Colorectal cancer cases in kids have risen sixfold over past 2 decades ‪—‬ researchers are racing to understand why

More children, teens and very young adults are being diagnosed with colorectal cancer in the United States, and new research suggests they often experience aggressive forms of the disease.

While diagnosis rates are rising, the disease is still rare among young people. Colorectal cancer, which affects the lower intestines and rectum, is largely a disease of age: 55% of all colorectal cancers are diagnosed in people over 65, and only 16% occur in people ages 49 or younger, according to a 2026 study published in the flagship journal of the American Cancer Society. Only a few hundred cases per year are diagnosed in people under age 21 in the U.S.

Nevertheless, the numbers of cases in the very young are rising, even as colorectal cancer rates decline or hold steady in older individuals. This increase coincides with an overall rise in colon and rectal cancer rates in people under 50.

The reasons for this schism aren't entirely understood. People over 50 receive routine colonoscopies in which precancerous polyps are removed, and that likely accounts for much of the decline in colorectal cancer diagnoses in older adults. But researchers suspect that environmental factors, such as ultraprocessed foods and sedentary lifestyles, might be behind the growing rates in young people.

"Most of the research has really focused on the gut microbiome," the community of bacteria and other microbes that live in the gut, said Dr. Christopher Lieu, a professor of medical oncology at the University of Colorado Anschutz and a medical adviser to the nonprofit Colorectal Cancer Alliance.

Microbiome disruptions may spur inflammation, which, in turn, may trigger DNA mutations that cause cancer. But these mechanisms are complicated, Lieu told Live Science, and there likely isn't one simple reason young people's microbiomes may be getting disturbed.

"It's going to be extraordinarily more complex than that," he said.

Aggressive disease in young people

What researchers are starting to learn is that colorectal cancer in people in their early 20s or younger tends to be a more aggressive disease than that often seen in older people.

"We do feel like it is a bit of a distinct disease than what we're seeing in older adults," said Dr. Erica Arnold, a pediatric surgery research fellow at Nationwide Children's Hospital in Columbus, Ohio. In October, Arnold presented new research on colorectal cancer in people ages 21 or younger at the annual meeting of the American Academy of Pediatrics.

Arnold and her colleagues analyzed the cases of 84 patients diagnosed between 2012 and 2023. They found that the median age of diagnosis was 16 years old and the median duration of symptoms before diagnosis was only 12 weeks long.

Only about 20% of the patients had a close relative with colorectal cancer, suggesting that for many of these young people, the disease did not necessarily emerge due to hereditary factors.

Eighty percent of the study participants were diagnosed with Stage III or Stage IV disease, meaning the cancer had already spread locally and to lymph nodes or to other, distant organs when the patients were diagnosed. For comparison, in colorectal cancer patients of all ages, 60% are diagnosed in Stage III or IV, according to the Centers for Disease Control and Prevention (CDC).

In addition, Arnold said, one-third of the patients in their study had cellular markers of particularly aggressive cancer.

"Some of that might be related to delays in diagnosis," Lieu said, "but if you want my honest opinion, it does suggest that these cancers are developing differently."

The study's data was not nationally representative, but a recent analysis of CDC data has also found that colorectal cancer rates in youth are on the rise. In 1999, the diagnosis rate in kids ages 10 to 14 was 1 in a million. By 2020, it had risen to 6 in a million. For teens between 15 and 19, the rate of diagnosis went from 3 in a million to 13 in a million in that same time frame.

Unclear causes

There is no definitive reason for this rise, Lieu said. Research on the microbiome has suggested that processed food, antibiotic exposure in childhood, stress, reduced exercise and other lifestyle factors may contribute to this increased risk of colorectal cancer.

Some microbes may play a particularly strong role, at least in some cases of colorectal cancer. For instance, a specific variant of the common gut bacterium Escherichia coli is strongly associated with colorectal cancer; the variant carries a genetic segment and produces compounds that are toxic to genes. But this variant alone cannot explain all colorectal cancer cases in young people. Nor is it clear why the gut microbiome might be undergoing a shift in the first place.

"It may be a combination of food, antibiotic use and environmental exposures," Lieu suggested.

Regardless of the exact causes behind the cases, Arnold's new research pointed to the symptoms that deserve closer scrutiny in young people. Among the 84 patients in the study, 75% reported experiencing back and abdominal pain before their diagnosis, 45% had changes in their bowel movements, 43% experienced unexplained weight loss and 38% had rectal bleeding.

These are classic colorectal cancer symptoms, Arnold said, but they might be overlooked in this young age group because these same symptoms can have more common causes.

Parents should know that in most cases, stomach pain and gastrointestinal disruptions in kids are not caused by colorectal cancer, Lieu said, calling the cancer an "extraordinarily rare event." Nevertheless, pain or gastrointestinal upset that doesn't ease or that worsens over time needs a checkup, and symptoms like weight loss and blood in the stool are very unusual in kids and deserve extra attention.

"It's just important to investigate it to make sure we're catching colorectal cancer earlier rather than later in these patients," Arnold said.

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