A single-center experience of managing colorectal carcinoma in children

Objective To retrospectively review the clinical manifestations, pathological characteristics and outcomes of colorectal carcinoma and compare them with those of adults. Methods Between January 2010 and January 2016, 3401 patients with colorectal carcinoma were hospitalized. There were 4 boys and 2 girls with a mean age of 13 years. Six of them (0.17%) were aged under 14 years. All diagnoses were confirmed by pathological examination. Two age groups of adult patients were randomly sampled [20-30 years (n=17) and 50-60 years (n=67)] and their clinical presentations and pathological characteristics were compared with those of adults. Results The presenting manifestations included abdominal pain, hematochezia, abdominal mass, intestinal obstruction, and change in frequency/form of stool. Tumor locations included colon (n=5) and rectum (n=1). The pathological diagnoses were mucinous adenocarcinoma (n=2), signet-ring cell carcinoma (n=3) and ductal carcinoma (n=1). Metastasis was regional lymphatic (n=5) and distant (n=1). One case had intestinal neuronal dysplasia while another was operated plus adjuvant chemotherapy for hepatoblastoma 10 years previously. Three of them received chemotherapy. Until 30 August 2016, there were death (n=3), lost to follow-up (n=1) and survival (n=2). Two survivors had a worse quality of life than healthy controls. The adult dominant presenting symptom was altered stool habit. Their pathological diagnoses were ductal carcinoma, poorly differentiated adenocarcinoma, signet-ring cell carcinoma and mucinous adenocarcinoma in those aged 20-30 years versus ductal carcinoma, mucinous adenocarcinoma, papillary tubular adenocarcinoma, poorly differentiated adenocarcinoma and undifferentiated cancer in those aged 50-60 years. Conclusions Pediatric colorectal carcinoma is extremely rare and our reviewed cases account for 0.17% of all reported cases. The clinical presentations are similar for children and adults. However, children present predominantly with recurrent abdominal pain, hematochezia, abdominal mass, intestinal obstruction and rarely alteration in stool habit, whereas this is the commonest presenting symptom in adults. Most tumors are located in colon. Mucinous adenocarcinoma and signet-ring cell carcinoma are the major pathological diagnoses in children. And most of them have regional lymphatic metastases while ductal carcinoma is more common in adults. Key words: Dolorectal neoplasms; Pathology, surgical