Colorectal adenocarcinoma as a second malignant neoplasm following Wilms' tumor and rhabdomyosarcoma

Abstract

Colorectal carcinoma is one of the most common primary malignancies in adults and occurs in older patients after pelvic radiation. It is rare in children and young adults. We report two cases of colonic adenocarcinoma which were second malignant neoplasms following treatment for early childhood malignancies. One child had Wilms' tumor at 9 months of age treated with preoperative radiation and surgery. He developed radiation colitis and rnultifocal intestinal adenocarcinomas 42 years later and died with abdominal carcinomatosis. The second child had retroperitoneal embryonal rhabdomyosarcoma at age 1 year and was treated with preoperative radiation, surgery, and chemotherapy. At age 2 years he had radiation colitis; at age 1 1 years he had rectal adenocarcinoma associated with adenomatous polyps, focal adenomatous change and radiation colitis. lmmunohistochemical studies revealed p53 positivity in both adenocarcinomas and in adenomas from the second patient, suggesting that p53 mutation was involved in carcinogenesis. The history of high-dose radiation in early childhood and the multifocal lesions suggest the adenocarcinomas in both patients were second malignant neoplasms, with associated reactive and benign neoplastic and prernalignant lesions well documented in one case. These two cases document the phenomenon of early onset of adult type tumors in survivors of childhood cancer and emphasize the need for continued clinical evaluation of patients at risk for second malignant neoplasms.o 1996 Wiiey-Liss, Inc

Risk of subsequent colorectal cancers after a solid tumor in childhood: Effects of radiation therapy and chemotherapy

“…From this, we demonstrated an increased risk of CRC with increasing radiation dose to the site of the CRC (EOR = 0.13 per Gy; 97.5% CI, 0.02–0.48). This association between radiation and CRC risk was in line with numerous previous studies, including an excess risk estimate from a case–control study by Nottage and colleagues of childhood cancer survivors (EOR = 0.17 per Gy; 95% CI, −0.05–0.31) . Some CRC cases in this report developed in survivors treated with less than 30 Gy at the site of the CRC .…”

Health status of the oldest adult survivors of cancer during childhood

“…36,37 In addition, no plateau in incidence of radiation-associated secondary malignancies in young adult survivors of childhood cancer has been identified. [7][8][9] Our study confirms that survivors are at risk for radiation-associated malignancies up to 50 years beyond the initial radiation exposure.…”