Colorectal cancer has officially become the leading cause of cancer-related death among people younger than 50, which is not the kind of record anyone wanted. While routine screening generally starts at 45 for average-risk adults, warning signs can show up earlier - and the American College of Surgeons (ACS) has rolled out free public education resources and a checklist to help younger patients get their concerns taken seriously before their primary care appointments.

"A lot of times when younger patients seek care for bowel symptoms, those symptoms are too often attributed to hemorrhoids or constipation and treated conservatively," said Dr. Marylise Boutros, a colorectal surgeon at Cleveland Clinic Florida who helped develop the materials. "As more young people are diagnosed with colorectal cancer, awareness of the subtle signs and symptoms can save lives." Indeed, diagnoses among younger people have been climbing: the American Cancer Society reports that about 1 in 5 colorectal cancer cases now occur in people under 54, compared to just 11% three decades ago. (That's math that gets worse the longer you stare at it.)

The ACS checklist highlights several warning signs that shouldn't be brushed off. Constipation, diarrhea, unusually narrow stools, or a lasting change in bowel habits may indicate trouble, as can a feeling that the bowel hasn't fully emptied. Rectal pressure or discomfort can also occur when a tumor causes inflammation or partial blockage. "Any bowel change that is new or different for you deserves medical attention," said Dr. Paula Denoya, a colorectal surgeon at Stony Brook University Hospital. An annual wellness visit is a perfect time to bring it up - assuming you remember between sips of lukewarm coffee.

Blood in the stool is a particularly important red flag, especially if it appears more than once. Research presented at the ACS Clinical Congress 2025 found that rectal bleeding was the strongest predictor of colorectal cancer in patients under 50, raising the odds by 8.5 times. "Bleeding is the most common symptom of colorectal cancer but can also be caused by other diseases," noted Dr. James T. McCormick of Allegheny Health Network. "Any amount of recurring blood should be evaluated." Changes in stool appearance - bright red, dark/tarry, or mucus-laden - also warrant a look-see, even if they don't always mean cancer.

Systemic symptoms like unexplained weight loss, persistent tiredness, weakness, reduced appetite, nausea, or vomiting can also point to colorectal cancer or other GI issues. The U.S. Preventive Services Task Force recommends starting screening at 45 for average-risk adults, but those with a family history or inflammatory bowel conditions (Crohn's disease, ulcerative colitis) may need to start sooner. Colonoscopy remains the gold standard because it can both detect cancer and remove precancerous polyps in one go - a two-for-one deal you actually want.

"Colorectal cancer is highly treatable when found early," Dr. Boutros said. "I encourage patients to be proactive and use the checklist to start a conversation with their primary care provider." Because the alternative - ignoring symptoms until they become unavoidable - is a conversation nobody wants to have.