Colorectal adenocarcinoma in childhood and adolescent

Abstract

Eleven new cases of colorectal carcinoma in children (0-15 years of age) are added to the 212 cases already described in the literature. Mucinous adenocarcinoma was the most frequent histological type. Acute abdominal obstruction was the most frequent presentation. A radiologic diagnosis of malignancy was made in only six of eleven cases. The interval between onset of clinical symptoms and diagnosis ranged from two days to one year. Duration of symptoms, pathologic findings, stage, and prognosis differed markedly as compared with adult colorectal carcinomas. In spite of its rarity, colorectal malignancies may occur in children.

Important considerations in treating children, adolescents and young adults with colorectal carcinoma

“…Occasionally they can present with acute localized pain suggestive of appendicitis [26,30,34]. Acute pain from perforation, obstruction or mirroring acute appendicitis can be the presenting complaints in up to 50% of young CRC patients in some reports [15,18,21,22,26,30]. This is contrasted with an estimated 15-20% of adults who have similar acute abdominal presentations [71].…”

“…In contrast, these same symptoms in a 60-year old would prompt an immediate colonoscopy. This delay in evaluation is thought by some to be the explanation for advanced stage presentation in these young patients [18,22,26,31,73]. However it could also be related to an intrinsic biologic difference.…”

“…While enrichment for HNPCC in the pediatric and AYA patients may explain some of the differences in the disease process compared with older patients, evidence suggests, for example, that MSI can occur in the former group in the absence of any predisposing inherited genetic defects [79]. Many reports also suggest these young patients have a very poor prognosis [11][12][13]15,[18][19][20][21][22][24][25][26][27]30,31,[33][34][35]40,42,43,94]. Some suggest this inferior outcome is due to the rarity of the disease, resulting in a delay in diagnosis and a more advanced stage at presentation.…”

Colorectal carcinoma in children and adolescents

“…1,32,35,36 It has been hypothesized that such delay may account, in part, for the presentation of more advanced stages. [36][37][38] CRC is classified based on the following histologic patterns and grades (pediatric frequency based on data from the SEER Program): 3…”

Carcinoma colorrectal en niños y adolescentes

“…1,32,35,36 Se ha hipotetizado que dicha demora explicaría, en parte, la presentación en estadios más avanzados. [36][37][38] El CCR se clasifica según los siguientes patrones y grados histológicos (frecuencia en pediatría según datos de SEER): 3 • Patrones histológicos -Adenocarcinoma no especificado (NOS por sus siglas en inglés) (43 %). -Adenocarcinoma mucinoso (22 %).…”