The Crisis on the Operating Table: A Surgical–Intensivist’s View of Early-Onset Colorectal Cancer
- Aden Davis
- 1 day ago
- 5 min read
I wrote about this a couple years ago as an "Emerging Crisis" and presented information on this last year. Those words no longer fit. Early-onset colorectal cancer is no longer "Emerging". It is here!
Once relegated to the realm of later life, colorectal cancer (CRC) now casts a growing shadow over younger generations. Its insidious rise among individuals under 50 demands urgent attention, a shift in clinical paradigms, and a deeper understanding of the unique biological landscape driving this concerning trend.
As both a surgeon and an intensivist, my professional life moves between these two spaces—between prevention and rescue, between early intervention and late consequences. Over the last several years, those worlds have begun to collide in a way that is deeply unsettling.
I see patients in their 30s and 40s—people in the prime of their lives—presenting with advanced colorectal cancer. Not rare cases. Not curiosities. A pattern.
A Mortality Shift We Can No Longer Ignore
Recent national data published in JAMA confirms what many clinicians are now witnessing firsthand. While overall cancer mortality in adults under 50 has fallen dramatically over the last three decades, colorectal cancer stands apart.
Among adults aged 20–49:
Cancer has become one of the leading causes of death.
Colorectal cancer has emerged as a leading cause of cancer-related death, now the most lethal cancer in men under 50 and one of the top causes in women.
This matters not just because of the numbers—but because it represents a fundamental shift in who is dying of colorectal cancer and when. Other cancer deaths are declining.
Colorectal cancer is not following the same script.
That divergence should make all of us pause.
When the Epidemiology Matches the Bedside
The population data now aligns uncomfortably well with clinical reality.
Incidence in adults under 50 continues to rise, with annual percent changes ranging from approximately 1–3% and clear acceleration over the last decade.
Roughly 13.5–20% of colorectal cancers now occur in adults under 50–55, with a disproportionate burden of rectal cancers.
Younger patients are significantly more likely to present with advanced-stage disease, particularly in colon cancer.
From a surgical standpoint, this means more locally advanced tumors, fewer curative windows, and higher-risk operations.
From an ICU standpoint, it means young patients with postoperative complications, sepsis, obstruction, bleeding, or prolonged critical illness—patients who never expected to be here and whose physiology often deteriorates quickly.
This Is Not the Same Disease Showing Up Earlier
Early-onset colorectal cancer (EOCRC) is not simply colorectal cancer occurring sooner on the calendar. It behaves differently.
In younger patients, tumors are more likely to:
Arise in the distal colon and rectum
Present at more advanced stages
Demonstrate aggressive histologic features, including poor differentiation and mucinous or signet-ring characteristics
These features are not academic footnotes. They translate directly into worse outcomes when diagnosis is delayed.
The Most Uncomfortable Truth: The Symptoms Were There
Perhaps the most troubling aspect of EOCRC is not that it is biologically aggressive—but that it is often clinically visible long before diagnosis.
More than 85% of young patients are symptomatic at the time of diagnosis.
Rectal bleeding.
Changes in bowel habits.
Abdominal pain.
Fatigue.Iron-deficiency anemia.
Weight loss.
And yet, many patients wait months before seeking care. Some are reassured. Some lack access. Some are embarrassed. Some are told—explicitly or implicitly—that they are “too young” for cancer.
As clinicians, this is where the crisis becomes uncomfortable. Because this is not just about biology. It is about recognition.
In critical care, we are trained to respect physiology when it whispers, not just when it screams. EOCRC demands the same mindset earlier in the disease course—before rescue is all that remains.
A Sentinel Disease of Modern Life
When you step back and look globally, a striking pattern emerges. EOCRC rises fastest in high–Human Development Index (HDI) countries—including the United States, Australia, New Zealand, South Korea, and parts of Europe.
HDI reflects progress: longer life expectancy, education, and economic stability.
But it also tracks profound lifestyle shifts:
Ultra-processed diets and excess sugar
Sedentary behavior
Rising obesity and metabolic disease
Early-life exposure to inflammatory and endocrine-disrupting environments
From an intensivist’s perspective, this pattern feels familiar. These are the same forces driving metabolic syndrome, diabetes, and chronic inflammation—conditions that quietly reshape physiology long before acute illness appears.
EOCRC increasingly looks like a sentinel disease of modern life—an early warning that the metabolic and inflammatory costs of progress are showing up sooner, and more aggressively, than we expected.
Why Screening Alone Will Not Solve This
Lowering the average-risk screening age to 45 was necessary and appropriate. But screening alone will not rescue the young adults now filling oncology clinics, operating rooms, and ICUs.
Many EOCRC patients:
Are younger than screening thresholds
Present with symptoms rather than screen-detected disease
Experience diagnostic delays that allow stage migration to occur
This means the solution must go beyond guidelines. It requires clinical vigilance.
Rectal bleeding is not benign until proven otherwise. Persistent bowel changes are not “just IBS” by default. Iron-deficiency anemia in a young adult deserves an explanation.
A Surgeon’s Plea—and an Intensivist’s Warning
As a surgeon, I would much rather meet you for a routine colonoscopy than for an emergency bowel resection.
As an intensivist, I know how narrow the margin becomes once physiology begins to fail.
Early-onset colorectal cancer is no longer rare, no longer theoretical, and no longer confined to epidemiologic curves. It is reshaping who gets cancer, how sick they become, and how often rescue replaces prevention.
The data are clear. The bedside evidence is clearer.
Colorectal cancer no longer waits for screening age. Neither should we.
Stay Informed:
Colorectal Cancer Alliance: https://www.ccalliance.org/: https://www.ccalliance.org/
American Cancer Society: https://www.cancer.org/cancer/types/colon-rectal-cancer.html: https://www.cancer.org/cancer/types/colon-rectal-cancer.html
National Cancer Institute: https://www.cancer.gov/types/colorectal/hp: https://www.cancer.gov/types/colorectal/hp
Colorectal Cancer Coalition: https://coloncancercoalition.org/
Let's break the silence, fight back against CRC, and protect the health of future generations. Remember, knowledge is power in this fight. Share this information, raise awareness, and empower young adults to prioritize their colorectal health.
Together, we can make a difference.
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