For years, colorectal cancer was thought of as a “later-in-life disease,” something that shows up after 50. But oncologists across India are now seeing something deeply worrying: A rising number of patients in their 20s, 30s, and early 40s walking into clinics with advanced tumours that would traditionally be seen decades later.
At Tata Memorial Hospital, one of India’s leading cancer centres, the average age of colorectal cancer patients was just 47.2, and 35% were below 40. Dr Avanish Saklani, Director – Surgical Oncology at Fortis Hospital Mulund, calls this shift “a disturbing trend,” noting that some patients are as young as 19. This isn’t a statistical blip. It’s a pattern.
1. Young Indians are showing up with more aggressive cancers
Doctors are seeing far more cases of signet-ring cell carcinoma, an aggressive subtype linked to poorer outcomes. In the TMH audit, 13.4% of patients had signet-ring tumours, far higher than the 1% typically seen in Western populations.
Dr Saklani confirms this clinical reality: younger patients often harbour aggressive variants that progress faster and present later because symptoms are overlooked or misdiagnosed.
Common early symptoms like:
- Rectal bleeding
- Persistent abdominal pain
- Changes in bowel habits
…are often dismissed as piles, fissures, or “just acidity,” delaying diagnosis by months.
2. India’s system and social habits contribute to dangerous delays
The TMH audit shows patients were symptomatic for an average of four months before seeking help. Rectal bleeding was the most common warning sign, but often ignored.
According to Dr Saklani, multiple barriers worsen this delay:
- Reluctance among primary doctors to perform rectal exams
- Lack of privacy or chaperones in clinics
- Stigma around discussing bowel symptoms
- Young patients assume they’re “too young” for cancer
By the time many reach a specialist, 28.8% already have metastatic disease, often involving the liver or peritoneum.
3. Lifestyle changes are shaping risk, and India's youth are most exposed.
Genetics plays a role, but inherited syndromes account for only a few per cent of all cases.
Doctors believe that the culprits are largely environmental:
- Ultra-processed, low-fibre diets
- Sedentary lifestyle
- Rising obesity and metabolic disease
- Altered gut microbiota
- Exposure to environmental toxins
These factors reflect Western lifestyle risks, but in India, the shift is fast and in a much younger population.
4. India lacks the screening systems that save lives elsewhere
In the US and UK, routine screening begins at 45–50, catching many cancers early. India has no such national programme. The TMH data highlights this gap: only 3.8% of patients were diagnosed at Stage I.
Dr Saklani stresses that any rectal bleeding, unexplained anaemia, persistent bowel changes, or weight loss should trigger a colonoscopy, even in someone under 30.
5. Two distinct patient profiles are emerging
Indian oncologists now treat two very different groups:
- Younger patients
- aggressive biology
- Late presentation
- Need advanced, sometimes robotic surgeries
- Often misdiagnosed early on
- Older patients
- Earlier diagnosis
- More comorbidities
- Require different surgical and medical considerations
Both groups reflect a shifting cancer landscape, one that India’s healthcare system must adapt to quickly.
What doctors want every young Indian to know
Dr Saklani’s message is clear: “Don’t ignore rectal bleeding or bowel changes, no matter your age.” The data backs him up. India’s largest CRC audit shows that young age is no longer a protection. Aggressive biology and delayed diagnosis are fuelling a silent epidemic, one that demands awareness, screening access, and lifestyle change.
Because here’s the truth: Early detection doesn’t just improve outcomes, it saves lives.
Also read: Is your desk job a hidden trigger for pancreatic cancer? Oncologist warns
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