Locally Recurrent Rectal Cancer
11 results
1 - 11
Malignancy- A 75-year-old woman underwent a transanal excision of a cT1N0M0 rectal cancer. The final pathology was T1 with negative margins and no aggressive features. What is the appropriate endoscopic surveillance regimen?
- A 64-year-old woman with a history of cervical intraepithelial neoplasia presents with a firm 3-cm mass protruding at the anal verge. Anoscopy shows a fixed mass just distal to the dentate line. A biopsy of the lesion is performed, which has the findings shown in the Figure. Colonoscopy findings are unremarkable and computed tomography of the chest, abdomen, and pelvis reveals no evidence of distant disease. Magnetic resonance imaging reveals no locoregional nodal or sphincter involvement. The next best step in management for this patient is:
- A 64-year-old woman undergoes colonoscopy for a positive fecal immunochemical test result. A mass is found in the midrectum (Figure). Pathology findings show an adenocarcinoma. For local staging of the tumor, what is the most appropriate next study to perform?
- A 56-year-old man presents to the office with biopsy-proven midrectal adenocarcinoma on colonoscopy. Rigid sigmoidoscopy in the office shows a 5-cm circumferential mass 8 cm from the anal verge. Staging evaluation with computed tomography of the chest, abdomen, and pelvis and magnetic resonance imaging of the pelvis preoperatively demonstrates a T3N1M0 cancer. What is the next step in management for this patient?
- A 72-year-old patient with severe systolic congestive heart failure and oxygen-dependent chronic obstructive pulmonary disease completes chemoradiation for a locally advanced rectal adenocarcinoma 5-cm proximal to the anal verge. Reexamination of the rectum 8 weeks after chemoradiation reveals normal, intact mucosa, and magnetic resonance imaging of the pelvis reveals no visible cancer or suspicious mesorectal nodes. What is the most appropriate therapy for this patient?
- A 62-year-old man was found to have 1-cm posterior rectal lesion that is 3 cm from the anal verge. Histopathologic findings are consistent with a well-differentiated adenocarcinoma without lymphovascular or perineural invasion. Magnetic resonance imaging shows that the tumor is limited to the submucosa and there are no suspicious mesorectal lymph nodes. Metastatic workup uncovers no findings. What is the most appropriate management?
- A 64-year-old man received neoadjuvant chemoradiotherapy followed by a low anterior resection 3 years ago for the treatment of rectal cancer. He complains of persistent fecal urgency, occasional fecal incontinence, clustered stools, and incomplete evacuation, which has persisted since the time of surgery. What is the most likely cause of these symptoms?
- A 53-year-old man has a 2-cm peripheral lung lesion on surveillance computed tomography of the chest, abdomen, and pelvis 3 years after undergoing a low anterior resection for a pT3N0 rectal cancer. No other lesion is found. Multidisciplinary evaluation concludes that this is a colorectal metastasis. What is the best treatment recommendation for this patient?
- A 53-year-old man is diagnosed with rectal adenocarcinoma 7 cm from the anal verge. Preoperative pelvic magnetic resonance imaging (MRI) demonstrates a threatened circumferential radial margin. After total neoadjuvant chemoradiation, a repeat MRI demonstrates a persistently threatened radial margin. Which of the following adjuncts should be considered in operative planning for this patient?
- Benign Disease
- A 58-year-old man with chronic ulcerative colitis is found to have a 3-cm mass approximately 5 cm from the anal verge on surveillance colonoscopy. Biopsies reveal moderately differentiated adenocarcinoma. On rectal examination, the mass is fixed and tethered. Staging reveals a T3N0 lesion, with no evidence of distant metastasis. The best next step in management is:
- An 85-year-old man presents to your office with complaints of intermittent rectal bleeding. His history is notable for prostate cancer treated with external beam radiation. Sigmoidoscopy reveals mucosal pallor, superficial ulceration, and telangiectasias in the distal rectum, and a biopsy specimen is obtained from the anterior rectal wall. Two weeks later, the patient develops pelvic pain, fever, and a watery rectal discharge that occurs while voiding. This presentation is most concerning for: