Early-Onset Gastrointestinal Cancers: Epidemiology, Biology, Endoscopy and Clinical Challenges

Over the past two decades, the incidence of gastrointestinal (GI) cancers diagnosed in individuals under the age of 50 has risen at an alarming rate worldwide. This trend is particularly evident in colorectal cancer, but is increasingly recognized in gastric, pancreatic, and esophageal malignancies. Early-onset GI cancers (EO-GI cancers) represent a distinct and evolving clinical entity, raising critical questions regarding their epidemiology, underlying biology, diagnostic pathways, and optimal management.Unlike traditional, age-related GI cancers, early-onset cases often present at more advanced stages and may exhibit unique molecular and clinical features. While hereditary syndromes account for a subset of these patients, the majority appear sporadic, suggesting a complex interplay between genetic susceptibility, environmental exposures, lifestyle factors, and the gut microbiome.The rising burden of EO-GI cancers has major implications for screening strategies, particularly in the context of shifting age thresholds and risk stratification approaches. Endoscopy plays a central role in early detection and prevention, yet its optimal use in younger populations remains controversial. Furthermore, the clinical management of these patients presents unique challenges, including differences in tumor biology, treatment response, survivorship issues, and psychosocial impact.This Research Topic aims to provide a comprehensive and multidisciplinary overview of early-onset GI cancers, spanning epidemiology, molecular mechanisms, diagnostic innovations—including advances in endoscopy—and evolving therapeutic strategies. By integrating insights from basic, translational, and clinical research, this collection seeks to advance understanding and improve outcomes in this rapidly emerging field.We welcome original research articles, systematic reviews, meta-analyses, high-quality narrative reviews, an exceptional case reports, as well as perspectives and clinical studies addressing, but not limited to, the following areas:Epidemiology and Risk Factors• Global and regional trends in EO-GI cancer incidence and mortality• Environmental, dietary, and lifestyle risk factors• Socioeconomic and demographic disparities• Role of obesity, metabolic syndrome, and early-life exposuresMolecular and Biological Mechanisms• Genomic, epigenomic, and transcriptomic profiles of EO-GI cancers• Differences between early-onset and late-onset tumors• Role of hereditary cancer syndromes vs sporadic disease• Tumor microenvironment and immune landscape• Microbiome and host interactionsEndoscopy and Early Detection• Advances in endoscopic detection in younger populations• Artificial intelligence in endoscopy for early diagnosis• Screening strategies and risk-adapted approaches• Missed lesions and interval cancers• Quality indicators and innovations in endoscopic practiceClinical Management and Therapeutic Challenges• Treatment patterns and outcomes in EO-GI cancers• Precision oncology and biomarker-driven therapies• Differences in response to chemotherapy, targeted therapy, and immunotherapy• Fertility preservation, survivorship, and quality of life• Multidisciplinary care modelsHealth Policy and Screening Implications• Lowering screening age: evidence and controversies• Cost-effectiveness of early screening strategies• Public health initiatives and awareness campaigns• Implementation of personalized screening programsTranslational and Future Directions• Novel biomarkers for early detection and prognosis• Liquid biopsy applications in EO-GI cancers• Preventive strategies and risk prediction models• Integration of multi-omics and artificial intelligence Topic editors: Angel Lanas, Rodrigo JOVER, Uri Ladabaum Source: https://www.frontiersin.org/research-topics/80543/early-onset-gastrointestinal-cancers-epidemiology-biology-endoscopy-and-clinical-challenges