Childhood Colorectal Cancer Treatment (PDQ®): Treatment - Patient Information [NCI]

General Information About Childhood Colorectal Cancer

Colorectal cancer is a disease in which malignant (cancer) cells form in the tissues of the colon or the rectum.

The colon is part of the body's digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the mouth, throat, esophagus, stomach, and the small and large intestines. The colon (large bowel) is the main part of the large intestine and is about 5 feet long in an adult. Together, the rectum and anal canal make up the last part of the large intestine and are 6 to 8 inches long. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).

Having certain inherited syndromes increases the risk of colorectal cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your child's doctor if you think your child may be at risk.

Childhood colorectal cancer may be part of an inherited syndrome. Some colorectal cancers in young people are linked to a gene mutation that causes polyps (growths in the mucous membrane that lines the colon) to form that may turn into cancer later. The risk of colorectal cancer is increased by having inherited conditions, such as the following:

• Familial adenomatous polyposis (FAP).
• Attenuated FAP.
• MUTYH-associated polyposis.
• Oligopolyposis.
• Change in the NTHL1 gene.
• Juvenile polyposis syndrome.
• Cowden syndrome.
• Peutz-Jeghers syndrome.
• Neurofibromatosis type 1 (NF1).

Polyps that form in the colon of children who do not have an inherited syndrome are not linked to an increased risk of cancer.

Signs and symptoms of colorectal cancer include pain in the abdomen, constipation, and diarrhea.

Signs and symptoms of childhood colorectal cancer usually depend on where the tumor forms. These and other signs and symptoms may be caused by colorectal cancer or by other conditions.

Check with your child's doctor if your child has any of the following:

• Tumors of the rectum or lower colon may cause pain in the abdomen, constipation, or diarrhea.
• Tumors in the part of the colon on the left side of the body may cause:
  • A lump in the abdomen.
  • Weight loss for no known reason.
  • Nausea and vomiting.
  • Loss of appetite.
  • Blood in the stool.
  • Anemia (tiredness, dizziness, fast or irregular heartbeat, shortness of breath, pale skin).
• Tumors in the part of the colon on the right side of the body may cause:
  • Pain in the abdomen.
  • Blood in the stool.
  • Constipation or diarrhea.
  • Nausea and vomiting.
  • Weight loss for no known reason.

Tests that examine the colon and rectum are used to diagnose colorectal cancer.

The following tests and procedures may be used:

• Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
• Colonoscopy: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It also has a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.
• Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.
• Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.
• Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the blood sample made up of red blood cells.
• Carcinoembryonic antigen (CEA) assay: A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of colorectal cancer or other conditions.

Certain factors affect prognosis (chance of recovery).

Prognosis depends on the following:

• Whether the tumor was completely removed by surgery.
• Whether the cancer has spread to other parts of the body, such as the lymph nodes, lung, liver, pelvis, ovaries, or bone.
• Whether the cancer has just been diagnosed or has recurred (come back).