Paediatr Drugs. 2008;10(3):177-92. doi: 10.2165/00148581-200810030-00006.
Epidemiology and management options for colorectal cancer in children.
Paediatric drugs
Raya Saab, Wayne L Furman
Affiliations
Affiliations
- Pediatric Hematology-Oncology, American University of Beirut, Beirut, Lebanon.
PMID: 18454570
DOI: 10.2165/00148581-200810030-00006
Abstract
Colorectal carcinoma (CRC), although primarily a disease of adulthood, accounts for 2% of malignancies in adolescents and has been reported in children as young as 9 months of age. Our knowledge of CRC in pediatrics is based on a handful of case series and case reports. Apart from one small clinical trial, there has been a lack of prospective clinical studies in this age group. Based on these published reports, most CRC in children is sporadic, but it can also arise in the setting of predisposing conditions, such as gastrointestinal polyposis syndromes, nonpolyposis familial cancer syndromes, and inflammatory bowel disease. Despite some similarities to adult disease, CRC in childhood may be intrinsically different biologically, because it differs from adult-onset CRC in several respects. Childhood CRC tends to be diagnosed at an advanced stage, is largely of mucinous histology, and (probably because of these features) tends to have a poorer outcome. As a result of its rarity in children and the lack of prospective pediatric studies, recommendations for therapy are primarily extrapolated from adult clinical trials. A review of pediatric case series in the English literature emphasizes the prognostic significance of stage of disease, as well as extent of surgical resection. As in adults, early detection is critical in an effort to capture the disease at less advanced stages. Complete surgical resection with aggressive lymph node dissection is essential for cure, and neoadjuvant chemotherapy may be used in an effort to render unresectable lesions resectable. Active agents in adults with CRC include fluorouracil, folinic acid (leucovorin), oxaliplatin, and irinotecan. Furthermore, newer targeted therapeutic agents, such as bevacizumab and cetuximab, have added additional efficacy to the standard chemotherapy backbone. Collaborative multi-institutional pediatric clinical trials are needed to evaluate the prognosis, optimal treatment response, and the basic biology of childhood onset CRC.
References
- Surgery. 1983 Mar;93(3):409-14 - PubMed
- J Pediatr Hematol Oncol. 2005 Jan;27(1):39-41 - PubMed
- Int J Cancer. 1988 Apr 15;41(4):513-7 - PubMed
- Eur J Pediatr Surg. 2001 Oct;11(5):338-41 - PubMed
- Ann Surg Oncol. 1995 Sep;2(5):386-91 - PubMed
- Hepatogastroenterology. 1997 Mar-Apr;44(14):441-4 - PubMed
- Cell. 1996 Oct 18;87(2):159-70 - PubMed
- Arch Pathol Lab Med. 2000 Dec;124(12):1759-63 - PubMed
- Ann Thorac Surg. 2000 Aug;70(2):380-3 - PubMed
- Cancer. 2001 Jul 15;92(2):452 - PubMed
- J Med Genet. 1996 Feb;33(2):157-60 - PubMed
- Histopathology. 1988 Dec;13(6):619-30 - PubMed
