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This chapter reviews the molecular and clinical features that distinguish EOCRC, with attention to emerging precision oncology strategies, including germline testing, tumor genomic profiling, and biomarker-directed therapies. In metastatic disease, recent advances in targeting\n                    <jats:italic toggle=\"yes\">BRAF<\/jats:italic>\n                    V600E,\n                    <jats:italic toggle=\"yes\">KRAS<\/jats:italic>\n                    G12C,\n                    <jats:italic toggle=\"yes\">HER2<\/jats:italic>\n                    amplification, and microsatellite instability-high (MSI-H)\/mismatch repair deficiency tumors have reshaped therapeutic paradigms. Tumor sidedness and metastatic site patterns are now recognized as predictive and prognostic factors. In localized disease, neoadjuvant immunotherapy for MSI-H tumors and nonoperative management are redefining standard care, with special relevance to younger patients seeking fertility preservation or organ-sparing approaches. The chapter also addresses key gaps in EOCRC care, including underutilization of fertility preservation counseling and limited guidance for cancer management during pregnancy. A multidisciplinary, lifecycle-based framework is essential to optimize outcomes and improve quality of life for this unique and growing patient population.\n                  <\/jats:p>","DOI":"10.1200\/edbk-25-473618","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T19:59:11Z","timestamp":1752177551000},"source":"Crossref","is-referenced-by-count":15,"title":["Early-Onset Colorectal Cancer: From Genetic Discovery to Clinical Innovation"],"prefix":"10.1200","volume":"45","author":[{"given":"Anita","family":"Turk","sequence":"first","affiliation":[{"name":"Division of Hematology\/Oncology, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebasti\u00e1n","family":"Mondaca","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Cat\u00f3lica de Chile, Red de Salud UC Christus, Cancer Institute, Santiago, Chile"},{"name":"Center for Cancer Prevention and Control, CECAN, School of Medicine, Pontificia Universidad Cat\u00f3lica de Chile, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Nervi","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Cat\u00f3lica de Chile, Red de Salud UC Christus, Cancer Institute, Santiago, Chile"},{"name":"Center for Cancer Prevention and Control, CECAN, School of Medicine, Pontificia Universidad Cat\u00f3lica de Chile, Santiago, Chile"},{"name":"Vanderbilt University School of Medicine, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison D.","family":"Morris","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Finer","sequence":"additional","affiliation":[{"name":"Vanderbilt-Ingram Cancer Center, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreana N.","family":"Holowatyj","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN"},{"name":"Vanderbilt-Ingram Cancer Center, Nashville, TN"},{"name":"University of Utah School of Medicine, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw322"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21772"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2014.1756"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2019-319511"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zraf024"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-020-00445-1"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.02378"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.5194"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.71.0012"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.11.004"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.61.4503"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.04.013"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(21)00426-X"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pky054"},{"key":"e_1_3_5_16_2","article-title":"Multigene panel testing yields high rates of clinically actionable variants among patients with colorectal cancer","author":"Coughlin SE","unstructured":"Coughlin SE, Heald B, Clark DF, et al: Multigene panel testing yields high rates of clinically actionable variants among patients with colorectal cancer. 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