This review summarizes the unmet reproductive needs, gonadal toxicity, fertility effects of treatment, and maternal and fetal/neonatal outcomes in patients with early-onset colorectal cancer, aiming to optimize overall prognosis in this population.
Key Findings
Background
Colorectal cancer diagnoses in young adults are rising significantly despite an overall decline in incidence and mortality of colorectal cancer.
Early-onset colorectal cancer (EOCRC) refers to colorectal cancer diagnosed in individuals under age 50.
The rising incidence in young adults represents a notable epidemiological shift that is driving increased concern about long-term reproductive health outcomes.
As more young patients survive their primary disease, reproductive health considerations are becoming increasingly clinically relevant.
Background
Patients with early-onset colorectal cancer have significant unmet reproductive needs that are inadequately addressed in current clinical practice.
The review specifically identifies 'unmet reproductive needs' as a key gap in care for EOCRC patients.
Young patients face unique challenges because treatment decisions must balance oncologic outcomes with preservation of reproductive potential.
The review was conducted to summarize and highlight these gaps to optimize overall prognosis.
Results
Treatments for early-onset colorectal cancer exert gonadal toxicity and negatively affect fertility in young patients.
Primary treatments including surgery, chemotherapy, and radiation are associated with gonadal toxicity.
Fertility effects of treatment were identified as a central concern for EOCRC patients of reproductive age.
The review synthesizes available literature on how standard oncologic treatments impair reproductive function in this population.
Results
Pregnancy outcomes in colorectal cancer patients are associated with multiple adverse maternal and fetal/neonatal complications.
The most commonly reported adverse events in labor included cesarean section, pre-eclampsia, and preterm birth.
Neonatal complications associated with preterm birth were also among the most frequently reported adverse outcomes.
The review notes 'considerable controversy in the available literature regarding the outcomes of pregnancies in patients with colorectal cancer, including maternal and fetal/neonatal outcomes.'
Discussion
There is considerable controversy in the literature regarding maternal and fetal/neonatal outcomes of pregnancy in colorectal cancer patients.
Available studies on pregnancy outcomes in EOCRC patients show inconsistent findings, limiting definitive clinical guidance.
Both maternal outcomes (e.g., pre-eclampsia, cesarean delivery) and neonatal outcomes (e.g., preterm birth complications) have been variably reported across studies.
This controversy underscores the need for further research to establish clearer evidence-based recommendations for reproductive counseling in EOCRC patients.
What This Means
This research suggests that colorectal cancer is being diagnosed in younger adults (under age 50) at increasing rates, even as overall colorectal cancer rates decline. Because more of these young patients are surviving their cancer, questions about their ability to have children and the safety of pregnancy after treatment have become increasingly important. This review paper pulled together existing research on these topics to identify what is known and what gaps remain in caring for this population.
The review found that cancer treatments such as surgery, chemotherapy, and radiation can damage the reproductive organs and reduce fertility in young colorectal cancer patients. When these patients do become pregnant, there are elevated risks of complications including cesarean delivery, high blood pressure during pregnancy (pre-eclampsia), premature birth, and health problems in newborns related to being born early. However, the research also highlights that the existing studies on these outcomes are inconsistent and sometimes contradictory, meaning doctors don't yet have clear, unified guidance on how to counsel young patients about reproduction.
This research suggests that the reproductive needs of young colorectal cancer patients are not being fully met by current medical practice. Better understanding of fertility preservation options, the reproductive risks of different treatments, and the safety of pregnancy after cancer treatment could help doctors and patients make more informed decisions—ultimately improving both cancer outcomes and quality of life for this growing group of survivors.
Jiang Q, Xu X, Sun P, Hua H. (2025). Sexual and Reproductive Health of Patients With Early-Onset Colorectal Cancer.. Clinical and translational gastroenterology. https://doi.org/10.14309/ctg.0000000000000870