Rectal Cancer: Neoadjuvant Therapy [sounds like]
14 results
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Malignancy- A 67-year-old man who has never had colonoscopy presented to the emergency room reporting abdominal pain, distention, constipation, and blood per rectum for the past 2 days. He says his bowel movements are thin in caliber. Computed tomography (CT) of abdomen and pelvis shows a large mass in the mid rectum with proximal colonic distention. Magnetic resonance imaging (MRI) of the pelvis with rectal cancer protocol shows a mid-rectal T4N2M0 lesion. The mass is not amendable to endoscopic placement of stent due to angulation. The best next step is
- A 56-year-old obese man with locally advanced distal rectal cancer is treated with total neoadjuvant chemoradiation therapy. His is a 45-pack-per-year smoker. Restaging reveals no sign of metastasis. Magnetic resonance imaging (MRI) rectal protocol reveals partial clinical response and flexible sigmoidsociopy that shows a 3-cm tumor involving the sphincteric complex. What is the best surgical approach in his care?
- 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 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 48-year-old man with T3N1 rectal adenocarcinoma is treated with total neoadjuvant therapy. He undergoes repeat clinical staging with computed tomography (CT) of his chest, abdomen, and pelvis, and magnetic resonance imaging (MRI) of his pelvis. He is found to have flexible sigmoidoscopy revealing a complete clinical response. Which of the following is an accurate prognosis?
- 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 57-year-old man undergoes total neoadjuvant therapy (TNT) for management of a cT3N1M0 rectal cancer. After completion of both chemotherapy/radiotherapy and consolidation chemotherapy, the presence of complete clinical response to treatment is assessed by
- 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
- A 55-year-old male patient presents to the clinic for evaluation of intermittent fecal incontinence and fecal urgency. The patient has a history of stage III rectal cancer for which he completed total neoadjuvant therapy (TNT) and low anterior resection (LAR) with diverting loop ileostomy. He is now 3 months status post ileostomy reversal. Despite fiber supplementation and intermittent antidiarrheal medication use, he experiences stool stacking and incomplete evacuation 3 days per week. The patient’s symptoms are consistent with
- Perioperative
- Miscellaneous
- Benign Disease
- A 55-year-old man with a history of ulcerative colitis (UC) diagnosed in his early 20s presents with a new diagnosis of distal rectal moderately differentiated adenocarcinoma. Mismatch repair (MMR) protein expression is intact; routine surveillance endoscopy showed a mass starting ~2 cm from the anal verge with all other biopsies negative for dysplasia. Laboratory results reveal unremarkable levels of carcinoembryonic antigen (CEA), comprehensive metabolic panel (CMP), and complete blood count (CBC). Systemic staging is negative for metastatic disease. Local staging with magnetic resonance imaging (MRI) reveals a T3N1 lesion. Based on a multidisciplinary tumor board discussion, the patient is planned for total neoadjuvant chemotherapy with upfront chemoradiation followed by consolidation chemotherapy. After this therapy is completed, what is the optimal surgical course for this patient?
- A 55-year-old man with obesity has completed neoadjuvant chemoradiation therapy for CT3 N2 M0 distal rectal cancer. During his posttreatment evaluation, he is found to have a partial clinical response and is offered a low anterior resection. His total mesorectal excision is completed uneventfully; however, the mesentery to his terminal ileum is thickened and foreshortened causing difficulty in getting the bowel to reach the abdominal wall in the ideal location. The best option for fecal diversion in this patient is
- Colon and Rectal Surgery Educational Program (CARSEP)