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Nofi CP, Siskind S, Deutsch GB, Ricci JP, Lipskar AM. NCCN Guideline Concordance Improves Survival in Pediatric and Young Adult Rectal Cancer. J Pediatr Surg 2024; 59:464-472. [PMID: 37903675 DOI: 10.1016/j.jpedsurg.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Although management guidelines in adult rectal cancer are widely studied, no consensus guidelines exist for the management of pediatric and young adult rectal cancer. METHODS The National Cancer Database (2004-2018) was queried for pediatric (age 0-21) and young adult (age 22-40) patients with rectal cancer. Patients were analyzed for receipt of National Comprehensive Cancer Network (NCCN) guideline-concordant therapy. Impact on survival was evaluated using Cox regression and Kaplan-Meier analysis. RESULTS 6655 patients (108 pediatric and 6547 young adult patients) with rectal cancer were included. Similar to previously published NCCN quality measures with overall guideline concordance approaching 90 % in adults, 89.6 % of pediatric and 84.6 % of young adult patients were classified as receiving pre-operative guideline-concordant therapy. However, pediatric patients were significantly less likely to receive post-operative guideline-concordant therapy than young adult patients (65.3 % verse 76.7 %, respectively, p = 0.008). Risk of death was significantly lower for pediatric patients who received post-operative guideline-concordant therapy (HR, 0.313; CI, 0.168-0.581; p < 0.001). In young adult patients, risk of death was significantly lower for those who received pre-operative guideline-concordant therapy (HR, 0.376, CI 0.338-0.417, p < 0.001), and post-operative guideline-concordant therapy (HR, 0.456; CI 0.413-0.505; p < 0.001). DISCUSSION NCCN-based guidelines may reasonably guide peri-operative management decisions and improve survival in pediatric and young adult rectal cancer. Given the rarity of this cancer in young patients, employment of an experienced surgical and oncologic multidisciplinary team, along with discussion and involvement of the patient and family, are keys for balancing risks and benefits to offering the best therapeutic strategy. TYPE OF STUDY Retrospective. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Colleen P Nofi
- Cohen Children's Medical Center, Division of Pediatric General, Thoracic, and Endoscopic Surgery, 269-01 76th Avenue, Queens NY 11040, USA; Northwell North Shore/Long Island Jewish, Department of Surgery, 300 Community Drive, Manhasset NY 11030, USA.
| | - Sara Siskind
- Northwell North Shore/Long Island Jewish, Department of Surgery, 300 Community Drive, Manhasset NY 11030, USA
| | - Gary B Deutsch
- Northwell North Shore/Long Island Jewish, Department of Surgery, 300 Community Drive, Manhasset NY 11030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead NY 11548, USA
| | - John P Ricci
- Northwell North Shore/Long Island Jewish, Department of Surgery, 300 Community Drive, Manhasset NY 11030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead NY 11548, USA
| | - Aaron M Lipskar
- Cohen Children's Medical Center, Division of Pediatric General, Thoracic, and Endoscopic Surgery, 269-01 76th Avenue, Queens NY 11040, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead NY 11548, USA
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Caecal Diverticulum Causing Catastrophic Gastrointestinal Bleeding in a Child: A Case Report. THE ULSTER MEDICAL JOURNAL 2022; 91:30-31. [PMID: 35169336 PMCID: PMC8835424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/09/2022]
Abstract
Solitary caecal diverticulae are rare in children and presentation with massive gastrointestinal (GI) bleeding is seldom reported. We present the case of a 13-year-old boy with a two-year history of abdominal pain and multiple inconclusive investigations presenting with a life threating lower GI bleed. We also review the literature surrounding solitary caecal diverticulae and caecal duplication cysts (CDCs).
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Donkol A, AlSomali RA, AlShammari AM, AlKhamis HA, AlHarbi LK, AlHazmi AA, Daiel AAM, Mohzari DAM, Hejres AJ, AlRefaei NA, AlShehri BM. Review on Diagnosis and Management of Colorectal Carcinoma. CLINICAL CANCER INVESTIGATION JOURNAL 2022. [DOI: 10.51847/dxsj8lrq5w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bilal S, Saeed SM, Sidique MZ, Yusuf MA. Metallic stent insertion to relieve malignant bowel obstruction in a child: a case report. Ther Adv Gastrointest Endosc 2022; 15:26317745221111942. [PMID: 35860788 PMCID: PMC9290144 DOI: 10.1177/26317745221111942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
Self-expandable metallic stents (SEMS) have been widely used in adults to relieve obstruction secondary to colorectal tumours. However, there is a paucity of literature about their use in children, with only a few case reports describing stent insertion in children with benign colonic conditions. There is one case report on a malignant colonic condition in a child by Hussain et al. in the literature. However, due to the rarity of the condition, there are currently no guidelines from learned societies on colorectal SEMS placement in paediatric patients. We share our experience of using a fully covered SEMS to relieve malignant colonic obstruction in a 6 year-old-child, who was on treatment for T cell lymphoma. This was done as a bridge to surgery, thereby allowing planned surgery, and avoiding colostomy in this child, who went on to have colonic resection with primary anastomosis.
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Affiliation(s)
- Sundus Bilal
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A, Block R-3, Johar Town, Lahore, Punjab 54000, Pakistan
| | - Saad M. Saeed
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Muhammad Z. Sidique
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Muhammed A. Yusuf
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
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Hippert F, Desing L, Diez S, Witowski A, Bernbeck B, Abele M, Seitz C, Erdmann F, Brecht I, Schneider DT. Rare Tumors in Children and Adolescents - the STEP Working Group's Evolution to a Prospective Registry. KLINISCHE PADIATRIE 2021; 234:146-153. [PMID: 34798669 DOI: 10.1055/a-1675-3145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Very rare tumors (VRT) in children and adolescents have such a low incidence that until recently, they have not been integrated into the clinical and scientific network of pediatric oncology. Data is very limited and consistent treatment strategies are missing. Thus, VRTs are classic orphan diseases. To counteract this problem, the Arbeitsgemeinschaft für Seltene Tumorerkrankungen in der Pädiatrie (STEP) was founded. Here we report on patient recruitment during the first 10 years. Patients Patients aged up to 18 years and not included in any other clinical trial or GPOH registry were included in this analysis. Methods Data was collected from 2008 to 2018 by means of a standardized form. The recorded diagnoses were descriptively analyzed focusing on histology, localization, and year of report. Results A total of 623 patients with VRTs were registered. During 2008-2014, the annual number of registrations was around 40 and is around 90 since 2015. Most frequent diagnoses included tumors of the skin (n=150), tumors of the gastrointestinal tract (n=102), tumors of the gonads (n=77), the ENT region (n=68), and miscellaneous tumors (n=107). Discussion With the establishment of central structures for clinical consultation and documentation of VRTs, the number of registrations increased. Comprehensively, VRTs are as common as other classic pediatric oncology tumors, but extremely heterogeneous in terms of localization, histology, and prognosis. By a centralized and complete registration and analysis of VRTs, also in collaboration with international partners, it is possible to develop treatment strategies and thus greatly increase treatment quality.
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Affiliation(s)
- Felicitas Hippert
- Clinic of Pediatrics, Municipal Hospital Dortmund, Dortmund, Germany
| | - Lena Desing
- Clinic of Pediatrics, Hospital Weiden, Weiden, Germany
| | - Sonja Diez
- Pediatric Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Andrea Witowski
- Clinic of Pediatrics, Municipal Hospital Dortmund, Dortmund, Germany
| | - Benedikt Bernbeck
- Clinic of Pediatrics, Municipal Hospital Dortmund, Dortmund, Germany
| | - Michael Abele
- Pediatric Hematology/Oncology, University Hospital Tubingen Department of Pediatrics, Tubingen, Germany
| | - Christian Seitz
- Pediatric Hematology/Oncology, University Hospital Tubingen Department of Pediatrics, Tubingen, Germany
| | - Friederike Erdmann
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ines Brecht
- Pediatric Hematology/Oncology, University Hospital Tubingen Department of Pediatrics, Tubingen, Germany
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Akinkuotu AC, Maduekwe UN, Hayes-Jordan A. Surgical outcomes and survival rates of colon cancer in children and young adults. Am J Surg 2021; 221:718-724. [PMID: 33678398 DOI: 10.1016/j.amjsurg.2021.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Colon cancer in children and young adults is rare. We sought to compare outcomes and survival between patients ≤and>25 years of age with colon cancer. METHODS Using the National Cancer Database, patients with colon cancer between 2004 and 2016 were identified. We included patients with histological codes consistent with invasive colon adenocarcinoma and excluded those missing data about treatment. Post-surgical outcomes and survival were compared. RESULTS Of 531,462 patients meeting criteria, 947 were ≤25 years. Patients ≤25 had more advanced disease (stage III:44.4%vs33.4%, stage IV:27.5%vs.15.3%) and higher rates of total colectomy (8.9%vs.2.7%) and proctocolectomy (5.0%vs.0.0%) than those >25 years. Stage for stage, 5-year survival was higher in patients ≤25 than those >25years. On multivariate regression, age was not associated with increased risk of mortality while male sex and uninsured status were. CONCLUSIONS Despite presenting with more advanced disease, patients ≤25 years with colon cancer had better survival than those >25 years.
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Affiliation(s)
- Adesola C Akinkuotu
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | - Ugwuji N Maduekwe
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Andrea Hayes-Jordan
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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Tian X, Wang Q, Cai W. <p>A Novel Mutation in <em>MYH</em> Gene Associated with Aggressive Colorectal Cancer in a Child: A Case Report and Review of Literature</p>. Onco Targets Ther 2020; 13:8557-8565. [PMID: 32904697 PMCID: PMC7457591 DOI: 10.2147/ott.s259587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/03/2020] [Indexed: 12/05/2022] Open
Abstract
Colorectal cancer is a rare pediatric tumor. Pediatric patients with colorectal cancer present with more aggressive tumor biology and at later stages of the disease, higher proportions of signet ring and mucinous histology, and less differentiation. The effective treatment is same as that received by adults. The overall prognosis of pediatric colorectal cancer is generally poor. Genetic mutations have been identified as the cause of inherited cancer risk in some colorectal cancers. Here, we presented a case of a pediatric patient carrying a maternally derived, heterozygous MYH germline mutation (c.934–2A>G,intron), the mutation was not reported in pediatric patients before. Also, the patient carried somatic mutations of proto-oncogene SMAD4 (R361C) and TP53 (Y234H). The patient underwent surgical resection, chemotherapy and targeted therapy, but the prognosis was not good. We also review the literature to summarize clinical features, gene mutations, management, and outcomes of pediatric colorectal cancer patient. Our results suggest that the genetic mutation of MYH together with somatic mutations of proto-oncogene SMAD4 and TP53 may lead to the early onset colorectal cancer of the patient. Although the overall prognosis of pediatric colorectal cancer is generally poor, the pathogenesis may be related to hereditary genetic mutations as was found with the MYH gene mutation in our case. Genetic screening can provide early diagnosis and improve prognosis.
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Affiliation(s)
- Xin Tian
- Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning110022, People’s Republic of China
| | - Qian Wang
- Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning110022, People’s Republic of China
| | - Weisong Cai
- Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning110022, People’s Republic of China
- Correspondence: Weisong CaiDepartment of Clinical Oncology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang110022, People’s Republic of China Email
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8
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Early onset colon cancer affected by Lynch syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Tiwari C, Zadpe A, Rathi P, Shah H. An Unusual Presentation of Rectal Carcinoma in a Child. Pediatr Gastroenterol Hepatol Nutr 2018; 21:72-75. [PMID: 29383308 PMCID: PMC5788954 DOI: 10.5223/pghn.2018.21.1.72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 11/23/2022] Open
Abstract
Colorectal carcinoma is a well-known malignancy in adults. However, it is rare in children. Besides, it also has different behaviour in paediatric age-group and usually presents with non-specific symptoms like abdominal pain, weight loss, and anaemia. This usually leads to delay in diagnosis. Adenocarcinoma in children has unfavourable tumour histology (mucinous subtype) and advanced disease stage at presentation which lead to poorer prognosis in children. Family history, genetic typing and sibling screening are essential components of management as this malignancy is frequently seen associated with hereditary syndromes. We describe a case of unusual presentation of rectal carcinoma in a 12-year-old girl.
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Affiliation(s)
- Charu Tiwari
- Department of Paediatric Surgery, TNMC & BYL Nair Hospital, Mumbai, India
| | - Ashish Zadpe
- Department of Paediatric Surgery, TNMC & BYL Nair Hospital, Mumbai, India
| | - Pravin Rathi
- Department of Gastroenterology, TNMC & BYL Nair Hospital, Mumbai, India
| | - Hemanshi Shah
- Department of Paediatric Surgery, TNMC & BYL Nair Hospital, Mumbai, India
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10
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Omar Carrim Y, Gaxa L, van der Schyff F, Bida NM, Omar F, Lockhat Z. Does radiotherapy prior to surgery improve long term prognosis in pediatric colorectal cancer in lower- and upper-middle income countries with limited resources? Our experience and literature review. J Egypt Natl Canc Inst 2017; 29:201-206. [PMID: 29233454 DOI: 10.1016/j.jnci.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/14/2017] [Accepted: 11/19/2017] [Indexed: 02/07/2023] Open
Abstract
Colorectal carcinoma in children and adolescents is extremely rare, with an annual incidence <0.3 cases per million, most frequently reported in the second decade of life. It accounts for severe morbidity and poor prognosis owing to the low index of suspicion, delayed diagnosis, advanced stage at presentation and the aggressive tumor nature. Patients present with abdominal pain, vomiting, constipation, abdominal distension, rectal tenesmus, iron-deficiency anemia, change in bowel habit and weight loss. Rectal bleeding is an uncommon presentation in children. Bowel obstruction presents frequently in children compared to adults. In 90% of pediatric cases, colorectal carcinoma occurs sporadically. In 10%, predisposing conditions and syndromes are identified. We present a case study of a 12-year-old female with advanced colorectal cancer without a predisposing disease or syndrome, who received radio-chemotherapy ten weeks prior to radical abdominopelvic surgery, followed by radio-chemotherapy postoperatively, with a positive outcome.
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Affiliation(s)
- Yacoob Omar Carrim
- Department of Radiology, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia 0007, South Africa.
| | - Luvo Gaxa
- Department of Radiology, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia 0007, South Africa.
| | - Francisca van der Schyff
- Department of Pediatric Surgery, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia 0007, South Africa.
| | - Nndweleni Meshack Bida
- Division of Anatomical Pathology, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia 0007, South Africa.
| | - Fareed Omar
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia 0007, South Africa.
| | - Zarina Lockhat
- Department of Radiology, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia 0007, South Africa.
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Poles GC, Clark DE, Mayo SW, Beierle EA, Goldfarb M, Gow KW, Goldin A, Doski JJ, Nuchtern JG, Vasudevan SA, Langer M. Colorectal carcinoma in pediatric patients: A comparison with adult tumors, treatment and outcomes from the National Cancer Database. J Pediatr Surg 2016; 51:1061-6. [PMID: 26703433 DOI: 10.1016/j.jpedsurg.2015.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/08/2015] [Accepted: 11/11/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pediatric colorectal cancer (CRC) is rare. Comparison with adult CRC tumors, management, and outcomes may identify opportunities for improvement in pediatric CRC care. STUDY DESIGN CRC patients in the National Cancer Data Base from 1998 to 2011, were grouped into Pediatric (≤21years), early onset adult (22-50) and older adult (>50) patients. Groups were compared with χ(2) and survival analysis. RESULTS A total of 918 pediatric (Ped), 157,779 early onset adult (EA), and 1,304,085 older adults (OA) were identified (p<0.01 for all comparisons). Patients ≤50 presented more frequently with stage 3 and 4 disease (Ped: 62.0%, EA: 49.7%, OA: 37.3%) and rectal cancer (Ped: 23.6%, EA: 27.5%, OA: 19.2%). Pediatric histology was more likely signet ring, mucinous, and poorly differentiated. Initial treatment was usually surgery, but patients ≤50 were more likely to have radiation (Ped: 15.1%, EA: 18.6%, and OA: 9.2%) and chemotherapy (Ped: 42.0%, EA: 38.2%, and OA: 22.7%). Children and older adults showed poorer overall survival at 5years when compared to early onset adults. Adjusting for covariates, age ≤21 was a significant predictor of mortality for colon and rectal cancers (colon HR: 1.22, rectal HR: 1.69). CONCLUSIONS This is the largest cohort of pediatric CRC patients, revealing more aggressive tumor histology and behavior in children, particularly in rectal cancer. Despite standard oncologic treatment, age ≤21 was a significant predictor of mortality. This is likely owing to worse tumor biology rather than treatment disparities and may signal the need for different therapeutic strategies.
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Affiliation(s)
| | - David E Clark
- Department of Surgery, Maine Medical Center, Portland, ME
| | - Sara W Mayo
- Department of Surgery, Maine Medical Center, Portland, ME
| | - Elizabeth A Beierle
- Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL
| | - Melanie Goldfarb
- Department of Surgery, John Wayne Cancer Institute, Providence St. John's Medical Center, Santa Monica, CA
| | - Kenneth W Gow
- Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA
| | - Adam Goldin
- Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA
| | - John J Doski
- Department of Surgery/Pediatric Surgery Division, University of Texas Health Science Center, San Rosa Children's Hospital, San Antonio, TX
| | - Jed G Nuchtern
- Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Houston, TX
| | - Sanjeev A Vasudevan
- Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Houston, TX
| | - Monica Langer
- Department of Surgery, Division of Pediatric Surgery, Tufts University School of Medicine, Maine Medical Center, Portland, ME.
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Metastatic Colon Cancer in an 18-Year-Old without Predisposing Factors. Case Rep Pediatr 2016; 2016:7820367. [PMID: 27110420 PMCID: PMC4826687 DOI: 10.1155/2016/7820367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/10/2016] [Indexed: 11/26/2022] Open
Abstract
While colorectal carcinoma is a common gastrointestinal cancer in adults, it is rare in pediatrics with an incidence of 1 : 1,000,000 and represents a fraction of neoplasms encountered in children. Malignant neoplasms represent a major cause of mortality in the pediatric age group. While presenting with weight loss, iron deficiency, rectal bleeding, abdominal pain, and change in bowel habits, or symptoms similar to acute appendicitis, the working diagnosis may be considered to be anorexia. This case illustrates the importance of considering colon cancer among other disease entities as a cause of unintentional weight loss in adolescents. While this is a rare occurrence in the pediatric population, significant unintentional weight loss with altered bowel habits should prompt a search for underlying malignancy—even in the absence of a positive family history or predisposing cancer syndromes.
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Weber ML, Schneider DT, Offenmüller S, Kaatsch P, Einsiedel HG, Benesch M, Claviez A, Ebinger M, Kramm C, Kratz C, Lawlor J, Leuschner I, Merkel S, Metzler M, Nustede R, Petsch S, Seeger KH, Schlegel PG, Suttorp M, Zolk O, Brecht IB. Pediatric Colorectal Carcinoma is Associated With Excellent Outcome in the Context of Cancer Predisposition Syndromes. Pediatr Blood Cancer 2016; 63:611-7. [PMID: 26575411 DOI: 10.1002/pbc.25839] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/15/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Colorectal carcinoma (CRC) is the second most common adult cancer in Germany, however, it is extremely rare in children and adolescents. In these patients, previous literature describes aggressive behavior and diagnosis at advanced stage. METHOD Thirty-one patients with CRC age ≤ 18 years and treated between 1990 and 2012 have been identified through the structures and registries of the German Society for Pediatric Oncology and Hematology. RESULTS The age range was 9-18 years (median 13.5 years); the median follow-up time was 43.9 months (range 1-124 months). Twenty-six patients (84%) were tested for a genetic tumor syndrome (GTS); of these, 11 patients (35% of all patients) tested positive (eight cases of Lynch syndrome, one patient with familial adenomatous polyposis, two patients with constitutional mismatch repair deficiency). An unfavorable histology was reported in 55% of the records (n = 17), a poor differentiation (grade III) in 68% of carcinoma (n = 21). Overall survival (OS) and event-free survival at 5 years was 52.0% and 65.6%, respectively. Five-year survival according to stage was 100% in stage II (n = 2), 100% in stage III (n = 13), and 12.9% in stage IV (n = 15; P < 0.001). Five-year OS in patients with and without a defined GTS was 100% and 36.5% (P = 0.019), respectively. CONCLUSION Children and adolescents with CRC are frequently diagnosed in advanced stages and have an unfavorable prognosis. In this study, a high percentage of pediatric CRC patients presented with a tumor predisposition syndrome and showed an especially favorable OS.
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Affiliation(s)
- Marie L Weber
- Department of Pediatric Hematology and Oncology, University Children's Hospital Erlangen, Germany
| | | | - Sonja Offenmüller
- Department of Pediatric Hematology and Oncology, University Children's Hospital Erlangen, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Germany
| | - Hagen Graf Einsiedel
- Department of Pediatric Oncology and Hematology, University Children's Hospital Greifswald, Germany
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria
| | - Alexander Claviez
- Pediatric Hematology and Oncology, University Children's Hospital Kiel, Germany
| | - Martin Ebinger
- Pediatric Hematology and Oncology, University Children's Hospital Tuebingen, Germany
| | - Christof Kramm
- Pediatric Hematology and Oncology, University Children's Hospital Goettingen, Germany
| | - Christian Kratz
- Pediatric Hematology and Oncology, University Children's Hospital Hannover, Germany
| | - Jennifer Lawlor
- Department of Pediatric Hematology and Oncology, University Children's Hospital Erlangen, Germany
| | - Ivo Leuschner
- Department of Paidopathology, University of Kiel, Germany
| | - Susanne Merkel
- Clinical Tumor Registry, Department of Surgery, University of Erlangen, Germany
| | - Markus Metzler
- Department of Pediatric Hematology and Oncology, University Children's Hospital Erlangen, Germany
| | - Rainer Nustede
- Department of Pediatric Surgery, University Children's Hospital Hannover, Germany
| | - Sabine Petsch
- Tumor Registry, University of Erlangen-Nuernberg, Germany
| | - Karl-Heinz Seeger
- Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg, Germany
| | - Meinolf Suttorp
- Department of Pediatric Hematology and Oncology, University Children's Hospital Dresden, Germany
| | - Oliver Zolk
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, University of Ulm, Germany
| | - Ines B Brecht
- Department of Pediatric Hematology and Oncology, University Children's Hospital Erlangen, Germany
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Selected case from the Arkadi M. Rywlin International Pathology Slide Club: carcinoma of the transverse colon in a young girl. Adv Anat Pathol 2015; 22:217-24. [PMID: 25844680 DOI: 10.1097/pap.0000000000000068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We report a case of a 14-year-old female with primary adenocarcinoma of the transverse colon. She was hospitalized after presenting with abdominal pain and signs of intestinal obstruction. There was no health antecedent or family history of neoplasia. Physical examination revealed a distended abdomen. Tenderness was elicited to palpation of the right lower quadrant. Magnetic resonance imaging of the abdomen revealed obstructive signs, with a constricting lesion in the mid-transverse colon of probable neoplastic nature. Laparoscopic segmental resection of the colon was followed by standard right hemicolectomy. A circumferential mid-transverse tumor was diagnosed as primary colorectal carcinoma (CRC) of signet-ring cell type, AJCC stage IIIC, Dukes' C stage. On the basis of immunohistochemistry and clinical data, hereditary nonpolyposis and hamartomatous colorectal cancer syndromes were excluded. Involvement of either the p53, BRAF, or K-RAS genes was ruled out by immunohistochemistry profiling and genetic testing. The neoplasm was categorized as sporadic. The possibility of activation of the Wnt signaling pathway was suspected, because of a defective turnover of the β-catenin protein. Postoperatively, the patient was treated with both systemic and intra-abdominal adjuvant chemotherapy, including oxaliplatin. Between 18 and 24 months after diagnosis, intra-abdominal tumor recurrences were detected. The patient underwent bilateral oophorectomies for Krukenberg tumors and received salvage chemotherapy. Recently, additional recurrent metastatic retroperitoneal disease caused hydronephrosis. The retroperitoneal mass was debulked and a ureteric stent was placed. At the time of this writing, 43 months after diagnosis, the patient is receiving FOLFOX chemotherapy combined with panitumumab. CRC of childhood is exceedingly rare, generally develops in the setting of unrecognized genetic predisposing factors to cancer, presents with advanced disease, is high grade, and tends to have dismal prognosis.
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Oyeniyi J, Wu J, Liu D, Yao JC, Green H, Albritton K, Huh W, Hayes-Jordan A. Treatment of carcinomatosis using cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in adolescents and young adults. Am J Surg 2015; 209:610-5. [DOI: 10.1016/j.amjsurg.2014.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/09/2014] [Accepted: 11/21/2014] [Indexed: 02/07/2023]
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Kotecha RS, Kees UR, Cole CH, Gottardo NG. Rare childhood cancers--an increasing entity requiring the need for global consensus and collaboration. Cancer Med 2015; 4:819-24. [PMID: 25664881 PMCID: PMC4472204 DOI: 10.1002/cam4.426] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/30/2014] [Accepted: 01/05/2015] [Indexed: 01/19/2023] Open
Abstract
Rare childhood cancers have not benefited to the same extent from the gains that have been made for their frequently occurring counterparts. In recent years, this gap has been recognized and a number of vehicles now exist to improve outcome, including rare tumor groups, disease-specific registries, and clinics. The multitude of approaches has allowed significant progress, however, this framework is limited by patient number and is not inclusive for every type of rare childhood cancer. These shortcomings can be overcome by a single global unified approach to the study of rare childhood tumors.
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Affiliation(s)
- Rishi S Kotecha
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.,School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia.,Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia
| | - Ursula R Kees
- Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia
| | - Catherine H Cole
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.,School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia
| | - Nicholas G Gottardo
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.,School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia.,Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia
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Bensch F, van Rooijen JM, Schröder CP, Reyners AKL. A 21-year-old patient with a HER2-positive colorectal cancer. Gastroenterology 2015; 148:20-1. [PMID: 25447849 DOI: 10.1053/j.gastro.2014.09.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 09/29/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Frederike Bensch
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Johan M van Rooijen
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Deng W, Sears S, Garand S, Farricielli L. Delayed diagnosis of familial adenomatous polyposis in an adolescent patient with a coexisting eating disorder. BMJ Case Rep 2013; 2013:bcr-2013-200439. [PMID: 24336579 DOI: 10.1136/bcr-2013-200439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Colorectal carcinoma in the population aged less than 20 years of age is rare but associated with poor prognosis, which is attributable to advanced disease at presentation and higher incidence of the unfavourable mucinous histology. Colorectal carcinoma commonly presents with non-specific gastrointestinal symptoms in conjunction with iron deficiency anaemia. Many of these symptoms can mimic eating disorders, which are common in adolescent women. We present the case of a 20-year-old woman with previously undiagnosed familial adenomatous polyposis and colorectal carcinoma who experienced a significant delay in diagnosis, given a coexisting eating disorder mimicking her symptoms. After confirmation of the diagnosis by colonoscopy and genetic testing, the patient underwent a successful proctocolectomy and experienced full recovery. This case is a reminder that underlying organic pathology should always be excluded prior to a diagnosis of an eating disorder.
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Affiliation(s)
- Wu Deng
- University of California, Irvine, USA
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Furman WL, Tricoli JV. Important considerations in treating children, adolescents and young adults with colorectal carcinoma. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
SUMMARY Colorectal carcinoma (CRC) in children, adolescents and young adults under 30 years of age is rare. When it occurs in these young people, is this just an ‘adult’ cancer occurring in a young patient or is it a different disease? How should these patients be managed? Here, we review what is known about the epidemiology and clinical presentation of CRC in children, adolescents and young adults, as well as the current model for CRC development to provide a framework for questioning whether CRC in these young patients is the same disease as that seen in their older adult counterparts. In addition, we will summarize the clinical options described in the peer-reviewed literature to provide a basis for management decisions of these young patients.
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Affiliation(s)
- Wayne L Furman
- Department of Oncology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
- University of Tennessee Department of Pediatrics, TN, USA
| | - James V Tricoli
- Diagnostic Biomarkers and Technology Branch, Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, 9609 Medical Center Drive, 3 West, Room 526, MSC 9728, Bethesda, MD 20892, USA
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