Colorectal cancer is now the leading cause of cancer death among people under 50
American College of Surgeons
Although
routine screening generally begins at age 45 for adults at average risk,
warning signs can appear earlier and should be discussed with a health care
provider at any age.
To help people recognize possible symptoms and speak with
their doctors sooner, the American College of Surgeons (ACS) has
introduced free public education
resources and a checklist designed for use before primary care
appointments.
Colorectal Cancer Is Rising in Younger Adults
"A lot of times when younger patients seek care for
bowel symptoms, those symptoms are too often attributed to hemorrhoids or
constipation and treated conservatively," said Marylise Boutros, MD, FACS,
FRCSC, FASCRS, a member of the ACS Patient Education Committee, and a
colorectal surgeon and vice-chair of Digestive Diseases Research at the
Cleveland Clinic Florida, who helped develop the new ACS educational materials.
"As more young people are diagnosed with colorectal cancer, awareness of
the subtle signs and symptoms of the disease can save lives. The ACS
educational materials and checklist were created to help patients clearly raise
concerns and keep conversations about colorectal cancer focused."
The disease is still diagnosed more frequently in older
adults, and approximately 1 in 25 men and
women will develop colorectal cancer during their lifetime. Even so,
diagnoses among younger people have continued to increase.
According to the American Cancer Society, about 1
in 5 colorectal cancer cases now occurs in people younger than 54. Three
decades ago, that figure was 11%
(about 1 in 10).
Colorectal Cancer Symptoms That Need Attention
The first signs of colorectal cancer can be mild, vague, or
easy to mistake for common digestive problems. However, symptoms that are new,
persistent, or unusual should not be dismissed without medical evaluation.
The ACS checklist calls attention to several possible
warning signs.
Persistent Changes in Bowel Habits
Constipation, diarrhea, unusually narrow stools, or a
lasting change in normal bowel habits may indicate an underlying problem. Some
people may also feel as though the bowel has not emptied completely.
Rectal pressure or discomfort can also occur. These symptoms
may develop when a tumor causes inflammation or partially blocks the bowel.
"In younger patients, these symptoms can sometimes be
due to noncancerous conditions," said Paula Denoya, MD, FACS, FASCRS,
Commission on Cancer (CoC) State Chair of the Eastern Long Island-New York
chapter, and a colorectal surgeon at Stony Brook University Hospital in New
York. "However, any bowel change that is new or different for you deserves
medical attention. An annual wellness visit is a good time to raise these
concerns."
Recurring Blood in the Stool
Blood in the stool is an important colorectal cancer warning
sign, particularly when it appears more than once.
Research presented
at the ACS Clinical Congress 2025 examined patients younger than 50 who
received a colonoscopy because they were experiencing symptoms. Rectal bleeding
was the strongest predictor of a colorectal cancer diagnosis, raising the odds
by 8.5 times.
"Bleeding is the most common symptom of colorectal
cancer but can also be caused by other diseases," said James T. McCormick,
DO, FACS, FASCRS, CoC State Chair of the Southwestern Pennsylvania chapter,
professor of surgery at Drexel College of Medicine, and chair of the Colorectal
Cancer Program at Allegheny Health Network in Pittsburgh, Pennsylvania.
"People may notice bright red blood on the toilet paper or in the bowl, or
it may cause a red or dark color when mixed in with the stool. Any amount of
recurring blood should be evaluated, and colonoscopy may be indicated to
determine the underlying cause."
Changes in Stool Color or Appearance
Changes in the way stool looks may provide additional clues.
Bright red stool, dark or tarry stool, or mucus in the stool can be associated
with bleeding somewhere in the gastrointestinal tract, colon, or rectum.
These changes do not always mean cancer is present, but they
should be evaluated if they continue or recur.
Unexplained Changes in Overall Health
Colorectal cancer and other gastrointestinal conditions can
sometimes cause symptoms that affect the entire body.
Unexplained weight loss, persistent tiredness, weakness,
reduced appetite, nausea, or vomiting may indicate an underlying medical
problem and warrant a conversation with a health care provider.
Family History and Colorectal Cancer Screening
The U.S.
Preventive Services Task Force recommends that adults at average risk
begin colorectal cancer screening at age 45.
Some people may need to start sooner. This includes those
with a family history of colorectal cancer and people with inflammatory bowel
conditions such as Crohn's disease or ulcerative colitis.
Several colorectal
cancer screening methods are available. Colonoscopy is still
considered the gold standard because it allows doctors to identify cancer and
remove precancerous polyps during the same procedure.
"Colorectal cancer is highly treatable when found early, and surgical advances continue to make treatment less invasive," Dr. Boutros said. "I encourage patients to be proactive and use the checklist to start a conversation with their primary care provider about any concerning bowel changes."