- CA Cancer J Clin. 2004 Nov-Dec;54(6):295-308 - PubMed
- J Clin Oncol. 2005 Jul 10;23(20):4553-60 - PubMed
- J Clin Oncol. 2000 Aug;18(16):2938-47 - PubMed
- Ann Oncol. 2005 Mar;16(3):425-9 - PubMed
- J Clin Oncol. 1997 Jan;15(1):246-50 - PubMed
- J Pediatr Gastroenterol Nutr. 1991 Apr;12(3):394-9 - PubMed
- Lancet. 2000 Mar 25;355(9209):1041-7 - PubMed
- J Clin Oncol. 2004 Jan 1;22(1):23-30 - PubMed
- N Engl J Med. 2004 Jun 3;350(23):2335-42 - PubMed
- N Engl J Med. 2005 Jun 30;352(26):2696-704 - PubMed
- Cancer. 1994 Apr 15;73(8):2076-82 - PubMed
- N Engl J Med. 1993 Apr 1;328(13):901-6 - PubMed
- Ann Surg. 2004 Oct;240(4):624-8; discussion 628-30 - PubMed
- Cancer. 1958 Jul-Aug;11(4):855-7 - PubMed
- Dis Colon Rectum. 1975 Jan-Feb;18(1):1-3 - PubMed
- J Surg Oncol. 2000 Feb;73(2):70-4 - PubMed
- Ann Intern Med. 1998 Jun 1;128(11):900-5 - PubMed
- Med Pediatr Oncol. 1999 Nov;33(5):470-5 - PubMed
- Clin Colorectal Cancer. 2005 Nov;5(4):257-62 - PubMed
- Hematol Oncol Clin North Am. 2005 Jun;19(3):565-71, vii-viii - PubMed
- Gastroenterology. 1995 Jun;108(6):1657-65 - PubMed
- AJR Am J Roentgenol. 2000 Apr;174(4):1005-8 - PubMed
- Gastroenterology. 1985 Aug;89(2):328-36 - PubMed
- J Clin Oncol. 2005 May 20;23(15):3502-8 - PubMed
- J Pediatr. 1956 Mar;48(3):279-91 - PubMed
- J Am Coll Surg. 2001 Jun;192(6):719-25 - PubMed
- Br J Cancer. 2002 Aug 12;87(4):393-9 - PubMed
- J Clin Oncol. 2005 Dec 20;23(36):9441-2 - PubMed
- J Clin Oncol. 2005 Mar 20;23(9):2038-48 - PubMed
- Arch Pathol Lab Med. 2003 Jun;127(6):673-9 - PubMed
- Ann Surg Oncol. 2003 Jan-Feb;10(1):65-71 - PubMed
- J Pediatr Surg. 1992 Aug;27(8):1085-9; discussion 1089-90 - PubMed
- Gastroenterology. 2000 Sep;119(3):837-53 - PubMed
- Gastroenterology. 2001 Jul;121(1):198-213 - PubMed
- J Clin Oncol. 1999 Nov;17(11):3553-9 - PubMed
- Dis Colon Rectum. 1977 Nov-Dec;20(8):661-8 - PubMed
- Br J Surg. 2004 Mar;91(3):349-54 - PubMed
- Pediatr Radiol. 1989;19(8):504-8 - PubMed
- J Nucl Med. 2003 Nov;44(11):1797-803 - PubMed
- Indian Pediatr. 2000 Dec;37(12):1353-8 - PubMed
- J Pediatr. 2001 May;138(5):621-8 - PubMed
- J Clin Oncol. 2008 Jan 20;26(3):399-405 - PubMed
- Pediatrics. 1963 Oct;32:558-71 - PubMed
- Lancet. 1995 Apr 15;345(8955):939-44 - PubMed
- Ann Surg. 2004 Jun;239(6):818-25; discussion 825-7 - PubMed
- Ann Intern Med. 2003 Apr 1;138(7):560-70 - PubMed
- Gastroenterology. 2003 May;124(6):1574-94 - PubMed
- South Med J. 1990 Apr;83(4):383-5 - PubMed
- Drugs. 2005;65(14):1935-47 - PubMed
- Eur J Pediatr Surg. 2003 Feb;13(1):66-8 - PubMed
- Cancer. 1985 Mar 15;55(6):1322-6 - PubMed
- Pediatr Blood Cancer. 2008 Mar;50(3):588-93 - PubMed
- J Pediatr Surg. 1999 Oct;34(10):1499-504 - PubMed
- Gut. 2005 Aug;54(8):1146-50 - PubMed
- J Clin Oncol. 2004 Jun 1;22(11):2084-91 - PubMed
- Gastroenterology. 2000 Dec;119(6):1447-53 - PubMed
- Clin Gastroenterol. 1976 Sep;5(3):505-25 - PubMed
- Cell. 1990 Jun 1;61(5):759-67 - PubMed
- Clin Colorectal Cancer. 2005 Nov;5(4):263-7 - PubMed
