Epidemiological and Clinical Aspects of Early-Onset Colorectal Cancer: A Comparative Study of 180 Cases

##plugins.themes.academic_pro.article.sidebar##

Published Aug 1, 2025
https://doi.org/10.62438/tunismed.v103i8.5904
Download
pdf
Vol. 103 No. 8 (2025): Tunis Med Aug 2025

##plugins.themes.academic_pro.article.main##

Hajer Hassine
Department of Gastroenterology "B", La Rabta University Hospital, Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Nesrine Krifa
Department of Gastroenterology "B", La Rabta University Hospital, Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Amin Sebei
Department of Surgery "A", La Rabta University Hospital, Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Hela Kchir
Department of Gastroenterology "B", La Rabta University Hospital, Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Souhaib Atri
Department of Surgery "A", La Rabta University Hospital, Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Chaima Jemai
Institute of Nutrition, Department "C", Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Rania Hajji
Department of Gastroenterology "B", La Rabta University Hospital, Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Tayssir Ben Achour
Internal Medicine Department, La Rabta University Hospital, Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Dhouha Cherif
Department of Gastroenterology "B", La Rabta University Hospital, Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Haythem Yacoub
Department of Gastroenterology "B", La Rabta University Hospital, Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Habiba Debbebi
Department of Gastroenterology "B", La Rabta University Hospital, Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Nadia Maamouri
Department of Gastroenterology "B", La Rabta University Hospital, Tunis, Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.

Abstract

Introduction: The incidence of early-onset colorectal cancer (EO-CRC), defined as occurring before 50 years, is rising significantly. While genetic syndromes account for a minority of cases, the majority are sporadic and influenced by both genetic and environmental factors. This study aimed to identify the epidemiological and clinical characteristics of EO-CRC.
Methods: We conducted a single-center, retrospective, comparative study over seven years, including all patients diagnosed with colorectal cancer (CRC). Patients were classified into two groups: <50 years (G1) and ≥50 years (G2). Clinical data, tumor characteristics, and treatment strategies were compared.
Results: Among 180 patients, 26.1% were under 50 years (G1). No significant differences were observed in sex ratio, smoking, alcohol consumption, obesity, or family history of cancer. Both groups presented with bowel transit disorders and general health deterioration, but diarrhea (p = 0.015) and rectal bleeding (p = 0.026) were more frequent in G1. Rectal localization was significantly more common in G1 (p < 0.001). Histologically, EO-CRC was more often poorly differentiated, exhibited greater lymph node involvement, and was diagnosed at more advanced stages, though differences were not statistically significant. A curative approach was more frequently proposed in younger patients, without significant difference.
Conclusion: EO-CRC represented over one-quarter of CRC cases in our cohort. It was predominantly rectal and frequently diagnosed at an advanced stage. These findings highlight the need for increased awareness, early diagnosis, and tailored management strategies for younger patients.

Keywords:

Colorectal cancer , Early onset , Risk factors , Epidemiology

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30.
  2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global
  3. Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49.
  4. Howlader N, Noone AM, Krapcho M, Miller D, Brest A, et al. SEER Cancer Statistics Review, 1975-2017, National Cancer Institute.
  5. Akimoto N, Ugai T, Zhong R, Hamada T, Fujiyoshi K, Giannakis M, et al. Rising incidence of early-onset colorectal cancer - a call to action. Nat Rev Clin Oncol. 2021;18(4):230–43.
  6. Boardman LA, Vilar E, You YN, Samadder J. AGA Clinical Practice Update on Young Adult-Onset Colorectal Cancer Diagnosis and Management: Expert Review. Clin Gastroenterol Hepatol. 2020;18(11):2415–24.
  7. Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019;14(2):89–103.
  8. Venugopal A, Stoffel EM. Colorectal Cancer in Young Adults. Curr Treat Options Gastro. 2019;17(1):89–98.
  9. Duggan MA, Anderson WF, Altekruse S, Penberthy L, Sherman ME. The Surveillance, Epidemiology, and End Results (SEER) Program and Pathology: Toward Strengthening the Critical Relationship. Am J Surg Pathol. 2016;40(12):e94–102.
  10. Vuik FE, Nieuwenburg SA, Bardou M, Lansdorp-Vogelaar I, Dinis-Ribeiro M, Bento MJ, et al. Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut. 2019;68(10):1820–6.
  11. Siegel RL, Torre LA, Soerjomataram I, Hayes RB, Bray F, Weber TK, et al. Global patterns and trends in colorectal cancer incidence in young adults. Gut. 2019;68(12):2179– 85.
  12. Lui RN, Tsoi KKF, Ho JMW, Lo CM, Chan FCH, Kyaw MH, et al. Global Increasing Incidence of Young-Onset Colorectal Cancer Across 5 Continents: A Joinpoint Regression Analysis of 1,922,167 Cases. Cancer Epidemiol Biomarkers Prev. 2019;28(8):1275–82.
  13. Stoffel EM, Murphy CC. Epidemiology and Mechanisms of the Increasing Incidence of Colon and Rectal Cancers in Young Adults. Gastroenterology. 2020;158(2):341–53.
  14. Keum N, Giovannucci E. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol. 2019;16(12):713–32.
  15. Cho YA, Lee J, Oh JH, Chang HJ, Sohn DK, Shin A, et al. Genetic risk score, combined lifestyle factors and risk of colorectal cancer. Cancer Research and Treatment. 2019;51(3):1033–40.
  16. Ye X, Chen Y, Gu J. Risk factors for advanced colorectal neoplasm in young adults: a meta-analysis. Future Oncol. 2023;19(18):1293–302.
  17. Baidoun F, Elshiwy K, Elkeraie Y, Merjaneh Z, Khoudari G, Sarmini MT, et al. Colorectal Cancer Epidemiology: Recent Trends and Impact on Outcomes. Curr Drug Targets. 2021;22(9):998–1009.
  18. Freedman AN, Slattery ML, Ballard-Barbash R, Willis G, Cann BJ, Pee D, et al. Colorectal cancer risk prediction tool for white men and women without known susceptibility. J Clin Oncol. 2009;27(5):686–93.
  19. Muñiz Pedrogo DA, Sears CL, Melia JMP. Colorectal Cancer in Inflammatory Bowel Disease: A Review of the Role of Gut Microbiota and Bacterial Biofilms in Disease Pathogenesis. J Crohns Colitis. 2024;18(10):1713–25.
  20. Gausman V, Dornblaser D, Anand S, Hayes RB, O’Connell K, Du M, et al. Risk Factors Associated With Early-Onset Colorectal Cancer. Clin Gastroenterol Hepatol. 2020;18(12):2752-2759.e2.
  21. Valle L, de Voer RM, Goldberg Y, Sjursen W, Försti A, Ruiz-Ponte C, et al. Update on genetic predisposition to colorectal cancer and polyposis. Mol Aspects Med. 2019;69:10–26.
  22. Friedenreich CM, Ryder‐Burbidge C, McNeil J. Physical activity, obesity and sedentary behavior in cancer etiology: epidemiologic evidence and biologic mechanisms. Mol Oncol. 2021;15(3):790–800.
