Colon cancer, while predominantly associated with older adults, can indeed affect children. Although it is considered rare, with fewer than 100 children diagnosed in the United States each year, its occurrence in younger individuals is a concern. The disease presents unique challenges in the pediatric population, often differing significantly from how it manifests in adults. Understanding these distinctions is important for recognizing the disease in its early stages.
Pediatric Colon Cancer Overview
The incidence of colorectal cancer in children is estimated to be approximately one case per million children. Studies indicate an increase in colorectal cancer cases among children and young adults. For instance, the rate of colorectal cancers grew by 500% in children aged 10 to 14 between 1999 and 2020.
When growths occur in a child’s colon, distinguishing between benign polyps and cancerous tumors is important. Not all growths are cancerous; some polyps may cause symptoms like bleeding or abdominal pain but are not linked to increased cancer risk unless part of an inherited syndrome. Benign polyps can lead to intestinal obstruction, bleeding, or anemia. Other polyps can be precancerous and may develop into cancer over time.
Primary Risk Factors in Children
Several underlying conditions and genetic predispositions increase a child’s risk of developing colon cancer. These factors often involve inherited genetic changes that affect cellular growth and repair mechanisms.
Genetic syndromes account for many pediatric colon cancer cases. Familial Adenomatous Polyposis (FAP) is an inherited condition where children develop hundreds to thousands of polyps throughout their colon, usually by their late teens or early adulthood. Without intervention, these polyps almost always become cancerous, often before age 40. Attenuated FAP (AFAP) is a milder form with fewer polyps but still carries a high cancer risk, with onset around age 55. Gardner syndrome and Turcot syndrome are variations of FAP, also caused by the same gene mutation; Turcot syndrome also increases the risk of brain cancer.
Lynch Syndrome (Hereditary Non-Polyposis Colorectal Cancer or HNPCC) is another inherited disorder that increases the risk of various cancers, including colon cancer. It results from changes in DNA mismatch repair genes. While considered an adult-onset illness, Lynch syndrome can manifest in childhood, making it a contributor to rare pediatric colorectal malignancies. Not all individuals with Lynch syndrome develop cancer, but their lifetime risk of colorectal cancer is higher than the general population.
Inflammatory Bowel Disease (IBD), encompassing chronic ulcerative colitis and Crohn’s disease, increases the risk of colon cancer in children. Long-standing inflammation in the digestive tract, characteristic of IBD, contributes to gastrointestinal cancers. Pediatric-onset IBD is often more extensive and severe, leading to a longer duration of disease. Studies show that children diagnosed with IBD before age 18 have twice the cancer risk compared to those without the condition.
Identifying Symptoms in Children
Recognizing the signs of colon cancer in children can be challenging because symptoms are often vague and can mimic common childhood ailments. Parents should monitor for persistent or worsening symptoms.
Changes in bowel habits are common indicators. These include unexplained constipation or diarrhea, alternating between the two, pencil-thin stools, or a persistent feeling of needing a bowel movement. Such alterations warrant medical evaluation, especially if ongoing.
Rectal bleeding or blood in the stool requires immediate medical attention. While bleeding can have many causes, its presence should not be ignored. Abdominal pain or cramping that does not resolve or recurs frequently is also a symptom in pediatric colon cancer cases.
Other symptoms include unexplained weight loss, fatigue, or anemia (low red blood cell count) as the cancer progresses. A palpable mass in the abdomen, though less common, indicates advanced disease. Any persistent symptoms lasting more than one to two weeks should be discussed with a doctor.
Diagnosis and Treatment Approaches
Diagnosing colon cancer in children involves a medical assessment, beginning with a detailed medical history and a physical examination.
Diagnostic tests include stool tests for hidden blood, blood tests for anemia or elevated tumor markers, and imaging studies (ultrasound, CT scans, or MRI) to visualize the colon and identify growths or disease spread. A colonoscopy is the primary diagnostic tool, allowing a doctor to view the colon’s interior and take tissue samples for biopsy to confirm cancer.
Treatment for pediatric colon cancer depends on the cancer’s stage. Surgery is often the primary treatment, aiming to remove the tumor and affected sections of the colon. Complete surgical removal is important for prognosis, though it may not always be possible if the cancer has spread.
Chemotherapy, using drugs to destroy cancer cells, is frequently used alone or in combination with other treatments. It may be given after surgery to treat remaining cancer cells or advanced disease. Radiation therapy may also be employed, particularly for tumors located in the rectum or lower colon. A team of specialists determines the overall treatment strategy.