Colorectal carcinoma in children and adolescents: the experience of the Istituto Nazionale Tumori of Milan, Italy.
BACKGROUND
Colorectal carcinoma (CRC) is one of the most common tumors in adults, but extremely rare in young age. This study retrospectively reports on a group of 27 patients <30 years of age, and particularly on 7 cases <18 years old, treated at the Istituto Nazionale Tumori, Milan, Italy, between 1985 and 2005.


METHODS
Among the children/adolescents (age 9-18, median 12 years), 5/7 had unfavorable CRC histotypes (poorly differentiated or mucinous adenocarcinoma) and all but one had advanced disease at onset. Initial surgical resection was complete in 5/7 cases, and all patients received postoperative chemotherapy.


RESULTS
In the subset of patients <18 years, 6/7 had tumor progression or relapse, and 5 died of their tumor: overall survival (OS) was 23% at 5 years. In the group of 19- to 29-year-olds (young adults), 5-year OS was 72.6%.


CONCLUSIONS
This study confirms the rarity and poor prognosis of CRC in children and adolescents: advanced stage and an aggressive biology are hallmarks of this tumor in pediatric age, while clinical findings and outcome in young adults seem more similar to those observed in adult series. Therapeutic recommendations should stay the same as for adults. Surgery remains the mainstay of treatment and early diagnosis is crucial: it is important for pediatricians to be aware that CRC does occur in children, in order to refer suspected cases to expert physicians professionally dedicated to the management of this cancer in adults.
Ferrari
Andrea
A
Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy. andrea.ferrari@istitutotumori.mi.it
Rognone
Alessia
A
Casanova
Michela
M
Zaffignani
Elena
E
Piva
Luigi
L
Collini
Paola
P
Bertario
Lucio
L
Sala
Paola
P
Leo
Ermanno
E
Belli
Filiberto
F
Gallino
Gianfranco
G
D000230:Adenocarcinoma / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics / Q000601:surgery; D011125:Adenomatous Polyposis Coli / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002648:Child; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics / Q000601:surgery; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000453:epidemiology; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents