Colorectal Carcinoma in Pediatric Age Group-Epidemiological Paradigm

Abstract

Objectives: Colorectal cancer is a rare disease in pediatric age group with an annual incidence of 1.3 cases per million children. Spectrum of colorectal cancer includes the pediatric population also, which usually presents at advanced stage, unfavorable histology and ultimately poor prognosis. Difficult differential diagnosis, delay in presentation and aggressive biological behavior leads to poor outcome. Methods: Retrospective analysis of all pediatric colorectal cancer patients presented to Division of Pediatric Surgery between June 2006 to June 2012 were included in the study. A specifically designed audit form was devised to capture all relevant information regarding clinical presentation, pathologic factors, treatment outcome, prognostic factors and follow up. Results: (Figure presented) During the study period of 6 years from June 2006 to June 2012 only 7 cases of pediatric colorectal cancer were reported. Median age was 11.8 years [range, 5-16years]. Five patients presented with features of intestinal obstruction and diagnosed during emergency laparotomy. The most common site of involvement was rectum (59%) & transverse colon being the next most common site (26%). Adenocarcinoma was histological type in all patients. 3 patients died within 2 years of follow-up. Rest 4 patients are receiving treatment and under follow-up. Conclusions: Colorectal cancer is a rare disease in pediatric age group. Diagnostic dilemma, difficult differential diagnosis, delayed presentation & treatment, advanced stage and poor histological features contributes to the poor prognosis of the disease in pediatric age group as compared to adults. As in adult colorectal cancer; early detection, stage stratification, multidisciplinary treatment plan and participation in prospective clinical trials will help in improving the prognosis and outcome in pediatric patients.