Colorectal Carcinoma in Children - Experience at a Tertiary Care Cancer Centre in Pakistan

Background: Colorectal carcinoma in the pediatric population is extremely rare. We report our experiencewith this disorder presenting in children and adolescents. Procedure: A retrospective review was conducted ofmedical records of all patients aged 18 years and less who were registered at Shaukat Khanum Memorial CancerHospital & Research Centre (SKMCH & RC), Lahore, Pakistan, with a diagnosis of colorectal carcinoma between1st January 1995 and 1st January 2006.
Results: Of a total of 2,142 pediatric patients with non-hematologicmalignancies registered at SKMCH & RC in the specified time period, 29 (1.35%) had colorectal carcinoma.Ages ranged from 7 to 18 years, with a median of 15 years. There were 25 males and 4 females. All were Pakistaniin origin, 22/29 belonging to rural areas of the country. Family history of gastrointestinal malignancy was foundin only 1 patient. The commonest presenting complaints were constipation and bleeding from the rectum. Therewas a site predilection for the rectum (16/29). Histopathology showed high grade adenocarcinoma in 17/29,signet ring carcinoma was prominent amongst this group, 9/17 (52.9%). Some 25 of 29 (86.2%) presented atTNM stages III or IV - 12 patients were fit only for palliation at presentation, the remaining 17 were given multimodalitytherapy using surgery, radiotherapy and chemotherapy. A total of 15 of 29 (51.7%) patients haveexpired, 4/29 were lost to follow-up, 10/29 are still alive but of these 5 have uncontrolled disease while 5 are alivewith no evidence of disease. Of the 5 who are in complete remission (CR), 1 remains free of disease 4 years posttreatment, 2 are in CR more than 2 years and 1 remains in remission 1.5 years after treatment of metastaticadenocarcinoma colon. The 5th patient went into remission with treatment of adenocarcinoma colon but developedglioblastoma multiforme immediately afterwards and is currently on treatment for GBM.
Conclusions: Ourclinical experience with these patients corresponds to other reports in literature that show a marked predominanceof high grade lesions, advanced stage at diagnosis, and poor responses to treatment in this age group. Our datasuggest that colorectal cancer in children may be more common in our local population compared to figuresfrom developed countries. Pediatricians and pediatric oncologists need to have a higher index of suspicion forcolorectal carcinoma in patients presenting with chronic gastrointestinal symptoms to allow early diagnosis andbetter clinical outcome in this age group. Future studies should concentrate on etiologic factors especially therole of environmental pollutants and possible influence of dietary and social habits.