Purpose: The incidence of early-onset rectal cancer (<50 years) has more than doubled since 2000 with growing concern that younger patients face diagnostic delays and present with advanced disease. This retrospective cohort study compared two unscreened aged groups during the study period and investigated whether patients aged 18-44 present with more advanced disease and longer diagnostic delays than those aged 45-49 and examined the frequency of digital rectal examinations (DRE) performed in primary care. Methodology: Patients aged < 50 who underwent resection of rectal adenocarcinoma between 2014-2022 at the Royal Brisbane and Women’s Hospital were included in this study, Patients with hereditary colorectal cancer syndromes or recurrent disease were excluded. Data were collected from Metro North Health electronic medical records and analysed using Chi-squared analysis with Fisher’s exact test, Mann-Whitney test, and Kaplan-Meier analysis. Results: There were 90 patients that met the inclusion criteria. Younger patients aged 18-44 did not present with more advanced disease or longer delays than those aged 45-49. In this study, 70% of patients presented with advanced disease, compared to 40% of the general population with the disease, according to nationwide AIWH data. The overall rate of DREs performed by general practitioners on the study cohort was 24%, despite 93% presenting with symptoms at their consultation. 5-year disease free survival for the 18-44 group was 58% and 72% for the 45-49 group (p = 0.73). Conclusion: A high proportion of symptomatic young patients were referred to specialist care without undergoing DRE. The findings suggest that patients in the study cohort are presenting with more advanced disease than the general population, and that raising awareness of young colorectal cancer with patients and general practitioners is important.