  23. Ye P, Xi Y, Huang Z, Xu P. Linking Obesity with Colorectal Cancer: Epidemiology and Mechanistic Insights. Cancers (Basel). 2020;12(6):1408.
  24. Socol CT, Chira A, Martinez-Sanchez MA, Nuñez-Sanchez MA, Maerescu CM, Mierlita D, et al. Leptin Signaling in Obesity and Colorectal Cancer. Int J Mol Sci. 2022;23(9):4713.
  25. Soltani G, Poursheikhani A, Yassi M, Hayatbakhsh A, Kerachian M, Kerachian MA. Obesity, diabetes and the risk of colorectal adenoma and cancer. BMC Endocr Disord. 2019;19(1):113.
  26. Yuhara H, Steinmaus C, Cohen SE, Corley DA, Tei Y, Buffler PA. Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol. 2011;106(11):1911–21.
  27. Goto A, Yamaji T, Sawada N, Momozawa Y, Kamatani Y, Kubo M, et al. Diabetes and cancer risk: A Mendelian randomization study. Int J Cancer. 2020;146(3):712–9.
  28. Botteri E, Borroni E, Sloan EK, Bagnardi V, Bosetti C, Peveri G, et al. Smoking and
  29. Colorectal Cancer Risk, Overall and by Molecular Subtypes: A Meta-Analysis. Am J Gastroenterol. 2020;115(12):1940–9.
  30. Zhou X, Wang L, Xiao J, Sun J, Yu L, Zhang H, et al. Alcohol consumption, DNA methylation and colorectal cancer risk: Results from pooled cohort studies and Mendelian randomization analysis. Int J Cancer. 2022;151(1):83–94.
  31. Norat T, Bingham S, Ferrari P, Slimani N, Jenab M, Mazuir M, et al. Meat, fish, and
  32. colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J Natl Cancer Inst. 2005;97(12):906–16.
  33. Zhao Z, Feng Q, Yin Z, Shuang J, Bai B, Yu P, et al. Red and processed meat consumption and colorectal cancer risk: a systematic review and meta-analysis. Oncotarget. 2017;8(47):83306–14.
  34. Connell LC, Mota JM, Braghiroli MI, Hoff PM. The Rising Incidence of Younger Patients With Colorectal Cancer: Questions About Screening, Biology, and Treatment. Curr Treat Options in Oncol. 2017;18(4):23.
  35. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019;394(10207):1467–80.
  36. Onis M, Habicht JP. Anthropometric reference data for international use:
  37. recommendations from a World Health Organization Expert Committee. Am J Clin Nutr. 1996;64(4):650–8.
  38. Doubeni CA, Corley DA, Quinn VP, Jensen CD, Zauber AG, Goodman M, et al.
  39. Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study. Gut. 2018;67(2):291–8.
  40. O’Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY. Rates of colon and rectal cancers are increasing in young adults. Am Surg. 2003;69(10):866–72.
  41. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683–91.
  42. Spaander MCW, Zauber AG, Syngal S, Blaser MJ, Sung JJ, You YN, et al. Young-onset colorectal cancer. Nat Rev Dis Primers. 2023;9(1):21.
  43. Brenner DR, Ruan Y, Shaw E, De P, Heitman SJ, Hilsden RJ. Increasing colorectal cancer incidence trends among younger adults in Canada. Prev Med. 2017;105:345–9.
  44. Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, et al.
  45. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians. 2018;68(4):250–81.
  46. Lin JH, Zhang SM, Rexrode KM, Manson JE, Chan AT, Wu K, et al. Association between sex hormones and colorectal cancer risk in men and women. Clin Gastroenterol Hepatol. 2013;11(4):419-424.e1.
  47. O’Sullivan DE, Sutherland RL, Town S, Chow K, Fan J, Forbes N, et al. Risk Factors for Early-Onset Colorectal Cancer: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2022;20(6):1229-1240.e5.
  48. Aarnio M. Clinicopathological Features and Management of Cancers in Lynch Syndrome. Pathology Research International. 2012;2012(1):350309.
  49. Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl J Med. 2003;348(10):919–32.
  50. Aelvoet AS, Buttitta F, Ricciardiello L, Dekker E. Management of familial adenomatous polyposis and MUTYH-associated polyposis; new insights. Best Pract Res Clin Gastroenterol. 2022;58–59:101793.
  51. Romaguera D, Fernández-Barrés S, Gracia-Lavedán E, Vendrell E, Azpiri M, Ruiz-Moreno E, et al. Consumption of ultra-processed foods and drinks and colorectal, breast, and prostate cancer. Clin Nutr. 2021;40(4):1537–45.
  52. Guesmi F, Zoghlami A, Sghaiier D, Nouira R, Dziri C. Les facteurs alimentaires prédisposant au risque de cancers colorectaux : Etude épidémiologique prospective. Tunis Med. 2010;88(03):184-189.
  53. Li H, Boakye D, Chen X, Hoffmeister M, Brenner H. Association of Body Mass Index With Risk of Early-Onset Colorectal Cancer: Systematic Review and Meta-Analysis. Am J Gastroenterol. 2021;116(11):2173–83.
  54. Ali Khan U, Fallah M, Tian Y, Sundquist K, Sundquist J, Brenner H, et al. Personal History of Diabetes as Important as Family History of Colorectal Cancer for Risk of Colorectal Cancer: A Nationwide Cohort Study. Am J Gastroenterol. 2020;115(7):1103–9.
  55. Seretis A, Cividini S, Markozannes G, Tseretopoulou X, Lopez DS, Ntzani EE, et al. Association between blood pressure and risk of cancer development: a systematic review and meta-analysis of observational studies. Sci Rep. 2019;9(1):8565.
  56. Elangovan A, Skeans J, Landsman M, Ali SMJ, Elangovan AG, Kaelber DC, et al.
  57. Colorectal Cancer, Age, and Obesity-Related Comorbidities: A Large Database Study. Dig Dis Sci. 2021 ;66(9):3156–63.
  58. Syed AR, Thakkar P, Horne ZD, Abdul-Baki H, Kochhar G, Farah K, et al. Old vs new: Risk factors predicting early onset colorectal cancer. World J Gastrointest Oncol. 2019;11(11):1011–20.
  59. Silva FMMD, Duarte RP, Leão CCA, Vissoci CM, Alvarenga ALAT, Ramos ABS, et al. Colorectal cancer in patients under age 50: a five-year experience. Rev Col Bras Cir. 2020;47:e20202406.
  60. Bailey CE, Hu CY, You YN, Bednarski BK, Rodriguez-Bigas MA, Skibber JM, et al. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA Surg. 2015;150(1):17–22.
  61. Rajagopalan A, Antoniou E, Morkos M, Rajagopalan E, Arachchi A, Chouhan H, et al. Is colorectal cancer associated with altered bowel habits in young patients? ANZ J Surg. ;91(5):943-946.
  62. Silva FMMD, Duarte RP, Leão CCA, Vissoci CM, Alvarenga ALAT, Ramos ABS, et al. Colorectal cancer in patients under age 50: a five-year experience. Rev Col Bras Cir. 2020;47:e20202406.
  63. Güzel HG, Koçer M, Yıldız M, Öztürk B, Salim DK, Karaca M. Rectal cancer in young adults: A single-center experience. J Adolesc Young Adult Oncol. 2024. Online ahead of print.
  64. Farge D, Frere C, Connors JM, Ay C, Khorana AA, Munoz A, et al. 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. The Lancet Oncology. 2019;20(10):e566–81.
  65. Chen F, Sun Y, Zhang C, Li L, Du Y, Zhou M, et al. Risk Factors of Venous Thromboembolism in Inpatients With Colorectal Cancer in China. Clin Appl Thromb Hemost. 2023;29:10760296231221133.
  66. Moore PA, Dilawari RA, Fidler WJ. Adenocarcinoma of the colon and rectum in patients less than 40 years of age. Am Surg. 1984;50(1):10–4.
  67. Schellerer VS, Merkel S, Schumann SC, Schlabrakowski A, Förtsch T, Schildberg C, et al. Despite aggressive histopathology survival is not impaired in young patients with colorectal cancer : CRC in patients under 50 years of age. Int J Colorectal Dis. 2012;27(1):71–9.
  68. Oktay K, Harvey BE, Partridge AH, Quinn GP, Reinecke J, Taylor HS, et al. Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2018 ;36(19):1994–2001.
  69. Lambertini M, Peccatori FA, Demeestere I, Amant F, Wyns C, Stukenborg JB, et al. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines†. Annals of Oncology. 2020 ;31(12):1664–78.