- J Clin Oncol. 2004 Aug 15;22(16):3408-19 - PubMed
- J Clin Oncol. 2005 Dec 1;23(34):8671-8 - PubMed
- Dis Colon Rectum. 1998 Oct;41(10):1244-9 - PubMed
- N Engl J Med. 2004 Jun 3;350(23):2343-51 - PubMed
- J Clin Oncol. 2005 Dec 1;23(34):8706-12 - PubMed
- Ann Surg. 1965 Aug;162:279-84 - PubMed
- Am Surg. 1995 Jan;61(1):78-82 - PubMed
- Gastroenterology. 1997 Oct;113(4):1146-58 - PubMed
- Cancer. 2006 Sep 1;107(5 Suppl):1153-61 - PubMed
- J Clin Oncol. 2005 Aug 1;23(22):4866-75 - PubMed
- Med Pediatr Oncol. 1999 Jun;32(6):459-60 - PubMed
- Curr Opin Pediatr. 2002 Oct;14(5):576-82 - PubMed
- Annu Rev Med. 2005;56:539-54 - PubMed
- Eur J Cancer. 2005 Jan;41(2):272-9 - PubMed
- Dig Dis Sci. 1990 Mar;35(3):349-52 - PubMed
- Eur J Surg Oncol. 2006 Nov;32(9):941-7 - PubMed
- J Pediatr Surg. 1992 Jul;27(7):919-21 - PubMed
- CA Cancer J Clin. 1997 Mar-Apr;47(2):93-112 - PubMed
- Semin Nucl Med. 2004 Jul;34(3):209-23 - PubMed
- J Clin Oncol. 1997 Mar;15(3):938-46 - PubMed
- N Engl J Med. 1988 Sep 1;319(9):525-32 - PubMed
- Chest. 2001 Apr;119(4):1069-72 - PubMed
- Ann Intern Med. 1993 May 15;118(10):785-90 - PubMed
- J Clin Oncol. 2005 Jun 1;23(16):3706-12 - PubMed
- Semin Oncol. 2005 Feb;32(1):11-23 - PubMed
- N Engl J Med. 2000 Sep 28;343(13):905-14 - PubMed
- Am J Clin Pathol. 1956 Jul;26(7):778-86 - PubMed
- Ann Thorac Surg. 1992 May;53(5):780-5; discussion 785-6 - PubMed
- J Gastroenterol Hepatol. 2005 Nov;20(11):1634-40 - PubMed
- Semin Oncol. 1991 Aug;18(4):381-7 - PubMed
- J Pediatr Surg. 1976 Dec;11(6):967-71 - PubMed
- J Clin Oncol. 2004 May 15;22(10):1797-806 - PubMed
- Gastroenterol Clin North Am. 2006 Sep;35(3):517-31 - PubMed
- Ann Surg Oncol. 2006 Jun;13(6):887-98 - PubMed
- Semin Oncol. 2006 Dec;33(6 Suppl 11):S36-8 - PubMed
- N Engl J Med. 1995 Mar 30;332(13):839-47 - PubMed
- J Clin Oncol. 2003 Jan 1;21(1):60-5 - PubMed
- Gastroenterology. 1985 Aug;89(2):398-407 - PubMed
- N Engl J Med. 1993 Dec 30;329(27):1977-81 - PubMed
- Ann Surg Oncol. 1996 Jul;3(4):344-8 - PubMed
- Gastroenterology. 1999 Jun;116(6):1453-6 - PubMed
- N Engl J Med. 2004 Jul 22;351(4):337-45 - PubMed
- J Clin Oncol. 2007 Dec 20;25(36):5808-14 - PubMed
- J Clin Oncol. 2001 Nov 1;19(21):4097-106 - PubMed
- Ann Surg. 1986 Feb;203(2):123-8 - PubMed
- N Engl J Med. 2000 Jan 13;342(2):137-8 - PubMed
- Semin Oncol. 2004 Jun;31(3):374-81 - PubMed
- Cancer Res. 1990 Dec 1;50(23):7717-22 - PubMed
- N Engl J Med. 1994 Dec 22;331(25):1669-74 - PubMed
- Arch Pathol Lab Med. 2000 Jul;124(7):979-94 - PubMed
- Cancer. 1976 Apr;37(4):1891-1900 - PubMed
- Ann Oncol. 2005 Aug;16(8):1305-10 - PubMed
- Eur J Pediatr. 2001 Mar;160(3):168-72 - PubMed
- Dis Colon Rectum. 2002 Jul;45(7):887-9 - PubMed
- Br J Surg. 1994 Oct;81(10):1485-9 - PubMed
- Dis Colon Rectum. 1993 Jan;36(1):49-54 - PubMed
- Cancer. 2000 May 15;88(10):2398-424 - PubMed
- Ann Oncol. 2004 Jun;15(6):933-9 - PubMed
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