Colorectal carcinoma in childhood and adolescence: a clinicopathologic review.
OBJECTIVE
Pediatric colorectal carcinoma (CRC) is rare, but the available data suggest that it is more likely than adult CRC to be advanced at presentation and to have a poor outcome. We sought to better characterize pediatric CRC.


METHODS
We reviewed the clinical and pathologic features, prognostic factors, and outcome of CRC in 77 children and adolescents (ages 7 to 19 years) referred to St Jude Children's Research Hospital between 1964 and 2003.


RESULTS
At presentation, 76 patients had one or more signs or symptoms of CRC (abdominal pain, altered bowel habits, weight loss, anemia). Tumors were evenly distributed between the right and left colon; 62% were mucinous adenocarcinoma. At presentation, 86% of patients had advanced-stage disease; more than half had distant metastases. Overall outcome was poor. Advanced stage and mucinous histology were significant predictors of adverse outcome. Stage-specific survival at 10 years was 67% +/- 27% (stage 1), 38% +/- 15% (stage 2), 28% +/- 11% (stage III), and 7% +/- 4% (stage 4). Although no patient had a diagnosis of polyposis syndrome before diagnosis of CRC, 17 (22%) had colon polyps and eight (including two who previously underwent pelvic radiotherapy) had multiple polyps.


CONCLUSIONS
Initial signs and symptoms of CRC are similar in pediatric and adult patients. The strikingly higher frequency of mucinous histology suggests that the biology of CRC differs in pediatric and adult patients and may contribute to poor outcomes. Children should be included in prospective clinical trials for CRC.
Hill
D Ashley
DA
Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA. hill@path.wustl.edu
Furman
Wayne L
WL
Billups
Catherine A
CA
Riedley
Shannon E
SE
Cain
Alvida M
AM
Rao
Bhaskar N
BN
Pratt
Charles B
CB
Spunt
Sheri L
SL
D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002648:Child; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome