Colorectal Carcinoma in Children and Adolescents

Sirs,

I have read with interest the paper by Vastyan et al ([3]) on colorectal carcinoma. Their findings are very different from our experience in Zaria, Nigeria ([1]). In their study, all parts of the colon were affected by the tumour and rectal bleeding was uncommon. Complete resection was possible in 5 out of 7 patients, 6 had postoperative chemotherapy and 2 had irradiation. In contrast, in our patients the tumours were left-sided in all 8 patients (rectum 7, sigmoid colon 1), rectal bleeding was a common symptom, curative resection was possible in only one patient and the others received only palliative treatment. Duke's stage was C in 5 patients and D in 2, while ours were D4, C2, B1 and undetermined in one. In our patients, most of the tumours were of the mucinous type. Our experience is similar to another report from India, a developing country like ours.

However, there are areas of similarity. Presentation was within 12 months. The cause of delay in developing countries is mostly because many patients are treated repeatedly for infectious and parasitic causes, which are common in the environment. In all the reports ([1], [2], [3]), survival seems to be uniformly poor, death occurring within 12 months in most patients. Perhaps the biology of this tumour is different in this age group compared to adults.

Though colorectal carcinoma is thought to be uncommon in children and adolescents, in our hospital 16.3 % of all patients with colorectal carcinoma are aged 18 years and below. A higher index of suspicion is necessary to make an early diagnosis and institute treatment early. This may improve the survival rate.

References

• 1 Ameh E A, Nmadu P T. Colorectal carcinoma in children and adolescents: a report of 8 patients from Zaria, Nigeria.  West Afr J Med. 2000;  19 273-276
• 2 Bhatia M S, Chandna S, Shah R, Patel D D. Colorectal carcinoma in Indian children.  Indian Pediatr. 2000;  37 1353-1358
• 3 Vastyan A M, Walker J, Pinter A B, Gerrard M, Kajtar P. Colorectal carcinoma in children and adolescents - report of seven cases.  Eur J Pediatr Surg. 2001;  11 338-341