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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 54-55

Carcinoma of rectum in a 9 year old girl a rare case report


Department of Radiotherapy, Indira Gandhi institute of medical sciences, Patna 14, India

Date of Web Publication12-Feb-2018

Correspondence Address:
Santhosh Meedimale
Senior Resident, Department of RCC, IGIMS, Sheikhpura, Patna-14, Bihar
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Colorectal cancer generally seen in elderly around 5th-6th decade of life and rarely seen in pediatric age group with an incidence of only 1.3-2 cases per million noticed. Due to the nonspecific symptoms and lack of awareness often diagnosed at advanced stage which results in poor prognosis. Children with altered bowel habits not responding to symptomatic treatment should be evaluated with simple digital rectal examination, followed by sigmoidoscopy or colonoscopy if required.


How to cite this article:
Meedimale S, Singh RK, Devi S, Sinha DK, Madhawi R. Carcinoma of rectum in a 9 year old girl a rare case report. J Indira Gandhi Inst Med Sci 2018;4:54-5

How to cite this URL:
Meedimale S, Singh RK, Devi S, Sinha DK, Madhawi R. Carcinoma of rectum in a 9 year old girl a rare case report. J Indira Gandhi Inst Med Sci [serial online] 2018 [cited 2022 Aug 10];4:54-5. Available from: http://www.jigims.co.in/text.asp?2018/4/1/54/302988




  Introduction : Top


Colorectal cancer remains one of the leading causes of death worldwide. It is the third most common malignancy generally seen after the 5th decade of life[1]. Incidence of colorectal cancer before the age of 40 years varies from 0.8% to 15%[2] and is extremely rare in pediatric age group with an incidence of only 1.3-2 cases per million population[3].

Because of nonspecific symptoms and lack of awareness, pediatric patients are often diagnosed at an advanced stage which results in poorer outcome when compared to adults.

Present case has been highlighted to consider in differential diagnosis while evaluating patients of pediatric age group with colonic symptoms of unknown etiology.


  Case Report: Top


A 9 year old girl presented with four months history of vague abdominal pain, bleeding per rectum, constipation. During this period she had significant weight loss of 4 kilograms in a span of two months. For these complaints she consulted local medical practitioner where her symptoms were not relieved and was referred to tertiary care center. The girl on physical examination looks pale, ill looking and below tenth percentile for height and weight. She has no family history of cancers. Abdominal tenderness and distention was noticed on palpation. On digital rectal examination firm, hard, nodular, circumferential intraluminal mass arising approximately 3 cm from the anal verge. Computer tomography of abdomen and pelvis revealed concentric and symmetrical thickening of anal canal and rectum, with soft tissue mass in pre sacral space. Fat planes between rectum and pelvic lateral wall were infiltrated. On laparotomy mass was seen arising from rectum and was infiltrating lateral and posterior pelvic walls, which was inoperable. Diverting colostomy was done to relieve the symptoms of intestinal obstruction. Biopsy was done and histopathology was suggestive of rectal adenocarcinoma (signet ring cell type). Multidisciplinary clinic opinion was sought and was started on concurrent chemo radiation with oral capecitabine 825mg/m2 along with radiation 5 days a week for a period of 6 weeks. She has completed 5 cycles of chemotherapy and lost on follow up for further management.
Figure 1: Histopathology report

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Figure 2: CT abdomen+pelvis

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  Discussion: Top


Colorectal cancers commonly seen in elderly but now a days the incidence is increasing in pediatric and adolescent group due to dietary and environmental factors. Incidence of only 1.3-2 per million been observed in pediatric age group.

Due to nonspecific symptoms in pediatric age group, usually diagnosis is being delayed and present only in advanced stages which results in poor prognosis among children. A retrospective study of colorectal cancer in young conducted by Ashutosh et al observed that abdominal pain was the major complaint and rectum was most commonly involved site in young patients[3]. Clinico-pathological profile of 76 children with diagnosis of colorectal cancer was reviewed by Ashley et al where he reported 86% of children presents in advance stage[4]. In our present case even patient with abdominal pain, bleeding per rectum was being misdiagnosed as amoebiasis because of pediatric age group. Due to lack of specific symptoms and clinical awareness young group of patients are usually diagnosed later associated with worst prognosis. The incidence of colorectal cancer at an early age may be correlated with modern dietary factors and epidemic obesity[5]. Early diagnosis with radical surgery and medical management improves the survival rate among children.The prognosis of colorectal cancers in children will only improve with increased awareness which leads to early diagnosis and treatment. Children with gastro intestinal tract symptoms who do not respond to symptomatic treatment should be evaluated with simple digital rectal examination followed by sigmoidoscopy or colonoscopy to rule out colorectal cancers.



 
  References Top

1.
Brenner H, Altenhofen L, Hoffmeister M. Sex, Age, and Birth Cohort Effects in Colorectal NeoplasmsA Cohort Analysis. Annals of internal medicine. 2010 Jun 1;152(11):697-703.  Back to cited text no. 1
    
2.
Lupinacci RM, Campos FG, Araújo SE, Imperiale AR, Seid VE, Habr- Gama A, Kiss DR, Gama-Rodrigues J. Análise comparativa das características clínicas, anátomo-patológicas e sobrevida entre pacientes com câncer colo-retal abaixo e acima de 40 anos de idade. Rev Bras Coloproct. 2003;23(3):155-62.  Back to cited text no. 2
    
3.
Mukherji A, Rathi AK, Sharma K, Kumar V, Singh K, Bahadur AK. A study on presentation and behavior of colo-rectal carcinoma in young Indian patients. Tropical Gastroenterology. 2011 Aug 9;32(2):122-7.  Back to cited text no. 3
    
4.
Hill DA, Furman WL, Billups CA, Riedley SE, Cain AM, Rao BN, Pratt CB, Spunt SL. Colorectal carcinoma in childhood and adolescence: a clinicopathologic review. Journal of Clinical Oncology. 2007 Dec 20;25(36):5808-14.  Back to cited text no. 4
    
5.
Hubbard JM, Grothey A. Adolescent and young adult colorectal cancer. Journal of the National Comprehensive Cancer Network. 2013 Oct 1;11(10):1219-25.  Back to cited text no. 5
    


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