Colorectal Cancer in Children

Colorectal cancer is a disease in which malignant (cancer) cells form in the tissues of the colon or the rectum. The colon is part of the body’s digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The colon (large bowel) is the first part of the large intestine and is about 5 feet long. Together, the rectum and anal canal make up the last part of the large intestine and are 6-8 inches long. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).

Childhood colorectal cancer may be part of an inherited syndrome. Some colorectal cancers in young people are linked to a gene mutation that causes polyps (growths in the mucous membrane that lines the colon) to form that may turn into cancer later.

The risk of colorectal cancer is increased by having certain inherited conditions, such as:

• Attenuated familial adenomatous polyposis.
• Familial adenomatous polyposis (FAP).
• Lynch syndrome.
• Li-Fraumeni syndrome.
• MYH-associated polyposis.
• Turcot syndrome.
• Cowden syndrome.
• Juvenile polyposis syndrome.
• Peutz-Jeghers syndrome.

Colon polyps that form in children who do not have an inherited syndrome are not linked to an increased risk of cancer.

Signs and symptoms of childhood colorectal cancer usually depend on where the tumor forms. Colorectal cancer may cause any of the following signs and symptoms.

Check with your child’s doctor if your child has any of the following:

• Tumors of the rectum or lower colon may cause pain in the abdomen, constipation, or diarrhea.
• Tumors in the part of the colon on the left side of the body may cause:
• A lump in the abdomen.
• Weight loss for no known reason.
• Nausea and vomiting.
• Loss of appetite.
• Blood in the stool.
• Anemia (feeling tired, dizziness, fast or irregular heartbeat, shortness of breath, pale skin).

Other conditions that are not colorectal cancer may cause these same signs and symptoms.

Tests to diagnose and stage colorectal cancer may include the following:

• Physical exam and history.
• X-ray of the chest.
• CT scan of the chest, abdomen, and pelvis.
• PET scan.
• MRI.
• Bone scan.
• Biopsy.

Other tests used to diagnose colorectal cancer include the following:

Colonoscopy: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.

Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silverwhite
metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and xrays
are taken. This procedure is also called a lower GI series.

Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.

Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:

• The number of red blood cells, white blood cells, and platelets.
• The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
• The portion of the blood sample made up of red blood cells.

Kidney function test: A test in which blood or urine samples are checked for the amounts of certain substances released by the kidneys. A higher or lower than normal amount of a substance can be a sign that the kidneys are not working the way they should. This is also called a renal function test.

Liver function test: A blood test to measure the blood levels of certain substances released by the liver. A high or low level of certain substances can be a sign of liver disease.

Carcinoembryonic antigen (CEA) assay : A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of colorectal cancer or other conditions.

Treatment of colorectal cancer in children may include the following:

• Surgery to remove the tumor when it has not spread.
• Radiation therapy and chemotherapy for tumors in the rectum or lower colon.
• Combination chemotherapy.

Treatment of recurrent colorectal cancer in children may include the following:

• A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.

Children with certain familial colorectal cancer syndromes may be treated with:

• Surgery to remove the colon before cancer forms.
• Medicine to decrease the number of polyps in the colon.

The prognosis (chance of recovery) depends on the following:

• Whether the entire tumor was removed by surgery.
• Whether the cancer has spread to other parts of the body, such as the lymph nodes, liver, pelvis, or ovaries.