Redefining the Nursing Role in Young-Onset Colorectal Cancer

Cancer centers are seeing a growing number of patients under the age of 50 years diagnosed with young-onset colorectal cancer (YO-CRC), leaving oncology nurses to navigate a rapidly evolving clinical landscape. Once viewed primarily as a disease of older adults, CRC is increasingly affecting younger individuals in the prime of their lives, including parents of young children, recent college graduates, and young professionals just beginning to build their careers.

The American Cancer Society estimates that approximately 108,000 people in the United States will be diagnosed with colon cancer this year alone, and 1 in 5 of those cases will occur in people younger than 55 years. Even more alarming, diagnoses in this younger group have doubled since 1995. Today, CRC has become the leading cause of cancer-related death among Americans under the age of 50. While rates are declining in older adults, they continue to rise among younger generations, a trend that is raising urgent questions and concerns.

Oncology nurses are uniquely qualified to raise awareness of YO-CRC, including its risk factors, symptoms, and rising incidence. They also play a vital role in supporting young adults with CRC, combining specialized clinical expertise with a nuanced understanding of the complex medical and life challenges these patients face.

Nina N. Grenon, DNP-AOCN, an oncology nurse practitioner and clinician-researcher at Dana-Farber Cancer Institute in Boston, Massachusetts, emphasized that oncology nurses must be attuned not only to the rising incidence of CRC in younger populations but also to the distinct pressures these patients face. Many are balancing treatment with raising children, continuing their education, or sustaining their careers, which adds layers of complexity to their care.

“Some patients are caregivers to young children or aging parents. Others are hoping to start a family someday,” Grenon said. “This is where psycho-oncology services play a critical role in helping patients adjust to their diagnosis and manage anxiety about treatment and the risk of recurrence.”

Grenon noted that anxiety is particularly common among younger patients. She encourages them to plan treatments around their lives, rather than the other way around, which can help restore a sense of control during an otherwise uncertain time.

To address the unique needs of young patients, Dana-Farber Cancer Institute established the Young-Onset Colorectal Cancer Center , a first in the United States and one of the first worldwide, for patients under 50. The center brings together a multidisciplinary team that includes physicians, advanced practice providers, nurses, a dedicated clinic coordinator, psychologists, and social workers to deliver coordinated patient-centered care.

Most recently, a qualitative study conducted at Dana-Farber Cancer Institute identified 4 key themes among patients with YO-CRC:

• feeling overwhelmed by the health care system and in need of navigation support;
• experiencing isolation and seeking peer connection;
• facing significant life disruption and needing psychosocial care; and
• expressing a strong interest in research participation and genetic testing.

Although the exact causes of YO-CRC remain unclear, Grenon notes that several risk factors have been identified. These include a family history of CRC or colon polyps, inflammatory bowel diseases (IBD) such as ulcerative colitis or Crohn’s disease, and lifestyle factors including physical inactivity, low-fiber and high-fat diets, obesity, and smoking. Grenon notes that the microbiome has been implicated as a possible causative factor, and its role is an area of growing research interest. However, Grenon says many patients diagnosed with YO-CRC don’t present with these known risk factors.

“I’ve had younger [patients with] CRC who are athletes and maintain a healthy diet and lifestyle,” she says.

Grenon acknowledges that a CRC diagnosis is often delayed in younger patients, in part because the patient may wait longer to report symptoms, and providers can often overlook CRC as a possibility in young patients. Additionally, many symptoms, such as rectal bleeding, changes in bowel habits, fatigue—which can result from anemia— constipation, and abdominal pain, are often attributed to more common conditions, such as hemorrhoids, IBD, or irritable bowel syndrome.

Striving to Diagnose YO-CRC Cases at an Earlier Stage

At City of Hope Orange County in Irvine, California, Jessica Huizar, RN, RSN, says one of the biggest challenges in treating young patients with CRC is achieving an earlier diagnosis.

Although the United States Preventive Services Task Force lowered the recommended screening age for CRC to 45 years from 50 years in 2021, researchers have found that only 1 in 4 eligible younger adults completed the screening.

“We don’t typically see younger people as having health issues, so when they have abdominal pain or blood in their stool, their providers may initially attribute these symptoms to hemorrhoids or recommend watchful waiting,” she says. “But if symptoms persist, they need to be investigated further in case something more serious is going on. Catching it earlier can significantly improve the chances of a cure.”

