Newswise — CHICAGO (February 21, 2020): Colon cancer is more likely to be lethal in children and young adults than middle-aged adults. In a single-institution study, researchers at The University of Texas MD Anderson Cancer Center, Houston, Tex., 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 and for the first time conclude that young people are more likely to have metastases outside the colon, into the abdominal cavity, when they are diagnosed. Their findings put families, clinicians, and surgeons on alert to be sure abdominal complaints in young people are thoroughly and carefully evaluated when first reported, and aggressively treated if cancer is discovered. Study findings appears in an “article in press” on the Journal of the American College of Surgeons website in advance of print.
Colon cancer is rare in individuals under age 25. Prevalence of the disease in patients under age 20 is 0.2 percent. While the Surveillance, Epidemiology and End Results Program (SEER) estimates more than 145,000 new cases of colon cancer for 2019, only about 290 cases are expected in children and young adult people. 1
The diagnosis of colon cancer in children, and young adults is often delayed. Most (70 percent) children and young adult patients in a 2019 survey by Colorectal Cancer Alliance were diagnosed with stage 3 or stage 4 disease. In contrast, older patients are more likely to be diagnosed with stage 1 or 2 disease. 2
“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. Or they may be seen by a pediatrician who knows all about treating children but nothing about colon cancer,” said Andrea Hayes-Jordan, MD, FACS, lead author of the paper, and Surgeon-in-Chief of the North Carolina Children’s Hospital, University of North Carolina, Chapel Hill. She was a professor and section chief of pediatric surgery at MD Anderson at the time the study was conducted.
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 5 to 6 times worse with treatment. So a child with Stage 4 disease has a 6 times higher chance of dying than an adult with the same stage of cancer,” Dr. Hayes-Jordan said.
For the study, researchers compared retrospective outcomes for 94 pediatric patients treated at MD Anderson 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 percent and 78 percent for adults versus 42 percent and 32 percent for children. Except for patients with stage 1 disease, a stage-for-stage comparison showed much lower survival rates for children. Five-year overall survival at stage 2 was 90 percent for adults versus 64 percent for children, at stage 3, 85 percent for adults versus 58 percent for children, and at stage 4, 55 percent for adults and 16 percent for children.
Relapse-free survival by stage were: 85 percent for adults versus 55 percent for children with stage 2 disease, 73 percent for adults and 31 percent for children with stage 3 cancer, and 27 percent for adults versus 5 percent for children with stage 4.
Although some congenital abnormalities have been associated with colon cancer in young people, 71 percent of the patients in this study had no predisposing syndrome. This study also is the first to show that peritoneal (inside the abdomen but outside of the colon) metastasis is significantly higher (p=0.00001) in pediatric patients, the authors report.
“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,” Dr. Hayes-Jordan said.
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, 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, and not dismissed as the stomach flu or a simple tummy ache after eating bad food,” she said.
Dr. Hayes-Jordan also recommends a surgical procedure up front 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.
Dr. Hayes-Jordan’s coauthors are Gideon Sandler, MD; Songphol Malakord, MD; Lian Chun- Xiao, PhD; Scott Kopetz, MD, PhD; Miguel Rodriguez-Bigas, MD, FACS; who are all with MD Anderson.
This study was presented at the Southern Surgical Association 131st Annual Meeting, Hot Springs, VA, December 2019.
Authors have no disclosures related to this study.
“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.
Citation: Colon Cancer in Patients Under 25 Years Old: A Different Disease? Journal of the American College of Surgeons.
1Surveillance, Epidemiology and End Results Program (SEER) 2019, www.seer.cancer-gov. Retrieved 2/10/2020.
2Yarden RI, Newcomer KL; Never Too Young Advisory Board, Colorectal Cancer Alliance. Young onset colorectal cancer patients are diagnosed with advanced disease after multiple misdiagnoses. Presented ahead of the 2019 AACR Annual Meeting; March 29-April 3, 2019; Atlanta, GA.
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About the American College of Surgeons The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 82,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.
