Pediatric rectal cancer: A success story

Abstract

Pediatric rectal adenocarcinoma is a rare disease with an incidence of 1.3 cases per million children; these numbers have been on the rise in the past two decades. Standard management guidelines are yet to be established because of their rarity and complex range of issues that need to be simultaneously addressed. Here, we demonstrate the treatment approach in a 10-year-old girl who presented with bleeding per rectum and was diagnosed with low rectal cancer; the histopathology was moderately differentiated adenocarcinoma. After discussions by a multidisciplinary team, she underwent laparoscopic bilateral ovarian transposition followed by neoadjuvant concurrent chemoradiation therapy. On follow-up, she achieved a complete clinical response that was evaluated by triple assessment (clinical examination, pelvic magnetic resonance imaging, and colonoscopy). For the past three years, the patient is being followed up using the watch and wait strategy, which is not standard in pediatric patients, and has remained disease-free. We believe that this novel perspective will enable the future development of individualized yet standardized management protocols; thus, it may help in minimizing morbidities. We discuss the complexity involved in treating pediatric rectal cancers by quoting the current case, being the first of its kind, to the best of our knowledge.