Parasuraman CA rectum post chemo 1.1.pptx

It is a presemtstion on carcinoma rectum

1. A CASE OF CARCINOMA RECTUM TUMOUR BOARD NO (223/23) Prof Dr T Babu Antony Sir’s - Unit S6

2. A 53 yrs old male, a K/C/O CA RECTUM - T3 N2 M0 STAGE IIIC diagnosed on August 2023 and was presented in tumor board (TB.NO: 138/23). As per tumor board consensus, pt has now completed CCRT (25 cycles RT with Tab.CAPECITABINE ) and is admitted for reassessment and further plan of management CASE DETAILS :

3. CLINICAL PICTURE : Parasuraman 53 years Male

4. ECOG- Patient- afebrile, hydr ation fair Vitals stable Per abdomen: Soft, No tenderness, guarding or rigidity. No palpable mass or organomegaly Left supraclavicular fossa – free Other system examination- normal ON EXAMINATION :

5. DIGITAL RECTAL EXAMINATION : (PRE CHEMO) Perianal region: Normal Anal tone: Normal Anal mucosa: A firm non friable irregular mass at 7O’Clock to 12 O’clock po sition about 4 cm from the anal verge . Admitting one finger. Unable to palpate the upper border. Normal fecal staining, no bleeding

6. DIGITAL RECTAL EXAMINATION : (POST CHEMO) Perianal region: Normal Anal tone: Normal Anal mucosa: An irregular ulceroproliferative growth at 4’o Clock to 8’o clock po sition about 5 cm from the anal verge . Admitting one finger. Unable to palpate the upper border. Normal fecal staining, no bleeding.

7. CECT ABDOMEN : (30/07/2023) Irregular eccentric wall thickening noted for a length of 4.5 cm with maximal wall thickening measuring 1 cm noted in mid and distal rectum extending from 7 to 12 O’Clock position with surrounding peri rectal fat stranding. Multiple (7-8) s ubcentimetric mesorectal lymph nodes noted largest measuring 7*7 mm IMPRESSION: Possibly malignant rectal growth – suggested scopy or HPE correlation

8. CT CHEST : (28/07/2023) No evidence of metastasis.

9. COLONOSCOPY : (07/08/2023) Ulceroproliferative growth from 5cm from anal verge extending up to 12cm from anal verge (biopsy taken)

10. MRI PELVIS : (12/8/23) (PRE CHEMO) Irregular circumferential asymmetric wall thickening with diffuse restriction noted involving mid and lower rectum for a length of 8.5 cm with maximum thickness measuring 12mm, lower extend up to anal verge. Invasion of serosa noted from 8 to 11’O clock position for a length of 3.6 cm with infiltration into mesorectal fat Mesorectal fascia appears involved 12-1 O’clock position No evidence of extramural vascular invasion noted Recto prostatic angle and neurovascular bundle of prostate appears to be spared Fat plane between the lesion and seminal vesicle, bladder appears spared Fat plane between the lesion and peritoneal reflection appears preserved Multiple (8-9) enlarged mesorectal lymph nodes largest measuring 7*6mm Few subcentimetric bilateral inhuman lymph nodes noted. Impression: F/S/O Rectal malignant growth – T3c N2b Mx, suggested HPE correlation

11. CCRT : Patient was started on concurrent chemoradiotherapy on 22/8/23 25 CYCLES OF RADIOTHERAPY + TAB. CAPECITABINE 500mg ON DAYS OF RT CCRT completed on 20/09/23

12. MRI PELVIS : (28.10.23) (POST CHEMO) Irregular asymmetric circumferential T2/STIR hyperintense wall thickening showing diffusion restriction for a length of 7.8cm, maximum thickness measuring 13mm noted in the rectosigmoid junction, with distal margin 2.7 cm from the anal verge. Lesion infiltrates the mesorectal fat for a depth of 3.5mm in the right lateral aspect. Extramural vascular invasion noted. Few (5-6) tiny lymph nodes without diffusion restriction noted in the mesorectum in right side largest measuring 3x2mm at 8’O clock position.

13. No evidence of enlarged lymph nodes in the obturator, internal iliac level. No evidence of pelvic deposits noted. No evidence of abnormal signal intensities noted in the visualized bones. IMPRESSION : K/C/O – CARCINOMA ANORECTUM POST CHEMORADIATON MALIGNANT GROWTH INOLVING ANORECTUM WITH MESORECTAL FAT INVASION – T3b N1 Mx

14. HISTOPATHOLOGY : (4361/23) (14/8/23) INFILTRATING ADENOCARCINOMA - MODERATELY DIFFERENTIATED GRADE II

15. DIAGNOSIS : CARCINOMA RECTUM ycT3b N1 M0 – STAGE IIIB

16. PLAN : Abdomino perineal resection (APR)

17. TUMOR BOARD CONSENSUS :

18. THANK YOU