancer have a higher risk of central lymph node invasion, suggesting a more aggressive disease biology. The presence of central lymph node invasion is associated with a worse outcome in young patients.
Understanding TikTok’s Role in Young- Onset Colorectal Cancer Awareness and Education Ayer D, Jain A, Singh M, Tawfik A, Tadros M. J Cancer Educ. 2025 Dec;40(6):859–64. doi: 10.1007/s13187-025-02585-3.
The incidence of colorectal cancer (CRC) in younger adults has risen by about 1–2% annually in the past decade. TikTok has become a popular venue for the discussion of health information among young adults.
This study analysed the top 85 most- 52
WWW.PATHOLOGYINPRACTICE.COM February 2026
liked TikToks under the search terms “early colon cancer” and “young adult colon cancer”, to evaluate their educational value. Data on the post uploader, content, analytics, and mentioned tips/symptoms were collected. Two independent researchers rated the
quality of each video using a global quality score (GQS). The videos analysed had a total of over 37 million views. Among them, 16.47% highlighted how misinformation contributed to delayed diagnoses, yet only 2.35% specifically educated viewers about such misinformation. Provider-posted content had higher GQS ratings than non-provider content (P<0.05), indicating beter quality, although total views were higher for non-provider content. The GQS did not differ significantly between highly viewed (>100,000 views) and lower-viewed (≤100,000 views) videos. These results highlight that TikTok is a
key platform for engaging young adults about rising CRC rates, though increased expert engagement is needed to address current gaps in combating misinformation and promoting high-quality educational content.
Increasing Annual Cancer Incidence in Patients Age 20-49 Years: A Real-Data Study
Ribelles N, Pascual J, Galvez-Carvajal L et al. JCO Glob Oncol. 2024 Mar;10:e2300363. doi: 10.1200/GO.23.00363.
Data from population-based studies have shown an increased incidence of certain types of neoplasms in patients younger than 50 years (early-onset cancer [EOC]); however, litle information is derived from other real-world data sources. In a non- population registry, the authors analysed changes in the incidence of several neoplasms in successive generations. This cross-sectional study included all patients with a cancer diagnosis registered in one university hospital in Málaga, Spain, between 1998 and 2021, and 18 neoplasms were analysed. For each neoplasm, the proportion of patients younger than 50 years and age 50 years and older (late- onset cancer [LOC]) of the total number of patients diagnosed each year was determined. In addition, the age limit was lowered to 45–40 years. Changes in these proportions between each year and the following year were assessed by calculating the annual percentage change (APC), and a final assessment of these changes was performed by determining the average APC (AAPC).
Of the 24,596 patients, 5,466 (22.2%)
had EOC, and 19,130 (77.8%) had LOC. The incidence of all tumours increased throughout the study period in both age groups. The AAPC increase was higher in
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