Colon carcinoma in childhood: review of the literature with four case reports

Abstract

Childhood CRC has an aggressive pathology and distinct genetic features, which result in an advanced stage at diagnosis and consequently a poor prognosis. Although the incidence is very low, every physician should be aware of CRC as a possible childhood diagnosis.

Dietary Methyl Donor Depletion Suppresses Intestinal Adenoma Development

“…One group that may benefit is adolescent FAP patients, in which a defined period of MDD may suppress polyposis, thereby delaying the need for colectomy. Due to the potential risk associated with dual-modulatory effect of folic acid on colorectal tumorigenesis (52), future clinical application of MDD should be combined with careful monitoring by colonoscopy, which is already used routinely for FAP patients (12). While most of the side effects of MDD are readily reversible upon methyl donor repletion, a thorough investigation of the potential effects of MDD on normal development and cardiovascular integrity will need to be undertaken prior to further clinical applications.…”

“…A randomized, placebo-controlled clinical trial by Cole and Baron found that men with a personal history of colorectal adenoma who received 1 mg/d supplemental folic acid were more likely to present with an advanced colonic lesion at a 5-year follow-up examination (11). This finding may be of particular concern for individuals with hereditary cancer syndromes, such as familial adenomatous polyposis (FAP), who develop multiple neoplastic foci at a young age (12) and as a result may be more susceptible to the potential cancer-promoting effects of folic acid supplementation. In addition, the prevalence of colorectal polyps in individuals over the age of 50 is estimated to be as high as 45% (13–15); these individuals, who are unlikely to become pregnant and are therefore not concerned with NTDs, could in fact be harmed by folic acid supplementation.…”

Selected Case From the Arkadi M. Rywlin International Pathology Slide Club

“…2 Abdominal pain, constipation, hematochezia, and diarrhea dating from a few days to a few months are the most common clinical symptoms, but acute presentation with nausea, vomiting, and intestinal obstruction has also been reported. 12,14,27 As a result, the outcome of pediatric CRC is less favorable, has a higher frequency of tumor progression and relapse, and a worse survival rate than in adults that correlates with the higher grade and stage observed in the first 2 decades of life, either in single case reports, small series, or large study worldwide. In general, CRC may be familial (10% to 20%), with the most frequent predisposing conditions being hereditary nonpolyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP), 14 but is more often sporadic, in the absence of any known predisposing factors, 21 and outside the context of other cancer predisposing syndromes.…”

“…12,14,27 As a result, the outcome of pediatric CRC is less favorable, has a higher frequency of tumor progression and relapse, and a worse survival rate than in adults that correlates with the higher grade and stage observed in the first 2 decades of life, either in single case reports, small series, or large study worldwide. In general, CRC may be familial (10% to 20%), with the most frequent predisposing conditions being hereditary nonpolyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP), 14 but is more often sporadic, in the absence of any known predisposing factors, 21 and outside the context of other cancer predisposing syndromes. 28 Sporadic CRC in children has sometimes also been reported either in association with chronic ulcerative colitis, 18 as a secondary malignant neoplasm after childhood cancer treatment and exposure to radiation and alkylating agents, 19 or occasionally in association with other nonhereditary genetic syndromes, such as Turner syndrome.…”

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

“…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.…”