Colorectal Cancer on the Rise in Children and Young Adults: A Series of Three Cases and Its Implications for Early Detection

INTRODUCTION. Mucinous colorectal adenocarcinoma, a rare type of colorectal cancer (CRC), ranks as the second most common primary malignancy of the gastrointestinal system in children, accounting for 1% of pediatric neoplasms. Its extreme rarity and non-specific symptoms frequently result in delayed diagnosis and poor prognosis. We present three cases of this distinctive condition in adolescents. CASE PRESENTATIONS. We present three adolescents with mucinous adenocarcinoma. The first patient complains of hematochezia, fluctuating abdominal pain, fatigue, and weight loss. The second patient complains of melena, left lower abdominal pain, weight loss, and an anal mass. The third patient complains of constipation, urinary retention, and weight loss. A digital rectal examination revealed a mass in the anorectal region, and the abdominal CT scan confirmed a malignant mass in that region. DISCUSSION. The mucinous histopathological type is the most prevalent, demonstrating an increased capacity to invade surrounding stromal tissue. It is primarily found in the proximal colon and is the most common form of pediatric colorectal cancer (CRC). Most cases involve a less frequent type of CRC, which typically presents with non-specific signs and symptoms that often persist for three months before diagnosis. This biological behavior is reported to be associated with its aggressive nature. Furthermore, the delayed diagnosis of colorectal carcinoma in children contributes to the advanced stage of the disease at the time of diagnosis. Some reports estimate that 60% to 80% of children and adolescents present with stage 3 and 4 CRC, leading to a poor prognosis. CONCLUSION. Mucinous colorectal adenocarcinoma occurs in both children and adolescents despite its rarity. Since symptoms are nonspecific in children, it can lead to a delay in diagnosis, and a poor prognosis is linked with this delay. This underscores the urgent need for more pediatric prospective studies to guide treatment guidelines, which are currently extrapolated from adults.