Ugonjwa wa kansa ya utumbo unaoweza kusababisha kifo kwa watoto na vijana kuliko kwa watu wazima wenye umri wa kati. Katika utafiti uliofanywa na Chuo Kikuu cha Texas MD Anderson Cancer Center, watafiti walipata tofauti katika viwango vya vifo vya watoto, vijana, na watu wazima vijana (wenye umri wa miaka 24 na chini) waliozaliwa na mwelekeo wa ugonjwa wa colon na kwa mara ya kwanza kuhitimisha kuwa vijana wana uwezekano mkubwa wa kuwa na metastases nje ya colon, ndani ya tumbo. Utafiti huo unawafanya wagonjwa, waganga na madaktari wa upasuaji kuwa makini na kuhakikisha kwamba malalamiko ya tumbo kwa vijana yanatathminiwa kwa uangalifu na kwa uangalifu wakati wa ripoti ya kwanza, na kutibiwa kwa nguvu ikiwa kansa imegunduliwa. Matokeo ya utafiti yanaonekana katika "kifungu katika vyombo vya habari" kwenye tovuti ya Jarida la Chuo cha Marekani cha Madaktari wa upasuaji kabla ya kuchapishwa. Saratani ya utumbo ni nadra kwa watu walio chini ya umri wa miaka 25. Ugonjwa huo unaenea kwa asilimia 0.2 kwa wagonjwa wenye umri wa chini ya miaka 20. Programu ya Ufuatiliaji, Epidemiolojia na Matokeo ya Mwisho (SEER) inakadiria zaidi ya visa vipya vya saratani ya utumbo kwa mwaka 2019, lakini inatarajiwa kuwa karibu visa 290 tu kwa watoto na watu wazima vijana. Ugonjwa wa kansa ya utumbo wa juu kwa watoto na watu wazima vijana mara nyingi hucheleweshwa. Zaidi ya asilimia 70 ya watoto na vijana waliopatikana katika uchunguzi wa 2019 uliofanywa na Chama cha Saratani ya Colorectal walipatikana na ugonjwa wa hatua ya 3 au hatua ya 4. Kwa upande mwingine, wagonjwa wazee-wazee wana uwezekano mkubwa zaidi wa kupatwa na ugonjwa wa hatua ya kwanza au ya pili. Watoto wenye kansa ya utumbo wa juu wanaweza kuanguka kupitia nyufa. Wanaweza kuonekana na mtaalamu wa kansa ambaye hutibu watu wazima lakini ambaye hajui jinsi ya kutibu watoto. "Au wanaweza kuonekana na daktari wa watoto ambaye anajua kila kitu kuhusu kutibu watoto lakini hakuna chochote kuhusu kansa ya utumbo mkubwa, ""alisema Andrea Hayes-Jordan, MD, FACS, mwandishi mkuu wa karatasi, na Daktari Mkuu wa Hospitali ya Watoto ya North Carolina, Chuo Kikuu cha North Carolina, Chapel Hill." Alikuwa profesa na mkuu wa idara ya upasuaji wa watoto katika MD Anderson wakati utafiti ulipofanywa. Matokeo ni hakuna njia ya wazi ya kutibu watoto wenye kansa ya utumbo mzito, isipokuwa kutoa matibabu sawa na watu wazima. Isitoshe, matokeo ya uchunguzi yanaonyesha wazi kwamba aina hizo za uingiliaji si zenye matokeo. Katika hatua kwa hatua, watoto wanaendelea kuwa mbaya mara tano hadi sita kwa matibabu. """Mtoto mwenye ugonjwa wa hatua ya nne ana uwezekano mkubwa mara sita wa kufa kuliko mtu mzima mwenye hatua sawa ya saratani,"" alisema Dk Hayes-Jordan." Kwa ajili ya utafiti huo, watafiti walilinganisha matokeo ya retrospective kwa wagonjwa 94 wa watoto waliotibiwa katika MD Anderson kati ya 1991 na 2017 na hifadhidata ya matokeo ya wagonjwa wazima waliotibiwa kwa kansa ya utumbo. Uhai wa miaka mitatu na usio na kurudia ulitofautiana sana: asilimia 90 na 78 kwa watu wazima dhidi ya asilimia 42 na 32 kwa watoto. Kwa wale walio na ugonjwa wa hatua ya kwanza, kiwango cha kuishi kilikuwa chini sana. Katika hatua ya pili, kiwango cha kuishi kwa miaka mitano kilikuwa asilimia 90 kwa watu wazima dhidi ya asilimia 64 kwa watoto; katika hatua ya tatu, asilimia 85 kwa watu wazima dhidi ya asilimia 58 kwa watoto; na katika hatua