Primary gastrointestinal malignancies in childhood and adolescence--an Asian perspective.

INTRODUCTION Primary gastrointestinal (GI) malignancies are a rarity in childhood and adolescence, with limited information from Asian populations. This study was conducted with the objective of identifying the existence of malignant GI tumors in the young population of Pakistan and to determine high risk geographical areas of the country. METHODOLOGY Pediatric and adolescence (<or=14 years; <or=19 years) gastrointestinal malignancies, ICD-10 categories C15-20 registered at the surgical pathology department of the Aga Khan University Hospital during 1st March 2004 to 30th April 2006 were included in the cross-sectional study. RESULTS Sixty cases in <or=19 year age group were studied. The mean age was 16.2 years (SD+/-4.56). Carcinoma comprised 47 cases (78.3%; 32 boys and 15 girls.) and lymphoma 13 cases (21.7%; 12 boys and 1 girl). All cases presented as advanced malignancies. Categorization of carcinoma by site was colon (85.1%), stomach (6.4%) and esophagus (8.5%). Lymphoid malignancies were diffuse large B-cell lymphoma (30.8%), Burkitt lymphoma (46.1%) and Burkitt-like lymphoma (23.1%). The mean age at presentation was 11.1 years (SD+/- 4.6). CONCLUSION This study has identified a substantial number of GI malignancies in the <or=19 year Pakistani population, involvement of esophagus, male predominance, preponderance of carcinoma versus lymphoma and a high signet ring cell and mucinous colo-rectal carcinoma. It has identified Baluchistan as a high risk region for esophageal cancer and diffuse large B-cell lymphoma and NWFP for Burkitt and Burkitt-like lymphoma. Most findings in the present study did not concur with published western data, indicating the need to study cancer in the Asian population.