Carcinoma of the large intestine with survival in a child of nine and in his father. A study of carcinoma of the colon with particular reference to children

Abstract

SUMMARYThe case reports are presented of a child aged g and his father aged 43 both with colorectal cancer unassociated with polyposis.A number of cases of carcinoma coli in children have been recorded but the outlook is depressingly poor; only I other long-term survival in a child appears to be authenticated.The literature is reviewed and the reasons for the frequent errors and delays in diagnosis are analysed. The fact that the condition often masquerades as appendicitis or mesenteric adenitis in children is stressed.A case is made for a positive approach when dealing with local recurrences even in anaplastic and colloid tumours.It is suggested that certain bowel tumours may invade aggressively but not metastasize via the bloodstream or lymph channels; in these lesions the prognosis will be good if radical surgery is undertaken.The evidence is in favour of a genetic basis for primary carcinoma of the colon and acceptance of this imposes the need for care in observing close relatives.PRIMARY carcinoma of the large gut may appear at any age but it is mainly a disease of older people in the sixth and seventh decades. T h e occurrence of this disease in children always evokes great interest and there are now a number of reports in the world literature. The colon is affected more frequently by cancer in childhood than any other part of the digestive system (Alaghemand, 1962). Alaghemand (1962) analysed 93 cases from the literature of colorectal malignancy in children 15 years old and under and found that in more than 77 per cent the subjects were over 10 years of age. Usually, the younger the age the worse the prognosis and, although a number of cases of iong-term survival are recorded in adolescents over the age of 15 (Scholefield, 1946; Moes and Dittmer, 1943; Hoerner, 1958;O'Brien, 1967)~ .a careful search shows that the child reported here is the youngest case of colonic carcinoma to be alive 10 years after the appearance of the disease. Middelkamp and Haffner (1963) reported a 12-year-old boy with adenocarcinoma of the colon and this patient has now survived to the age of 28 (Middelkamp, 1969). With rectal cancer, recurrence from the original lesion is negligible after 10 years (Bussey, 1963)~ and this applies as far as is known to *Based on a paper presented to the Hospital of the University of Pennsylvania in October, 1969. 59 OF HOSPITALS carcinoma of the colon (Bussey, 1969). It seems likely, therefore, that the boy reported here and Middelkamp's patient have both been cured of their original lesions, although the risk of metachronous cancer occurring in the future is still present (Bussey, Wallace, and Morson, 1967).The development of cancer in a young person raises the suspicion of a genetic basis for the disease and when the father of this child was later found to have a rectal cancer at an early age the possibility of a hereditary factor was greatly strengthened. A study of the family pedigree has been rather disappointing, but we may be dealing here with a 'mutation towards cancer proneness ' (Du...

Carcinoma of the colon: diagnosis by ultrasound and enema

“…The barium enema will also show the same constricting lesions. Two cases are reported, in one of which the initial diagnosis was made by ultrasound.Carcinoma of the colon is an uncommon condition in children and only about 200 cases have been reported [1,2]. We have diagnosed two cases in our radiology department in the last 10 years.…”

First-decade patient with colorectal cancer carrying both germline and somatic mutations in APC gene

“…The development of CRC in children raises the suspicion of a genetic basis for the disease. Pediatric CRC patients are usually related to familial polyposis or ulcerative colitis [ 2 , 3 ]. We recently treated a 10-year-old child for signet ring cell carcinoma of the colon, and this child had no familial polyposis or chronic ulcerative colitis.…”

Study of Colorectal Malignancy in Young Patients

“…he further observed that in children the colon is affected more frequently by cancer than any other parts of digestive system. [6] Inadequate screening and treatment due to low index of suspicion in young patients specially in familial adenomatous polyposis coli is one of the primary factors contributing to poorer prognosis in young patients. [7] Advanced stage at presentation, delay in diagnosis and poorly differentiated Section: Surgery carcinomas are some of the poor prognostic factors usually associated with carcinoma in younger age groups.…”