title: Colon carcinoma in children and adolescents: prognostic factors and outcome-a review of 11 cases.
abstract: 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.
authors.affiliation: Department of Surgery, National Children's Hospital, University of Costa Rica, PO Box 1654-1000, San Jose, Costa Rica. ssalasv@hnn.sa.cr
authors.forename: Sonia
authors.initials: S
authors.lastname: Salas-Valverde
authors.forename: Andrea
authors.initials: A
authors.lastname: Lizano
authors.forename: Yessica
authors.initials: Y
authors.lastname: Gamboa
authors.forename: Sergio
authors.initials: S
authors.lastname: Vega
authors.forename: Max
authors.initials: M
authors.lastname: Barrantes
authors.forename: Silvia
authors.initials: S
authors.lastname: Santamaría
authors.forename: Jose Barrantes
authors.initials: JB
authors.lastname: Zamora
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents