Colorectal Carcinoma in Children and Adolescents in Low Middle Income Countries: Single Center Experience

Wael Zekri; Soha Ahmed; Ahmed Elhemaly; Gehad Ahmed; Eman Zaki; Naglaa Elkinaee; Amr Elnashar; Marwan Adly; Alaa Younes; Asmaa Hamoda

doi:doi:10.11648/j.crj.20210901.12

Colorectal Carcinoma in Children and Adolescents in Low Middle Income Countries: Single Center Experience

Wael Zekri, Soha Ahmed, Ahmed Elhemaly, Gehad Ahmed, Eman Zaki, Naglaa Elkinaee, Amr Elnashar, Marwan Adly, Alaa Younes, Asmaa Hamoda

Published in Cancer Research Journal (Volume 9, Issue 1)

Received: 18 December 2020 Accepted: 8 January 2021 Published: 22 January 2021

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Abstract

Colorectal carcinoma (CRC) is rare in children with extremely poor prognosis. Proper management is obscure because of deficient data. The aim of the current study is to assess the clinical characteristics and to determine the different prognostic factors leading to dismal outcome. It is a retrospective study included all CRC patients, below 18 years, treated in Children’s Cancer Hospital of Egypt (CCHE) between 2007 and 2016. Demographic data, clinical characteristics, diagnostics, histological subtypes, disease stage, treatment methods, and survival outcome were collected. The result showed that, 15 patients below 18 years. All had unfavorable histopathology (mucinous adenocarcinoma) and 10 cases had metastatic disease. Initial surgical resection was done in 8/15 cases, all patients received neo adjuvant/adjuvant chemotherapy. Four patients had rectal adenocarcinoma and were treated with chemo-radiotherapy while 11 had colonic adenocarcinoma. Ten patients had progression or relapse, while 12 died at the end of follow up period; 3-years Overall Survival (OS) and Event Free Survival (EFS) were 17.8% and 16.5% respectively, the only three surviving patients were of lower stage disease. In Conclusions, Clinical presentation of CRC in pediatrics is similar to adults but delayed diagnosis and advanced stages contribute to poor outcome which is due to the absence of familiarity to CRC. The high frequency of mucinous adenocarcinoma may explain the poor outcome. Surgery remains the mainstay of treatment as in adults. Preoperative radiotherapy for rectal adenocarcinoma, offers better prognosis. Chemotherapy plays a role in the metastatic disease and can downstage the primary tumor for better local control.

Published in	Cancer Research Journal (Volume 9, Issue 1)
DOI	10.11648/j.crj.20210901.12
Page(s)	8-13
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Colon, Rectal, Adenocarcinoma, Childhood, Adulthood

References

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[4]	Spunt S, Furman W, La Quaglia M, et al, (2007). Colorectal Carcinoma in Childhood and Adolescence, Bethesda, MD, National Cancer Institute, NIH Pub. No. 06-5767, pp. 123, 2006-134.
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[6]	AJCC Cance Staging Manual. 6th ed. New York: Springer-Verlag; 2002.
[7]	Ferrari A, Bertario L, Signoroni S, et al (2008). Colorectal Carcinoma in Children and Adolescents, onlinelibrary.wiley.com/doi/10.1002/pbc.21220.
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[9]	Khan AM, Doig CM, Dickson AP. (1997). Advanced colonic carcinoma in children. Postgrad Med J. 1997; 73: 169–170.
[10]	Narla LD, Hingsbergen EA, Jones JE. (1999). Adult diseases in children. Pediatr Radiol. 1999; 29: 244–254.
[11]	Hill DA, Furman WL, Billups CA, Riedley SE, Cain AM, Rao BN, Pratt CB, Spunt SL.(2007). Colorectal carcinoma in childhood and adolescence: a clinicopathologic review J Clin Oncol. 2007 Dec 20; 25 (36): 5808-14.
[12]	Karnak I, Ciftci AO, Senocak ME, Bu¨yu¨kpamukc¸u N (1999) Colorectal carcinoma in children. J Pediatr Surg 34: 1499–1504.
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[14]	Brown RA, Rode H, Millar AJW et al (1992) Colorectal carcinoma in children. J Pediatr Surg 27: 919–921.
[15]	Abraha I, Aristei C, Palumbo I, Lupattelli M, Trastulli S, Cirocchi R, De Florio R, Valentini V. (2018). Preoperative radiotherapy and curative surgery for the management of localised rectal carcinoma. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD002102. DOI: 10.1002/14651858.

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Wael Zekri, Soha Ahmed, Ahmed Elhemaly, Gehad Ahmed, Eman Zaki, et al. (2021). Colorectal Carcinoma in Children and Adolescents in Low Middle Income Countries: Single Center Experience. Cancer Research Journal, 9(1), 8-13. https://doi.org/10.11648/j.crj.20210901.12

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ACS Style

Wael Zekri; Soha Ahmed; Ahmed Elhemaly; Gehad Ahmed; Eman Zaki, et al. Colorectal Carcinoma in Children and Adolescents in Low Middle Income Countries: Single Center Experience. Cancer Res. J. 2021, 9(1), 8-13. doi: 10.11648/j.crj.20210901.12

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AMA Style

Wael Zekri, Soha Ahmed, Ahmed Elhemaly, Gehad Ahmed, Eman Zaki, et al. Colorectal Carcinoma in Children and Adolescents in Low Middle Income Countries: Single Center Experience. Cancer Res J. 2021;9(1):8-13. doi: 10.11648/j.crj.20210901.12

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@article{10.11648/j.crj.20210901.12,
  author = {Wael Zekri and Soha Ahmed and Ahmed Elhemaly and Gehad Ahmed and Eman Zaki and Naglaa Elkinaee and Amr Elnashar and Marwan Adly and Alaa Younes and Asmaa Hamoda},
  title = {Colorectal Carcinoma in Children and Adolescents in Low Middle Income Countries: Single Center Experience},
  journal = {Cancer Research Journal},
  volume = {9},
  number = {1},
  pages = {8-13},
  doi = {10.11648/j.crj.20210901.12},
  url = {https://doi.org/10.11648/j.crj.20210901.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20210901.12},
  abstract = {Colorectal carcinoma (CRC) is rare in children with extremely poor prognosis. Proper management is obscure because of deficient data. The aim of the current study is to assess the clinical characteristics and to determine the different prognostic factors leading to dismal outcome. It is a retrospective study included all CRC patients, below 18 years, treated in Children’s Cancer Hospital of Egypt (CCHE) between 2007 and 2016. Demographic data, clinical characteristics, diagnostics, histological subtypes, disease stage, treatment methods, and survival outcome were collected. The result showed that, 15 patients below 18 years. All had unfavorable histopathology (mucinous adenocarcinoma) and 10 cases had metastatic disease. Initial surgical resection was done in 8/15 cases, all patients received neo adjuvant/adjuvant chemotherapy. Four patients had rectal adenocarcinoma and were treated with chemo-radiotherapy while 11 had colonic adenocarcinoma. Ten patients had progression or relapse, while 12 died at the end of follow up period; 3-years Overall Survival (OS) and Event Free Survival (EFS) were 17.8% and 16.5% respectively, the only three surviving patients were of lower stage disease. In Conclusions, Clinical presentation of CRC in pediatrics is similar to adults but delayed diagnosis and advanced stages contribute to poor outcome which is due to the absence of familiarity to CRC. The high frequency of mucinous adenocarcinoma may explain the poor outcome. Surgery remains the mainstay of treatment as in adults. Preoperative radiotherapy for rectal adenocarcinoma, offers better prognosis. Chemotherapy plays a role in the metastatic disease and can downstage the primary tumor for better local control.},
 year = {2021}
}

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TY - JOUR
T1 - Colorectal Carcinoma in Children and Adolescents in Low Middle Income Countries: Single Center Experience
AU - Wael Zekri
AU - Soha Ahmed
AU - Ahmed Elhemaly
AU - Gehad Ahmed
AU - Eman Zaki
AU - Naglaa Elkinaee
AU - Amr Elnashar
AU - Marwan Adly
AU - Alaa Younes
AU - Asmaa Hamoda
Y1 - 2021/01/22
PY - 2021
N1 - https://doi.org/10.11648/j.crj.20210901.12
DO - 10.11648/j.crj.20210901.12
T2 - Cancer Research Journal
JF - Cancer Research Journal
JO - Cancer Research Journal
SP - 8
EP - 13
PB - Science Publishing Group
SN - 2330-8214
UR - https://doi.org/10.11648/j.crj.20210901.12
AB - Colorectal carcinoma (CRC) is rare in children with extremely poor prognosis. Proper management is obscure because of deficient data. The aim of the current study is to assess the clinical characteristics and to determine the different prognostic factors leading to dismal outcome. It is a retrospective study included all CRC patients, below 18 years, treated in Children’s Cancer Hospital of Egypt (CCHE) between 2007 and 2016. Demographic data, clinical characteristics, diagnostics, histological subtypes, disease stage, treatment methods, and survival outcome were collected. The result showed that, 15 patients below 18 years. All had unfavorable histopathology (mucinous adenocarcinoma) and 10 cases had metastatic disease. Initial surgical resection was done in 8/15 cases, all patients received neo adjuvant/adjuvant chemotherapy. Four patients had rectal adenocarcinoma and were treated with chemo-radiotherapy while 11 had colonic adenocarcinoma. Ten patients had progression or relapse, while 12 died at the end of follow up period; 3-years Overall Survival (OS) and Event Free Survival (EFS) were 17.8% and 16.5% respectively, the only three surviving patients were of lower stage disease. In Conclusions, Clinical presentation of CRC in pediatrics is similar to adults but delayed diagnosis and advanced stages contribute to poor outcome which is due to the absence of familiarity to CRC. The high frequency of mucinous adenocarcinoma may explain the poor outcome. Surgery remains the mainstay of treatment as in adults. Preoperative radiotherapy for rectal adenocarcinoma, offers better prognosis. Chemotherapy plays a role in the metastatic disease and can downstage the primary tumor for better local control.
VL - 9
IS - 1
ER -

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Author Information

Wael Zekri

Department of Pediatric Oncology, Children Cancer Hospital Egypt, Cairo, Egypt
Soha Ahmed

Departmentof Clinical Oncology, Aswan University, Aswan, Egypt
Ahmed Elhemaly

Department of Pediatric Oncology, Children Cancer Hospital Egypt, Cairo, Egypt
Gehad Ahmed

Department of Surgery, Helwan University, Cairo, Egypt
Eman Zaki

Department of Radio–diagnosis, Children Cancer Hospital Egypt, Cairo, Egypt
Naglaa Elkinaee

Department of Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
Amr Elnashar

Department of Clinical Research, Children Cancer Hospital Egypt, Cairo, Egypt
Marwan Adly

Department of Clinical Research, Children Cancer Hospital Egypt, Cairo, Egypt
Alaa Younes

Department of Surgery, Helwan University, Cairo, Egypt
Asmaa Hamoda

Department of Pediatric Oncology, Children Cancer Hospital Egypt, Cairo, Egypt

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APA Style

Wael Zekri, Soha Ahmed, Ahmed Elhemaly, Gehad Ahmed, Eman Zaki, et al. (2021). Colorectal Carcinoma in Children and Adolescents in Low Middle Income Countries: Single Center Experience. Cancer Research Journal, 9(1), 8-13. https://doi.org/10.11648/j.crj.20210901.12

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ACS Style

Wael Zekri; Soha Ahmed; Ahmed Elhemaly; Gehad Ahmed; Eman Zaki, et al. Colorectal Carcinoma in Children and Adolescents in Low Middle Income Countries: Single Center Experience. Cancer Res. J. 2021, 9(1), 8-13. doi: 10.11648/j.crj.20210901.12

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AMA Style

Wael Zekri, Soha Ahmed, Ahmed Elhemaly, Gehad Ahmed, Eman Zaki, et al. Colorectal Carcinoma in Children and Adolescents in Low Middle Income Countries: Single Center Experience. Cancer Res J. 2021;9(1):8-13. doi: 10.11648/j.crj.20210901.12

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@article{10.11648/j.crj.20210901.12,
  author = {Wael Zekri and Soha Ahmed and Ahmed Elhemaly and Gehad Ahmed and Eman Zaki and Naglaa Elkinaee and Amr Elnashar and Marwan Adly and Alaa Younes and Asmaa Hamoda},
  title = {Colorectal Carcinoma in Children and Adolescents in Low Middle Income Countries: Single Center Experience},
  journal = {Cancer Research Journal},
  volume = {9},
  number = {1},
  pages = {8-13},
  doi = {10.11648/j.crj.20210901.12},
  url = {https://doi.org/10.11648/j.crj.20210901.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20210901.12},
  abstract = {Colorectal carcinoma (CRC) is rare in children with extremely poor prognosis. Proper management is obscure because of deficient data. The aim of the current study is to assess the clinical characteristics and to determine the different prognostic factors leading to dismal outcome. It is a retrospective study included all CRC patients, below 18 years, treated in Children’s Cancer Hospital of Egypt (CCHE) between 2007 and 2016. Demographic data, clinical characteristics, diagnostics, histological subtypes, disease stage, treatment methods, and survival outcome were collected. The result showed that, 15 patients below 18 years. All had unfavorable histopathology (mucinous adenocarcinoma) and 10 cases had metastatic disease. Initial surgical resection was done in 8/15 cases, all patients received neo adjuvant/adjuvant chemotherapy. Four patients had rectal adenocarcinoma and were treated with chemo-radiotherapy while 11 had colonic adenocarcinoma. Ten patients had progression or relapse, while 12 died at the end of follow up period; 3-years Overall Survival (OS) and Event Free Survival (EFS) were 17.8% and 16.5% respectively, the only three surviving patients were of lower stage disease. In Conclusions, Clinical presentation of CRC in pediatrics is similar to adults but delayed diagnosis and advanced stages contribute to poor outcome which is due to the absence of familiarity to CRC. The high frequency of mucinous adenocarcinoma may explain the poor outcome. Surgery remains the mainstay of treatment as in adults. Preoperative radiotherapy for rectal adenocarcinoma, offers better prognosis. Chemotherapy plays a role in the metastatic disease and can downstage the primary tumor for better local control.},
 year = {2021}
}

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