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Possible warning signs include blood in the stool, ongoing abdominal pain, constipation or diarrhea, nausea or vomiting, unexplained weight loss, loss of appetite, an abdominal lump, and symptoms of anemia such as unusual tiredness or pale skin. None of these symptoms by itself means a child has cancer: they can have many other causes, so a healthcare professional should assess symptoms that persist, worsen, or concern you.
Symptoms to watch for
The National Cancer Institute (NCI) lists the following as possible signs of childhood colorectal cancer. The symptoms vary, and they are not a checklist for diagnosing the disease.
Bleeding and bowel changes
- Blood in the stool: Blood may appear red, or stool may look dark. Bleeding has causes other than cancer, but it should be discussed with a clinician.
- A change in bowel habits: Constipation or diarrhea may be a change from the child’s usual pattern. A change in stool shape, including thin stools, is also noted in American Cancer Society guidance for adolescents and young adults; that broader guidance is not a pediatric diagnostic rule.
Abdominal and digestive symptoms
- Abdominal pain.
- Nausea or vomiting.
- A lump or mass in the abdomen.
- Loss of appetite.
Whole-body or anemia-related changes
- Weight loss for no known reason.
- Anemia, which may be associated with tiredness, dizziness, a fast or irregular heartbeat, shortness of breath, or pale skin.
- Low energy or weakness, also included in the American Cancer Society’s general information for adolescents and young adults.
These symptoms can overlap with common illnesses and other health problems. Their presence, combination, or location cannot establish whether cancer is present or where a tumor might be. NCI explains that a doctor is needed to determine the cause.
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When to contact a healthcare professional
Talk with the child’s healthcare professional about blood in the stool, a persistent or recurring change in bowel habits, ongoing abdominal symptoms, unexplained weight loss, or other changes that worry you. The American Cancer Society advises medical evaluation when a sign or symptom does not improve or go away. Seek guidance rather than trying to diagnose the cause from a symptom list.
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Childhood colorectal cancer is rare: NCI reports that fewer than 100 children are diagnosed each year in the United States. Rarity does not identify the cause of an individual child’s symptoms, and symptoms alone do not confirm cancer.
How a doctor may evaluate symptoms
The clinician may ask when symptoms started and how often they occur, review the child’s personal and family medical history, and perform a physical examination. Based on those findings, the doctor may recommend further tests. NCI describes colonoscopy as an examination of the colon and rectum that can also allow tissue sampling. Which evaluation is appropriate is a clinical decision; there is no single symptom-based test threshold established for every child.
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Risk factors to mention to the doctor
Some inherited conditions and inflammatory bowel diseases are associated with increased risk. Tell the clinician if the child has a relevant diagnosis or family history; a risk factor does not mean the child will develop cancer, and cases can occur without a known risk factor.
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- Inherited syndromes or gene changes listed by NCI: familial adenomatous polyposis (FAP), attenuated FAP, MUTYH-associated polyposis, oligopolyposis, NTHL1 gene changes, juvenile polyposis syndrome, Cowden syndrome, Peutz-Jeghers syndrome, neurofibromatosis type 1, and constitutional mismatch repair deficiency.
- Inflammatory bowel disease: Crohn disease and ulcerative colitis.
Sources and scope
- National Cancer Institute, Childhood Colorectal Cancer (PDQ®)–Patient Version, updated May 14, 2025.
- National Cancer Institute, Childhood Colorectal Cancer Treatment (PDQ®)–Health Professional Version.
- American Cancer Society, Finding and Diagnosing Cancer in Children.
- American Cancer Society, Finding and Diagnosing Adolescent and Young Adult (AYA) Cancer. Its symptom examples are general AYA guidance, not a pediatric diagnostic rule.
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