Indian Pediatrics 2001; 38: 933-934  

Colorectal Carcinoma in Children in Developing Countries

The paper by Bhatia et al.(1) on colorectal carcinoma in Indian Children was interesting to read. Their findings are similar in several areas to our experience in Zaria, Nigeria(2).

Colorectal carcinoma is thought to be rare in children. In developed countries, less than 1% of patients with this disease are below 20 years(3,4). Earlier reports from tropical Africa indicated that the disease was extremely rare in children and adolescents. However, recent experience in Zaria, Nigeria, showed that 16.3% of patients with this disease are aged 18 years or below(2), suggesting that the disease may not be as rare in this age group as widely believed, in developing countries. As observed by Sarin(5), if patients up to 18 years (most of who are managed by general surgeons in developing countries) are reviewed, more cases would be unearthed. In, Zaria, of the 8 children and adolescents seen in 10 years, hemorrhoids was present in 2 and Schistosoma mansoni infestation in one, and their treat-ments at peripheral hospitals was responsible for delayed referral and diagnosis. This may suggest that some cases may go undiagnosed in children because the disease is not suspected.

As in India, all 8 patients in Zaria had left sided tumours, in contrast to what is observed in western countries. Unfortunately, majority had advanced tumors (Duke’s stage D 4, C 2, B 1, undetermined in 1) and only palliative resection could be offered in most cases. They were mostly of poor histology (mucinous adenocarcinoma) and mortality was invariable within 7 months. The only hope for improved survival is early diagnosis; digital rectal examination must be performed in children with rectal bleeding and suspected cases referred early to the pediatric surgeon for further evaluation.

The biology of colorectal carcinoma in children in developing countries may be different from developed countries. Further studies in developing countries (including community based studies) are necessary to establish the epidemiology of these tumors and adequately characterize their physiology.

Emmanuel A. Ameh,
Lecturer and Consultant
Pediatric Surgeon,
Pediatric Surgery Unit,
Department of Surgery,
Ahmadu Bello University and Ahmadu Bello University Teaching Hospital,
Zaria, Nigeria,
E-mail: [email protected]

References

1.  Bhatia MS, Chandna S, Shah R, Patel DD. Colorectal carcinoma in Indian children. Indian Pediatr 2000; 37: 1353-1358.

2.  Ameh EA, Nmadu PT. Colorectal adenocarcinoma in children and adolescents: A report of 8 patients from Zaria, Nigeria. West Afr J Med 2000; 19: 273-276.

3.  Borger JA, Barbosa J. Adenocarcinoma of the rectum in a 15 year old child. J Pediatr Surg 1993; 28: 1592-1593.

4.  Moore PA, Dilawari RA, Fidler WJ. Adenocarcinoma of the colon and rectum in patients less than 40 years of age. Am Surg 1984; 50: 10-14.

5. Sarin YK. Colorectal carcinoma in Indian children. Indian Pediatr 2001; 38: 563-564.