Andrea Hayes-Jordan, MD, FACS

According to research published by Andrea Hayes-Jordan, MD, FACS, and colleagues in the Journal of the American College of Surgeons, children and young adults with colon cancer are more likely to have shorter overall survival and recurrence-free survival than middle-aged adults. In a single-institution study, researchers found that differences in mortality rates persist regardless of whether pediatric, adolescent, and young adult patients (aged 24 and younger) were born with a predisposition for colon abnormalities or disease. The researchers also concluded that young people are more likely to have metastases outside the colon (in the abdominal cavity) when they are diagnosed.

Diagnosis of Colon Cancer in Those Younger Than 25

Colon cancer is rare in individuals younger than 25 years old—prevalence of the disease in patients younger than 20 is 0.2%. Although the Surveillance, Epidemiology and End Results Program estimated more than 145,000 new cases of colon cancer would be diagnosed in 2019, only about 290 cases were expected to be found in children and young adults.

Additionally, the diagnosis of colon cancer in children and young adults is often delayed. According to results from a survey conducted by the Colorectal Cancer Alliance, most (70%) children and young adult patients were diagnosed with stage III or stage IV disease. In contrast, older patients are more likely to be diagnosed with stage I or II disease.

“Children with colon cancer can fall through the cracks. They may be seen by an oncologist who treats adults but who doesn’t know how to treat children; they may be seen by a pediatrician who knows all about treating children but nothing about colon cancer,” said lead study author Dr. Hayes-Jordan, Surgeon-in-Chief of the North Carolina Children’s Hospital at the University of North Carolina, Chapel Hill.

The result is no clear path for treating children with colon cancer, other than providing the same treatment as adults. Furthermore, study findings clearly show that these types of interventions are not effective. “Stage for stage, children fare five to six times worse with treatment…,” said Dr. Hayes-Jordan.

Results

In the study, researchers compared retrospective outcomes for 94 pediatric patients treated at The University of Texas MD Anderson Cancer Center between 1991 and 2017 with a prospectively maintained database of outcomes for adult patients who were treated for colon cancer.

Three-year overall and relapse-free survival differed markedly: 90% and 78% for adults, vs 42% and 32% for children. Except for patients with stage I disease, a stage-for-stage comparison showed much lower survival rates for children: 5-year overall survival for stage II was 90% for adults vs 64% for children; for stage III, 85% for adults vs 58% for children; and for stage IV, 55% for adults vs 16% for children.

Relapse-free survival rates by stage were 85% for adults vs 55% for children with stage II disease, 73% for adults and 31% for children with stage III cancer, and 27% for adults vs 5% for children with stage IV disease.

Although some congenital abnormalities have been associated with colon cancer in young people, 71% of the patients in this study had no predisposing syndrome. This study also is the first to show that peritoneal metastasis is significantly higher (P = .00001) in pediatric patients vs adult patients.

“Although some may think the study raises more questions than it answers, it at least illuminates the problem so we can start working on it,” stated Dr. Hayes-Jordan.

In fact, Dr. Hayes-Jordan will soon be co-leading a clinical trial that will gather tissue from adults and children with peritoneal disease and conduct genetic analyses to try to identify differences in tumors in children and investigate treatment alternatives that will benefit these patients.

Until more is known about pediatric colon cancer, Dr, Hayes-Jordan advises parents and clinicians to be vigilant. “Early symptoms—such as bloating, abdominal fullness, [and] general abdominal discomfort—need to be taken seriously. They need to be evaluated with computed tomography scans or other imaging technologies to identify the specific problem…,” she said.

Dr. Hayes-Jordan also recommended a surgical procedure upfront and surgical excision that removes as much of the tumor as possible.

“Children are not small adults. They should be treated with independent thought and careful evaluation,” she concluded.

Disclosure: For full disclosures of the study authors, visit journalacs.org.