Colon Adenoma and Carcinoma Among Adult Survivors of Childhood and Young Adult Cancer

Abstract

AIMS: Early initiation of colorectal cancer (CRC) screening is recommended for survivors of childhood and young adult cancer who were treated with radiotherapy to a field including the colon or rectum. Yet, little is known about colonoscopy findings in this population. MATERIALS AND METHODS: We conducted a retrospective investigation of colonoscopies performed between 2005 and 2015 in our institution among adult survivors of childhood and young adult cancer. Data were collected on cancer-related exposures, procedure indication, and findings. Advanced adenomatous lesions were defined as: large adenoma (≥ 1 cm), ≥ 3 adenomas, tubulovillous pathology, high grade dysplasia, or CRC. Screening yield was defined as having an adenoma or advanced adenomatous lesion among those who were asymptomatic at colonoscopy. RESULTS: A total of 1,189 survivors were identified. Of these, 183(15%) had at least one colonoscopy for any indication. Median age at cancer diagnosis was 16.6 years (range, 0-39.9) and at colonoscopy was 34.9 years (range 6.6-65.9). Colonoscopy was performed in 118(65%) survivors for diagnostic reasons, in 53(29%) for asymptomatic screening and in 12(7%) for surveillance. Overall, 43(24%) had at least one adenomatous finding; 29 (16%) had an advanced adenomatous lesion and 7(4%) had CRC. Of the 53 survivors who underwent screening colonoscopy, 18 had an adenomatous finding, resulting in a screening yield of 33%. CONCLUSIONS: Adult survivors of childhood and young adult cancer have significant findings on colonoscopy. Use of screening colonoscopy may need to be expanded, although further study is needed.