Locally Recurrent Rectal Cancer
11 results
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Malignancy- A 70-year-old woman with a medical history of hypertension and hypothyroidism reports rectal bleeding, maroon blood mixed in with her stool, and weight loss to her primary care physician. She is referred to undergo diagnostic colonoscopy. She is found to have a hepatic flexure mass with biopsies taken and tattoo placed distally, with pathology returning as moderately differentiated adenocarcinoma, mismatch repair (MMR) protein expression intact. Laboratory testing includes a complete blood count, basic chemistry, and carcinoembyronic antigen (CEA) with findings of anemia and a mildly elevated CEA level. What imaging is recommended for completion of the staging work-up in this patient?
- A synoptic pathology report of a rectal cancer specimen reads as moderately differentiated adenosquamous carcinoma with negative distal margin measuring >2 cm and a circumferential resection margin (CRM) measuring >2.5 mm. All 12 nodes are negative for metastasis, and there is positive extramural invasion. Which of these features is associated with higher risk for distant recurrence?
- A healthy 65-year-old male patient is diagnosed with a moderately differentiated rectal adenocarcinoma, microsatellite stable. Staging was negative for metastatic disease. Pelvic magnetic resonance imaging (MRI) shows possible involvement of the prostate with mesorectal lymph nodes suspicious for metastasis. What is the current recommended course of treatment for this patient, given these findings?
- A 60-year-old man undergoes diagnostic colonoscopy for a 6-month history of rectal bleeding and is found to have a 3-cm mass in the mid rectum. Biopsies reveal invasive adenocarcinoma. Staging computed tomography (CT) of the chest/abdomen/pelvis reveals no evidence of distant metastatic disease. Magnetic resonance imaging (MRI) of pelvis reveals a T3 mid-rectal mass, with evidence of enlarged mesorectal lymph nodes. His carcinoembryonic antigen (CEA) level is elevated to 7.5 ng/mL. In this patient, the use of neoadjuvant chemoradiation would be expected to provide which of the following?
- A 61-year-old man is found to have a 2-cm mass in the mid-rectum (8 cm from the anal verge) on diagnostic colonoscopy. Biopsy reveals moderately differentiated adenocarcinoma. Computed tomography (CT) reveals no evidence of metastatic disease, and magnetic resonance imaging (MRI) demonstrates a cT3, node-negative cancer. After presentation at a multidisciplinary tumor board, the patient agrees to total neoadjuvant therapy. The patient has a complete clinical response to treatment and opts for close radiologic and endoscopic surveillance in an effort to avoid surgery. On a surveillance proctoscopy 6 months after treatment, the patient is found to have a 7-mm recurrence at the original cancer site. Which of the following is the best next step in management?
- A 63-year-old woman is diagnosed with a poorly differentiated microsatellite–stable rectal cancer 7 cm from the anal verge on screening colonoscopy. She denies trouble with continence. Staging computed tomography (CT) of the chest/abdomen/pelvis does not demonstrate distant disease; a mass is confirmed in the mid rectum with evidence of lymphadenopathy. Rectal magnetic resonance imaging (MRI) demonstrates this tumor is a T4aN2M0 with threatened circumferential radial margin. The multidisciplinary tumor board recommends total neoadjuvant chemotherapy with FOLFOX and long-course chemoradiation therapy. Six weeks after completing neoadjuvant therapy, flexible sigmoidoscopy demonstrates persistent tumor. Restaging MRI after total neoadjuvant therapy is consistent with persistently threatened posterior radial margin with tumor extending to the presacral fascia. The multidisciplinary tumor board’s best recommendation for her is
- Which technical/surgical factor during proctectomy most influences the risk of local recurrence?
- A 67-year-old man with cT3cN0 with threatened circumferential radial margin chooses to undergo primary surgery without neoadjuvant chemoradiotherapy. The clinical impact of a curative resection (R0) versus R1 resection is increased rate of
- Anorectal Disease
- A 60-year-old male patient with a history of radiation for prostate cancer presents with pneumaturia and recurrent urinary tract infections. Workup reveals a 1-cm defect in the anterior rectum just above the dentate line, corresponding to a urethral defect on cystoscopy. There is evidence of radiation damage to the rectum but no active infection and no evidence of cancer recurrence. Which of the following is the most definitive management?
- A 45-year-old man, who reports sex only with men (MSM), has been referred to you for evaluation of a whitish anorectal lesion identified on initial screening colonoscopy. Biopsies confirmed high-grade squamous intraepithelial lesion (HSIL), for which he ultimately underwent excision and fulguration. What is the recommended surveillance?
- Colon and Rectal Surgery Educational Program (CARSEP)