Young-Onset Rectal Cancer is Overlooked: Outcome Analysis from a Tertiary Cancer Centre in North India

Young-onset rectal cancer (YRC) is increasing worldwide, particularly in low- and middle-income countries (LMICs), where delayed diagnosis and limited access to multimodal treatment adversely affect survival. This study is undertaken to understand the clinical profile of YRC patients at a tertiary cancer centre in North India.

We retrospectively reviewed all patients aged ≤ 40 years with histologically confirmed rectal adenocarcinoma treated between March 2019 and March 2024. Demographic, clinical, histopathological, treatment, and outcome data were collected. Overall survival (OS) was estimated using the Kaplan-Meier method. The study adhered to the STROBE reporting guidelines.

Among 151 patients (mean age 29.8 years; 63.6% male), the most common presentation was bleeding per rectum (72.8%), with a mean symptom duration of 7.2 months. Advanced-stage presentation was common, comprising stage III (42.4%) and stage IV disease (29.8%). Adenocarcinoma (64.2%) was the predominant histology, while mucinous (20.5%) and signet-ring cell (15.2%) variants were also frequent. A total of 67 patients (44.4%) were eligible for curative-intent treatment, of whom 47 (31.1% of the overall cohort; 70.1% of eligible patients) completed curative multimodal therapy. Among the remainder, 20 (13.2%) initiated but did not complete curative treatment, 24 (15.9%) received palliative systemic therapy, and 60 (39.7%) were managed with best supportive care alone. At a median follow-up of 12 months, the 1-year OS was 76.2% (95% CI 67.5-86.2). Inferior survival was observed in patients aged ≤ 20 years, those with non-low rectal tumors, and those with locally advanced disease.

Most YRC patients presented with advanced disease and limited access to complete multimodal care. Improving early recognition, ensuring timely referral, and expanding equitable access to standard oncologic therapy are essential to improve outcomes in resource-limited settings.