Findings from a publication in the Journal of the American Medical Association Network Open revealed that hematochezia, abdominal pain, altered bowel habits, and unexplained weight loss were the most common presenting signs and symptoms in patients diagnosed with early-onset colorectal cancer (EOCRC).

The authors wrote, “Early-onset colorectal cancer (EOCRC), defined as a diagnosis at younger than age 50 years, is increasing, and so-called red flag signs and symptoms among these individuals are often missed, leading to diagnostic delays. Improved recognition of presenting signs and symptoms associated with EOCRC could facilitate more timely diagnosis and impact clinical outcomes.”

This systematic review and meta-analysis aimed to quantify the incidence of red flag signs and symptoms among individuals with EOCRC, examine their relationship with EOCRC risk, and quantify the difference in time to diagnosis from sign or symptom presentation.

From data inception through May 2023, researchers reviewed data from PubMed/MEDLINE, Embase, CINAHL, and the Web of Science. This review and meta-analysis included studies that reported on sign and symptom presentation or time from sign and symptom presentation to diagnosis for patients aged younger than 50 years who were diagnosed with nonhereditary colorectal cancer.

A total of 12,859 articles were initially recovered, and 81 studies with 24,908,126 patients aged younger than 50 years were incorporated and reviewed. Among these studies, the most common presenting signs and symptoms, described by 78 included studies, were “hematochezia (pooled prevalence, 45% [95% CI, 40%-50%]), abdominal pain (pooled prevalence, 40% [95% CI, 35%-45%]), and altered bowel habits (pooled prevalence, 27% [95% CI, 22%-33%]),” wrote the authors. “Hematochezia (estimate range, 5.2-54.0), abdominal pain (estimate range, 1.3-6.0), and anemia (estimate range, 2.1-10.8) were associated with higher EOCRC likelihood. Time from signs and symptoms presentation to EOCRC diagnosis was a mean (range) of 6.4 (1.8-13.7) months (23 studies) and a median (range) of 4 (2.0-8.7) months (16 studies).”

Based on their findings, the authors concluded, “In this systematic review and meta-analysis of patients with EOCRC, nearly half of individuals presented with hematochezia and abdominal pain and one-quarter with altered bowel habits. Hematochezia was associated with at least a 5-fold increased EOCRC risk. Delays in diagnosis of 4 to 6 months were common.”

The authors indicated that their findings and the expanding incidence of at-risk individuals aged younger than 50 years emphasized the urgent need to expand awareness among clinicians and patients about these signs and symptoms to ensure that diagnostic workup and resolution are implemented promptly. Finally, to aid in diminishing rates of morbidity and mortality associated with EOCRC, the authors noted that modifying current clinical practice to recognize and address these signs and symptoms using thorough clinical triage and follow-up would be advantageous.

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