ya nne, asilimia 55 kwa watu wazima na asilimia 16 kwa watoto. Uhai bila marudio kwa hatua ilikuwa: asilimia 85 kwa watu wazima dhidi ya asilimia 55 kwa watoto wenye ugonjwa wa hatua ya 2, asilimia 73 kwa watu wazima na asilimia 31 kwa watoto wenye saratani ya hatua ya 3, na asilimia 27 kwa watu wazima dhidi ya asilimia 5 kwa watoto wenye hatua ya 4. Ingawa baadhi ya kasoro za kuzaliwa zimehusianishwa na kansa ya utumbo mwembamba kwa vijana, asilimia 71 ya wagonjwa katika utafiti huu hawakuwa na ugonjwa wa predisposing. Utafiti huu pia ni wa kwanza kuonyesha kwamba metastasis ya peritoneal (ndani ya tumbo lakini nje ya utumbo) ni ya juu sana (p = 0.00001) katika wagonjwa wa watoto. "Hata ingawa wengine wanaweza kufikiri utafiti huo unauliza maswali mengi kuliko unavyosema, angalau unaangazia tatizo hilo ili tuweze kuanza kulishughulikia,"" alisema Dakt. Hayes-Jordan." Hayes-Jordan pia amekuwa akiongoza majaribio ya kliniki ambayo yatakusanya tishu kutoka kwa watu wazima na watoto wenye ugonjwa wa peritoneal na kufanya uchambuzi wa maumbile ili kujaribu kutambua tofauti katika uvimbe kwa watoto na kuchunguza mbadala za matibabu ambazo zitafaidi wagonjwa hawa. "Hata hivyo, hadi wakati ambapo utafiti wa kina utaanza, Hayes-Jordan anasema, ""Tunaomba wazazi na waganga wa afya wawe makini.""" <unk> Dalili za mapema, kama vile kuvimba, ujauzito wa tumbo, usumbufu wa jumla wa tumbo zinahitaji kuchukuliwa kwa uzito. "Wanaweza kuchunguzwa kwa scans za tomografia au teknolojia nyingine za picha ili kutambua tatizo hususa, na sio kuondolewa kama mafua ya tumbo au maumivu ya tumbo rahisi baada ya kula chakula kibaya. """ Dr. Hayes-Jordan pia anapendekeza upasuaji wa mbele na upasuaji wa kuondoa uvimbe kadiri iwezekanavyo. Watoto si watu wazima wadogo. Wanapaswa kutibiwa kwa kufikiri kwa kujitegemea na tathmini ya uangalifu, <unk> yeye alihitimisha. "Hawa ni pamoja na Gideon Sandler, MD, Song Phel Malakord, MD, Lian Chun-Xiao, PhD, Scott Kopetz, MD, PhD, Miguel Rodriguez-Bigas, MD, FACS, na wengineo.""" Utafiti huo ulifanyika katika mkutano wa kila mwaka wa 131 wa Chama cha upasuaji cha Kusini huko Hot Springs, Virginia, Desemba 2019. Waandishi hawana ufunuo unaohusiana na utafiti huu. <unk>FACS<unk> inaashiria kwamba daktari-mpasuaji ni Mwanachama wa Chuo cha Marekani cha Madaktari-mpasuaji. Ugonjwa wa kansa ya utumbo mwembamba kwa wagonjwa chini ya miaka 25 ni ugonjwa tofauti. Jarida la Chuo cha Marekani cha Madaktari wa upasuaji. Programu ya Ufuatiliaji, Epidemiolojia na Matokeo ya Mwisho (SEER) 2019 Imetolewa 2 10 2020 "Kama ""Yarden"" (Kilimo cha Newcomer) na ""Never Too Young"" (Kilimo cha Newcomer) na ""Colorectal Cancer Alliance"" (Kilimo cha Newcomer)." Wagonjwa wa saratani ya utumbo mweusi wanaogunduliwa kuwa na ugonjwa uliopita hatua baada ya kugundua vibaya mara nyingi. Mkutano wa Mwaka wa AACR 2019 (Mchi 29 - Aprili 3, 2019) ni shirika la kitaaluma la upasuaji la Marekani, lililoanzishwa mnamo 1913 ili kuongeza viwango vya mazoezi ya upasuaji na kuboresha ubora wa huduma kwa wagonjwa wa upasuaji. Chuo ni wakfu kwa mazoea ya maadili na uwezo wa upasuaji. Mafanikio yake yameathiri sana mwendo wa upasuaji wa kisayansi nchini Marekani na yameiweka kama mtetezi muhimu kwa wagonjwa wote wa upasuaji. Chuo hicho kina wanachama zaidi ya 82,000 na ni shirika kubwa zaidi la madaktari wa upasuaji ulimwenguni. Kwa habari zaidi, tembelea www.facebook.org.