Primary Gastrointestinal Malignancies in Childhood and Adolescence - the Asian Perspective

Introduction: Primary gastrointestinal (GI) malignancies are a rarity in childhood and adolescence, withlimited information from Asian populations. This study was conducted with the objective of identifying theexistence of malignant GI tumors in the young population of Pakistan and to determine high risk geographicalareas of the country. Methodology: Pediatric and adolescence (≤14 years; ≤19 years) gastrointestinal malignancies,ICD-10 categories C15-20 registered at the surgical pathology department of the Aga Khan University Hospitalduring 1st March 2004 to 30th April 2006 were included in the cross-sectional study.
Results:Sixty cases in ≤19year age group were studied. The mean age was 16.2 years (SD±4.56). Carcinoma comprised 47 cases (78.3%;32 boys and 15 girls.) and lymphoma 13 cases (21.7%; 12 boys and 1 girl). All cases presented as advancedmalignancies. Categorization of carcinoma by site was colon (85.1%), stomach (6.4%) and esophagus (8.5%).Lymphoid malignancies were diffuse large B-cell lymphoma (30.8%), Burkitt lymphoma (46.1%) and Burkittlikelymphoma (23.1%). The mean age at presentation was 11.1 years (SD± 4.6).
Conclusion: This study hasidentified a substantial number of GI malignancies in the ≤19 year Pakistani population, involvement of esophagus,male predominance, preponderance of carcinoma versus lymphoma and a high signet ring cell and mucinouscolo-rectal carcinoma. It has identified Baluchistan as a high risk region for esophageal cancer and diffuse largeB-cell lymphoma and NWFP for Burkitt and Burkitt-like lymphoma. Most findings in the present study did notconcur with published western data, indicating the need to study cancer in the Asian population.