Colon carcinoma in children and adolescents: prognostic factors and outcome-a review of 11 cases.
BACKGROUND
Carcinoma of the colon and rectum is rare in the pediatric age group, and usually presents with an advanced stage disease bearing a poor prognosis. Colorectal carcinoma should be considered in children with signs of intestinal obstruction, alteration in bowel habits, gastrointestinal bleeding and chronic abdominal pain. We performed a retrospective study to evaluate the clinical characteristics, and prognosis of these patients.


METHODS
Between 1974 and 2007, 11 patients were identified and treated for colorectal carcinoma at the Oncology Unit. The medical records were studied to analyze the age, sex, clinical presentation, diagnostic procedures, extent of disease (Dukes staging), treatment, histological types, and outcome.


RESULTS
There were seven boys and four girls ranging from 7 to 17 of age. Predisposing diseases and syndromes were encountered in three children, (1 with Turner's syndrome and two with adenomatous familial polyposis). Abdominal pain, acute intestinal obstruction, rectal bleeding and weight loss were the commonest symptoms. Surgical procedures were done in 11 patients (incomplete resection with segmental resection in 4 patients, complete resection in the other 4, and biopsy alone in 3 patients).The predominant histological type was mucinous carcinoma. Seven patients received adjuvant chemotherapy, all of whom did not survive. Two patients died shortly after initial surgery, and two patients are alive, and well.


CONCLUSIONS
Colorectal carcinoma in children is very uncommon and could be easily misdiagnosed, resulting in advanced stage disease at diagnosis. Because radical surgery which is the mainstay of treatment is possible only in patients with early stage disease, a high level of awareness and early diagnosis are critical.
Salas-Valverde
Sonia
S
Department of Surgery, National Children's Hospital, University of Costa Rica, PO Box 1654-1000, San Jose, Costa Rica. ssalasv@hnn.sa.cr
Lizano
Andrea
A
Gamboa
Yessica
Y
Vega
Sergio
S
Barrantes
Max
M
Santamaría
Silvia
S
Zamora
Jose Barrantes
JB
D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D002648:Child; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D003113:Colonoscopy; D003364:Costa Rica / Q000453:epidemiology; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
D000970:Antineoplastic Agents