Salas-Valverde Sonia, Lizano Andrea, Gamboa Yessica, Vega Sergio, Barrantes Max, Santamaría Silvia, Zamora Jose Barrantes
Department of Surgery, National Children's Hospital, University of Costa Rica, PO Box 1654-1000, San Jose, Costa Rica.
Pediatr Surg Int. 2009 Dec;25(12):1073-6. doi: 10.1007/s00383-009-2491-y. Epub 2009 Oct 9.
Carcinoma of the colon and rectum is rare in the pediatric age group, and usually presents with an advanced stage disease bearing a poor prognosis. Colorectal carcinoma should be considered in children with signs of intestinal obstruction, alteration in bowel habits, gastrointestinal bleeding and chronic abdominal pain. We performed a retrospective study to evaluate the clinical characteristics, and prognosis of these patients.
Between 1974 and 2007, 11 patients were identified and treated for colorectal carcinoma at the Oncology Unit. The medical records were studied to analyze the age, sex, clinical presentation, diagnostic procedures, extent of disease (Dukes staging), treatment, histological types, and outcome.
There were seven boys and four girls ranging from 7 to 17 of age. Predisposing diseases and syndromes were encountered in three children, (1 with Turner's syndrome and two with adenomatous familial polyposis). Abdominal pain, acute intestinal obstruction, rectal bleeding and weight loss were the commonest symptoms. Surgical procedures were done in 11 patients (incomplete resection with segmental resection in 4 patients, complete resection in the other 4, and biopsy alone in 3 patients).The predominant histological type was mucinous carcinoma. Seven patients received adjuvant chemotherapy, all of whom did not survive. Two patients died shortly after initial surgery, and two patients are alive, and well.
Colorectal carcinoma in children is very uncommon and could be easily misdiagnosed, resulting in advanced stage disease at diagnosis. Because radical surgery which is the mainstay of treatment is possible only in patients with early stage disease, a high level of awareness and early diagnosis are critical.
结直肠癌在儿童年龄组中较为罕见，通常表现为疾病处于晚期，预后较差。对于出现肠梗阻体征、排便习惯改变、胃肠道出血和慢性腹痛的儿童，应考虑结直肠癌。我们进行了一项回顾性研究，以评估这些患者的临床特征和预后。
1974年至2007年间，肿瘤病房共确诊并治疗了11例结直肠癌患者。研究病历以分析患者的年龄、性别、临床表现、诊断程序、疾病范围（杜克分期）、治疗方法、组织学类型和预后。
患者共7名男孩和4名女孩，年龄在7至17岁之间。3名儿童有易感疾病和综合征（1例患有特纳综合征，2例患有家族性腺瘤性息肉病）。腹痛、急性肠梗阻、直肠出血和体重减轻是最常见的症状。11例患者均接受了手术治疗（4例行节段性切除不完全切除，4例行完全切除，3例仅行活检）。主要组织学类型为黏液癌。7例患者接受了辅助化疗，均未存活。2例患者在初次手术后不久死亡，2例患者存活且状况良好。
儿童结直肠癌非常罕见，很容易误诊，导致诊断时疾病已处于晚期。由于根治性手术是主要治疗手段，仅早期疾病患者可行，因此高度的认识和早期诊断至关重要。