Although most CRC cases in patients over age 50 years are identified at earlier stages, younger patients are more often diagnosed at advanced stages (3 or 4). This disparity is likely due to CRC frequently being asymptomatic in its early phases, combined with delays in care. Finding from a survey by the Colorectal Cancer Alliance showed that 75% of young patients with CRC visited at least 2 physicians before receiving a diagnosis, and 40% said their provider dismissed their symptoms and concerns.³

Huizar notes there is also a common misconception that a later-stage diagnosis automatically means palliative care.

“We do have patients with stage 3 and 4 disease who have been cured, or are undergoing treatment with curative intent,” she says. “It depends on genetic factors and the type of tumor.”

City of Hope receives patient referrals from around the world. In many cases, patients initially treated for suspected hemorrhoids that do not respond to therapy undergo additional imaging, which ultimately leads to a CRC diagnosis.

Huizar highlights a reality that many younger patients face but don’t always expect. A cancer diagnosis doesn’t just affect their health; it can also impact their finances, careers, and plans for starting a family. That’s why she emphasizes the importance of honest, early conversations about how certain treatments may affect fertility, along with the options available to preserve it.

For many, the emotional weight is just as significant.

“It can be quite difficult for younger patients to cope with a cancer diagnosis,” Huizar explains. “It’s not something they ever expect to hear.” In those moments, connection is powerful, and Huizar says helping younger patients find community through support groups allows them to share their stories, feel less alone, and gain strength from others navigating similar situations.

Research findings support this perspective. Because standard treatments for CRC include chemotherapy, radiation, and surgery, fertility, bowel and bladder function, and sexual health can all be affected. Data from one study exploring the psychosocial effects of YO-CRC revealed that younger patients often face deeply personal struggles, especially around self-image and sexual health, on top of the physical burden of the disease.

To address the rise in YO-CRC, City of Hope’s Ajay Goel, PhD, AGAF, has developed a promising blood test to detect cancer at earlier stages, potentially making it part of annual checkups for patients as young as 18 years. Meanwhile, Mayo Clinic is advancing research on a cancer vaccine currently being evaluated in a clinical trial .

Expanding awareness of clinical trials remains equally critical. Results from a survey by the Colorectal Cancer Alliance showed that 70% of patients with stage 3 and stage 4 metastatic YO-CRC reported never discussing clinical trial options before beginning treatment.

Working as Part of a Multidisciplinary Team to Address Concerns

Anndee Meyer, RN, a nurse navigator at UC Health in Cincinnati, Ohio, says a first visit with patients with YO-CRC goes far beyond the basics of medical care. It is about helping them navigate life.

During that initial appointment, she and her colleagues walk patients through the support services available to them, from managing anxiety and stress to addressing practical concerns such as nutrition, medical costs, and even fertility preservation.

“We try to coordinate as much as possible on the same day, so they aren’t making multiple trips back and forth,” Meyer explains.

Meyer has also observed that younger patients with CRC often approach health care differently.

“Many take a more holistic view and rely heavily on information they find online,” she says, noting that she reassures patients their care aligns with established National Comprehensive Cancer Network (NCCN) guidelines. “They may have strong concerns about the chemicals used in treatment, so it’s essential they understand the seriousness of their diagnosis and receive clear, evidence-based education to make informed decisions.”

She adds that it is equally important to address alternative treatments patients may encounter, such as ivermectin, which lack credible evidence in this context and can delay effective care, potentially allowing the cancer to progress to a more advanced, metastatic stage.

What she hears most from younger patients, however, is a desire for clarity and control.

“Most younger patients want a timeline,” she says. “They want to understand how disruptive treatment will be to their lives and how soon they can get back to normal.”

The questions they ask reflect the reality of balancing treatment with everyday responsibilities.

• Can I keep working while I’m going through chemotherapy?
• I have a toddler. How do I manage recovery from surgery if I can’t lift anything for 6 weeks?

For these younger patients, cancer care is not just about treatment; it is about finding a way to keep life moving forward.

References

1. Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;76(2):e70067. doi:10.3322/caac.70067

2. Fletcher KM, Revette A, Enzinger A, et al. Experience and needs of patients with young-onset colorectal cancer and their caregivers: a qualitative study. JCO Oncol Pract. 2024;20(12):1604-1611. doi:10.1200/OP.24.00002

3. Colorectal Cancer Alliance. Never Too Young Survey Report 2020. 2020. Accessed April 23, 2026. https://colorectalcancer.org/sites/default/files/media/documents/CCAlliance_NeverTooYoung_2020SurveyReport.pdf