Adjuvant chemotherapy after resection of stage II colon cancer is still debated. Recurrence risk factors play a significant role in determining treatment recommendations. Researchers set out to characterize the patient and clinicopathologic differences between early-onset and late-onset colorectal cancer and to ascertain whether or not these variations have any bearing on the standard of care. They postulated that the use of adjuvant chemotherapy for stage II colorectal cancer would be significantly impacted by age-specific differences in the presence of high-risk features. A historical cohort study was conducted. Both the National Cancer Institute Intramural Research Program and a hospital designated by the Commission on Cancer participated in the study. Clinicopathologic features of patients with stage II colon cancer who underwent resection were gathered from the National Cancer Database. The patients were divided into 3 groups based on their ages: those less than or equal to 45 years, those between 50 and 75, and those over 75. Adjuvant chemotherapy use and the presence of high-risk clinicopathologic features were quantified. In all, 14,966 people were eligible for the study. Patients under the age of 40 were more likely to have at least 1 high-risk feature (n = 489, 44%) than those between the ages of 40 and middle age (n = 3,734, 40%) or over the age of 60 (n = 1,890, 42%). Comparatively, 627 (56%), younger, and 2,854 (30%) patients received adjuvant chemotherapy. When other important clinicopathologic factors were taken into account, age remained a significant predictor of receiving adjuvant chemotherapy. The treatment decisions were not specifically examined because this was a retrospective study. The efficacy of adjuvant chemotherapy for both high- and low-risk tumors in young patients is debatable. Adjuvant therapy is not commonly used for patients over the age of 65. Whether medical or surgical, oncologists should be cognizant that age is a factor in patients’ treatment outcomes and should avoid basing decisions on age alone.