Introduction:Colorectal cancer has been primarily considered a disease of the elderly, but recent data have shown an alarming rise among young people. It has been also suggested that young age is associated with aggressive histopathological characteristics and advanced stages of the disease at diagnosis. As there are few studies and none from our part of the country evaluating the clinicopathological profile of early-onset versus late-onset rectal cancer patients, this analysis was conducted to assess and compare the clinical and pathological characteristics of patients with rectal cancer diagnosed with ages over and below 50 years. Materials and method:The relevant details of all biopsy proven rectal cancer patients undergoing radiotherapy at a tertiary cancer hospital, from January 2017 to December 2019, were collected. All the data were categorised into two groups, an early-onset group (age <50 years) and a late-onset group (age ≥50 years), and comparison of the clinicopathological characteristics between the two groups was made.Results: A total of 224 patients with rectal cancer, 150 male and 74 female, were included in the study. About two-thirds of the patients were less than 50 years of age, with an average age of 42 years. The comparative analysis showed a significantly higher number of young patients presenting with bleeding and pain. Patients below 50 years also had a significantly higher number of adenocarcinoma grade III and clinical stage III than those in the late-onset group. Conclusion:Our study revealed a significant number of early-onset rectal cancer patients. There should be a high index of suspicion in any young patient presenting with symptoms suggestive of rectal malignancy and they should be evaluated promptly.