Updating Care Models for Patients With Early-Onset GI Cancer

Youssef Bouferraa, MD Cleveland Clinic | Shruti Patel, MD Stanford Medicine

February 4, 2026

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Key Points

  • The risk of gastrointestinal (GI) cancers is higher than historic norms, and the incidence of early-onset GI cancer is rising.

  • Treatment toxicities may have a larger impact on younger patients, particularly during longer survivorship periods.

  • Oncologists should update their screening and care models to consider the challenges faced by this growing patient population.

Distinct Challenges When Treating Early-Onset GI Cancer 

Youssef Bouferra, MD, of Cleveland Clinic, discussed the growing incidence of early-onset GI cancers with Shruti Patel, MD, of Stanford Medicine, ahead of her presentation titled “Survivorship Issues in Early-Onset Gastrointestinal Cancers” at the 2026 American Society of Clinical Oncology Gastrointestinal Cancers Symposium. Dr. Patel identified gaps in screening and care models for this younger patient population. 

Patients with early-onset GI cancers should undergo genetic testing, as they have an increased risk of carrying germline genetic mutations. These mutations may not be linked to family history or common GI cancer–associated mutations, though the mechanisms behind this are not yet clear, said Dr. Patel.

Compared with older populations, younger patients with early-onset GI cancer may be more affected by treatment burdens, including financial toxicity, work interruption, persistent symptoms, and impaired fertility or sexual function, said Dr. Patel. She follows up with patients in survivorship every three months to help address these challenges. 

Preserving fertility and sexual health are key issues for younger patients receiving pelvic radiation. In her practice, Dr. Patel refers patients to reproductive endocrinology and infertility specialists, and preserves fertility and sexual health with ovarian transposition, sperm cryopreservation, pelvic floor therapy, or anti-erectile dysfunction medication. 

It’s crucial to ask patients about their goals before treatment, and their lingering effects after treatment, as not every patient brings them up with their oncologist, said Dr. Patel.