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.
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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.
