In Egypt, there is an increasing incidence of colorectal cancer, especially among patients < or = 40 years of age. The aim of this work was to study the characteristics of rectal cancer in a group of young Egyptian patients treated at Alexandria Main University hospital, Alexandria, Egypt, from June 1998 to June 2001. This study included 50 rectal cancer patients. They were divided into two groups. Group I was patients < 40 years of age (26 patients), and group II was patients > 40 years of age (24 patients). Both groups were evaluated regarding history taking and physical examination, the gross tumor characteristics, the presence or absence of metastases, the histopathological characteristics of the tumor, and the treatment failure within the 3-year period of this study. Group I patients had a significantly longer duration of complaint. A total of 15.4% of patients in this group presented with intestinal obstruction compared with 8.3% in group II. A total of 30.8% of patients in group I presented with metastatic disease compared with 20.8% in group II. More patients in group I had fixed and/or circumferential lesions than did those of group II (38.5% and 53.8% versus 20.8% and 8.3%, respectively). More patients in group I had nonresectable tumors. A total of 62.5% of group II patients underwent curative resection compared with 53.8% of the patients in group I. A total of 38.5% of patients in group I had mucoid carcinoma compared with 8.3% in group II. At the end of the 3-year period of this study, only 38.5% of group I patients were alive and free of disease compared with 45.8% in group II. In Egypt, rectal cancer patients <40 years of age have more advanced disease at presentation and a higher incidence of treatment failure caused by both a delay in the diagnosis and a more aggressive pattern of the disease.