SAN DIEGO — Rates of advanced stage colorectal cancer are climbing in young patients, marking a need for increased vigilance, according to data presented during the American Academy of Pediatrics 2026 National Conference & Exhibition Oct. 2-6, 2026, at the San Diego Convention Center.
The research, “Clinical Presentation and Epidemiology of Pediatric and Adolescent Colorectal Carcinoma: A Pediatric Surgical Oncology Research Collaborative Study,” retrospectively examined the medical files of 84 patients 21 years or younger who were diagnosed with colorectal cancer between 2012 and 2023. Data showed that while only 20% of those diagnosed had first- or second-degree family history of colorectal cancer, most patients had aggressive forms of the disease, either at Stage III or IV.
The authors state that the research further emphasizes concerns about the growing rates of colorectal cancer in young people along with the advanced stage of disease at presentation. Signs and symptoms such as lower back and abdominal pain, changes in bowel habits, weight loss, and rectal bleeding are often overlooked due to low rates of this type of cancer in young people.
“Colorectal cancer is, unfortunately, becoming more common in adolescents and young adults and represents a different disease than colorectal cancer diagnosed in older adults,” said study author and pediatric surgery research fellow Erica Arnold, MD. “When diagnosed, it is often aggressive, presenting with late-stage disease and associated with high rates of disease relapse and mortality.”
Researchers found that these delays in diagnosis, on top of the aggressive tumor behavior, ultimately can lead to poor long-term outcomes. Over a third of the patients studied developed recurrent disease and nearly half died as a result of their diagnosis.
The authors emphasize serious consideration of symptoms like unexplained weight loss or rectal bleeding when present in younger patients. As early-onset adult cancers are seen in younger and younger patients, the logistical considerations of adult and pediatric care teams and carefully tailored treatment regimens are paramount.
Media Relations Contact:
Study author Erica Arnold and Danielle Cameron are scheduled to present the research, which is below, from 1:47 PM – 1:55 PM on Saturday, Oct. 3, 2026, for the Section on Surgery at the San Diego Convention Center. To request an interview with the authors, contact mediarelations@nationwidechildrens.org and emurphy@mgb.org .
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ABSTRACT
Submission Type: Section on Surgery
Abstract Title: Clinical Presentation and Epidemiology of Pediatric and Adolescent Colorectal Carcinoma: A Pediatric Surgical Oncology Research Collaborative Study
Erica Arnold
Columbus, OH, United States
10/03/2026 1:47 PM - 1:55 PM
Colorectal cancer (CRC) is increasing in adolescent and young adult patients. This study aimed to characterize the clinical presentation and epidemiology of sporadic CRC in patients ≤21 years old using a large, multi-institutional cohort.
This retrospective study included patients 21 years or younger with CRC diagnosed between 2012-2023 at 34 institutions participating in the Pediatric Surgical Oncology Research Collaborative. Patients with a known CRC predisposition syndrome, including genetic syndromes as well as inflammatory bowel disease, before CRC diagnosis were excluded. Data collected included patient demographics, disease characteristics, surgical and oncologic treatment, pathology, and outcomes.
A total of 84 patients with CRC were identified; 65 (77.4%) had colon adenocarcinoma, and 19 (22.6%) had rectal adenocarcinoma. Of the 65 colon cancers, most were in the sigmoid colon (27.7%, n=18) and ascending colon (27.7%, n=18), including five appendiceal adenocarcinomas. The median age at diagnosis was 16.5 years (IQR:14.0, 19.0), and 56.0% (n=47) were male. Seventeen (20.2%) patients reported having a first- or second-degree relative with CRC. The most common presenting symptoms included back/abdominal pain (73.8%, n=62), change in bowel habits (45.2%, n=38), weight loss (42.9%, n=36), and rectal bleeding (38.1%, n=32). The median duration of symptoms prior to diagnosis was 12 weeks (IQR: 2.0, 24.0), and median time to colonoscopy was 13 weeks (IQR: 6.0, 32.0). The majority presented with Stage III (51.0%, n=43) or Stage IV disease (29.0%, n=24). Sixty-two patients (73.8%) underwent upfront resection, 4 (4.8%) attempted resection with only ostomy creation due to unresectable disease, 15 (17.9%) received neoadjuvant chemotherapy, and 3 (3.6%) received definitive chemoradiation. On pathology, 33.3% (n=28) had signet ring features, 39.3% (n=33) had mucin, and 41.6% had poorly differentiated histology. Forty-six patients (54.8%) underwent germline testing, of which 4 (8.6%) had a TP53 mutation, 2 (4.3%) an APC mutation, and 8 (17.4%) a mismatch repair mutation. Thirty-one patients (36.9%) experienced relapse of their disease at a median of 11 months (IQR: 10.0, 21.0), and 96.8% were stage III/IV disease at diagnosis. Those with relapse were more likely to have positive lymph nodes (90.3% vs 50.9%, p=0.0004), poorly differentiated histology (64.5% vs 28.3%, p=0.0047), and signet ring features (61.3% vs 17.0%, p=0.0002) than those without relapse. All patients with relapse received adjuvant chemotherapy. At the end of the study period, 38 (45.2%) patients died due to CRC.
Children and adolescents without known CRC predisposition syndromes experience delays in diagnosis and the majority do not have a known family history. Most young patients with sporadic CRC present with locally advanced and metastatic disease, with aggressive histologic features often present. Given the increasing incidence of adolescent CRC, practitioners should include CRC in their differential for symptoms such as abdominal pain and rectal bleeding in adolescents without an alternative diagnosis.
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Clinical Presentation and Epidemiology of Pediatric and Adolescent Colorectal Carcinoma: A Pediatric Surgical Oncology Research Collaborative
2-Oct-2026