Clinicopathological Characteristics of Early-Onset Colorectal Cancer among Young Adults in Northeast Bangladesh: A Hospital-Based Cross-Sectional Study

Abstract Background: Colorectal cancer (CRC), historically predominant in older populations, is increasingly identified in individuals below 50 years of age, a subset classified as early-onset colorectal cancer (EOCRC), which frequently presents with advanced-stage disease and distinct clinicopathological features in young adults. Objective: To observe the demographic, clinical, and pathological characteristics, risk factors, and treatment outcomes of EOCRC in young adults in Northeast Bangladesh. Methods: A hospital-based cross-sectional study was conducted at the Department of Clinical Oncology, Mount Adora Hospital, Sylhet, from July 2023 to December 2024. Patients were purposively selected, and data were extracted from hospital records. The study included 112 histopathologically confirmed colorectal cancer patients aged 18-40 years, with information on demographics, family history, clinical presentation, tumor characteristics, tumor markers, treatments, and treatment response analyzed. Results: The mean age of EOCRC patient’s was 32.8±3.2 years; 68.0% were male, and 71.0% resided in urban areas. Obesity (34.0%) and smoking (24.0%) were the most common risk factors, while family history (13.0%) and inflammatory bowel disease (9.0%) were less frequent. The leading symptoms were combined per-rectal bleeding and abdominal pain (77.7%), generalized weakness with anorexia and pallor (59.8%), rectal bleeding (50.0%), and altered bowel habits (42.9%). The rectum was the predominant tumor site (51.0%), followed by the distal colon (33.0%). Most tumors were adenocarcinoma NOS/Grade 1–2 (66.0%), and the majority presented at Stage III (58.0%). Total neoadjuvant therapy was the most common treatment (48.0%). Partial and complete responses were observed in 39.0% and 27.0% of patients, respectively, while 13.0% showed disease progression. Conclusion: Young adults with EOCRC in Sylhet frequently present with advanced-stage, distal tumors and exhibit modifiable lifestyle risk factors such as obesity and smoking. Early recognition and targeted interventions are critical to improve outcomes in this population.