Background: Young-onset colorectal cancers (yCRCs) have increased globally 
over the last several decades by 2.8%–36.5%. The publications about yCRC in 
developing countries in general and Egypt specifically are scarce. Moreover, 
there is a lack of large single-center or multicenter evaluations of yCRC in 
developing countries. 
Patients and Methods: We evaluated the clinicopathological characteristics 
and survival outcomes in patients with colorectal cancer who were aged < 50 
years old at South Egypt Cancer Institute from 2008 to 2017. 
Results: There were 744 patients with a median age of 40 years (range: 18 – 49 
years). yCRC represented 49.9% of all colorectal cancers. The commonest 
symptoms among the patients were bleeding (37.1%) and pain (36%) followed 
by obstruction (21.9%). rectal/rectosigmoid junction cancers represent 43.3% of 
the whole cohort. In the younger age group (18 - 29 years) we found a higher 
incidence of pain and obstructive manifestations, signet-ring carcinoma, lung, 
and peritoneal metastases in comparison with the older age group (40 - 49 
years). There was a significantly higher relapse rate with a lower five- and tenyears disease free and overall survival in the lower age group. 
Conclusion: There is a higher burden of yCRCs, advanced stage at presentation, 
and a lower survival outcome in the age group between 18 and 29 years, but the 
survival rates in the current study were higher compared with previous 
publications on yCRC worldwide. So, lowering the age for screening to be 
below 45 years is crucial, which is already updated. yCRC represents a nation 
problem necessitating further studies.