Rising Early-Onset Colorectal Cancer Cases Linked to Poorer Outcomes

NEW research has highlighted a concerning rise in early-onset colorectal cancer (EOCRC) cases, accompanied by more aggressive disease and inferior survival.

Using data from Taiwan’s national cancer registry and patients diagnosed with colorectal cancer (CRC) at Chang Gung Memorial Hospital between 2008-2019, the study compared clinicopathological characteristics, pre-diagnostic symptoms, and survival outcomes between EOCRC, defined as those diagnosed before age 50 years, and late-onset CRC (LOCRC) groups, those diagnosed after age 50.

The authors found a steady annual increase in EOCRC across all age groups, with colon cancer and rectal cancer cases rising by 3.2% and 3.3%, respectively. This increasing trend was more significant among male rectal cancer than male colon cancer, followed by female colon cancer, and female rectal cancer. When stratified by age, patients aged 40–49 years showed the highest increase in EOCRC incidence.

The study also revealed that patients with EOCRC tend to present with more aggressive disease characteristics compared to those with LOCRC, with more complex histological subtypes such as signet-ring cell adenocarcinoma, mucinous adenocarcinoma, and poorly differentiated grade. Patients in the EOCRC group also reported rectal bleeding, changes in bowel habits, and abdominal pain more frequently than those with LOCRC, suggesting distinct pre-diagnostic symptoms. The study also found a strong correlation between stool-related symptoms and left-sided CRC.

Furthermore, EOCRC was more frequently diagnosed at advanced stages (III and IV) compared with LOCRC (62.4% versus 50.3%). While surgical outcomes were similar for both groups, the 5-year cancer-specific survival rate for patients with Stage IV EOCRC was significantly lower than that of LOCRC patients (32.8% versus 51.9%, P=0.012).

In response to the alarming rise in EOCRC and its aggressive clinical course, the authors called for increased awareness, timely screening, and early detection strategies targeting younger populations.

Ada Enesco, EMJ

Reference

Liao CK et al. Differences in characteristics and outcomes between early-onset colorectal cancer and late-onset colorectal cancers. Eur J Surg Oncol. 2024; DOI:10.1016/j.ejso.2024.108687.