Cancer of the large bowel in children

We present the morphologic and clinical features of large bowel carcinoma in 22 patients seen over 18 years at St. Jude Children's Research Hospital. We saw 18 cases of mucinous adenocarcinoma, three of well differentiated adenocarcinoma, and one case of poorly differentiated adenocarcinoma. The patients ranged in age from 9 to 19 years with a median age of 15. There were 12 female and ten male patients; 12 were black and ten were white. Eighteen patients had Dukes' stage C disease, with median survival of seven months and one patient alive 12 months after diagnosis. Three patients had Dukes's stage B disease, with two patients surviving 16 months each and one presently alive seven months after diagnosis. Only one patient had Dukes' stage A disease and is alive 121 months after diagnosis. Large bowel carcinoma in children is predominantly mucinous adenocarcinoma and occurs in the adolescent age group. Tumor distribution is fairly even throughout the large bowel, and all subtypes of the tumor are positive for carcinoembryonic antigen (CEA) on immunohistologic study. Active tumor and tumor regrowth are always accompanied by high serum levels of CEA. The tumor has no predilection for sex, but is significantly more frequent in blacks (P less than .05). Discovery of the tumor in an early stage improves the prognosis.