<p>Young onset colorectal cancer (YOCRC) is a significant clinical problem in India. This study aims to compare the clinical and pathological characteristics of colorectal cancer in younger (&lt; 45&#xa0;years) and older (≥ 45&#xa0;years) patients. This study is based on the retrospective analysis of data from a prospectively maintained database of a tertiary cancer center. Age was divided into two categories, with those aged 45 and above being classified as normal onset and those below the age of 45 being classified as young or early onset. Data regarding clinical and pathological characteristics were collected and analysed. A total of 964 patients met the inclusion criteria and were included in the study. The mean age of the study population was 52 ± 14&#xa0;years and 568 (58.9%) were men. Of the total study population, 279 (28.8%) were under the age of 45 at the time of diagnosis. Aggressive histology, such as signet ring cell (<i>p</i> = 0.000), mucinous (<i>p</i> = 0.001) or poor differentiation (<i>p</i> = 0.000) were significantly increased in the under 45 group. Younger patients as a whole were also significantly associated with increased risk of advanced T (<i>p</i> = 0.006) and N (<i>p</i> = 0.001) stage at presentation as well as increased presence of metastatic disease on initial evaluation (<i>p</i> = 0.016). Younger patients with CRC are more frequently diagnosed with unfavourable histological subtypes and also present at more advanced stages, frequently with node positive and metastatic disease. These findings highlight the need for greater clinical awareness and possibly earlier screening strategies in younger populations.</p>