Preoperative Staging
9 results
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Malignancy- A 53-year-old man with rectal cancer starting at 2 cm from anorectal ring presents to the office to discuss further management. He has undergone chemoradiation and consolidation FOLFOX chemotherapy for cT3N1aM0 microsatellite proficient tumor. He has a partial response with a residual palpable mass. He normally has up to five bowel movements per day with urgency and fecal leakage. What is the best next surgical treatment for him?
- 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 45-year-old patient undergoes emergent right hemicolectomy for an obstructing colon cancer with a small area of contained perforation. The patient recovers well and presents to your office for postoperative follow-up. Final pathology is T4aN0, with 0/13 nodes positive, margins negative, and mismatch repair intact. The best next step in this patient’s treatment plan is
- 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 62-year-old woman is found to have a large near-obstructing sigmoid cancer on colonoscopy; biopsy returns as adenocarcinoma. Preoperative staging includes a carcinoembryonic antigen (CEA) level of 8 ng/mL, and imaging shows a few prominent lymph nodes near the sigmoid lesion. She is referred for surgical management. Frozen section on peritoneal nodules found near the lesion return as adenocarcinoma, and oncological resection is completed. Which of the following is the best determinant of the prognosis for this patient?
- Perioperative
- An 88-year-old man presents from a local nursing home with a new onset rectal bleeding. The patient has multiple medical comorbidities, including coronary heart disease previously treated with coronary artery bypass graft surgery, congestive heart failure, and peripheral vascular disease. The patient is wheelchair-bound and has an Eastern Cooperative Oncology Group performance status of 4. The patient is found to have an ascending colon adenocarcinoma without evidence of metastatic disease on staging computed tomography (CT). His preoperative carcinoembryonic antigen (CEA) is 2.1 ng/mL. After an extensive conversation with the patient and his family he desires to proceed with minimally invasive right hemicolectomy. Which of the following is a marker for increased postoperative morbidity, mortality, and length of stay?
- A 45-year-old man is diagnosed with sigmoid colon cancer on screening colonoscopy. Staging workup shows no evidence of metastatic disease. Which of the following combinations, in addition to standard intravenous antibiotic prophylaxis, is recommended to decrease surgical site infection after segmental colectomy?
- Colon and Rectal Surgery Educational Program (CARSEP)
- Pelvic Floor