Incidental Colorectal Adenomas in Adolescents: Clinical Management, Genetic Evaluation, and Surveillance

The rising incidence of early-onset colorectal cancer has renewed attention to colorectal adenomas in adolescents and young adults (AYA), although these lesions remain rare and poorly characterized in adolescents. Lack of age-specific guidance creates uncertainty regarding genetic evaluation, surveillance intervals, and long-term management when these lesions are identified in adolescents. This narrative review synthesizes current evidence and expert perspective on epidemiology, evaluation, endoscopic management, surveillance, genetic considerations, and psychosocial implications of incidentally identified colorectal adenomas across the AYA spectrum, with emphasis on adolescents as a distinct clinical population. Available data largely derive from adults aged 20-49 years but suggest that adenomas in adolescents are uncommon and more likely to prompt evaluation for hereditary colorectal cancer syndromes. Accordingly, adolescents with incidental colorectal adenomas should be referred for genetic counseling, with consideration of multigene panel testing, even in the setting of isolated lesions. Endoscopic management generally parallels adult practice, and young age alone does not appear to increase risk of metachronous advanced neoplasia. These findings support guideline-concordant surveillance without routine interval shortening when accurate polyp size assessment and confident complete resection are achieved, although adolescent-specific evidence remains limited. We propose a pragmatic clinical management algorithm integrating adenoma features, genetic risk assessment, and surveillance planning to support consistent, evidence-informed care in this understudied population.