Colorectal carcinoma in childhood: a retrospective multicenter study.
OBJECTIVE
Colorectal carcinoma, a common adult malignancy, has an estimated childhood incidence of 0.3 to 1.5/million in Western countries and 0.2/million in Israel. Diagnosis is difficult because adult screening measures are unfeasible in children. The tumor is frequently associated with predisposing genetic factors, aggressive biological behavior, and poor prognosis. The aim of this multicenter study was to document the clinical profile, treatment and prognosis of colorectal carcinoma in children in Israel.


METHODS
The clinical, laboratory, therapeutic, and prognostic parameters of all 7 children from 4 medical centers in Israel who were diagnosed with colorectal carcinoma over a 25-y period were reviewed.


RESULTS
Patients presented with rectal bleeding (4 of 7), abdominal pain (2 of 7), and abdominal distension (2 of 7). Average time to diagnosis was 6 months. Six patients underwent surgery (1 refused), and 5 received chemotherapy. Histopathological studies showed poorly differentiated mucinous adenocarcinoma, signet-ring type, in 4 cases, moderately differentiated adenocarcinoma in 2, and well-differentiated carcinoma in 1. Three patients died of the disease, 2 shortly after diagnosis. One patient with recurrent metastatic disease was lost to follow-up.


CONCLUSIONS
Colorectal carcinoma in children is characterized by aggressive tumor behavior and delayed diagnosis, resulting in a worse prognosis than in adults. Heightened physician awareness of the possibility of this disease in children, with special attention to adolescents with predisposing factors and rectal bleeding, could help to improve outcome.
Kravarusic
Dragan
D
Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
Feigin
Elad
E
Dlugy
Elena
E
Steinberg
Ran
R
Baazov
Arthur
A
Erez
Ilan
I
Lazar
Ludvig
L
Kapuller
Vadim
V
Grunspan
Moshe
M
Ash
Shifra
S
Freud
Enrique
E
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000628:therapy*; D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002675:Child, Preschool; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies
D000970:Antineoplastic Agents