Rectal cancer case presentation in limited-resource setting.pptx

This presention is about a rare case of rectal carcinoma

1. CLINICAL HISTORY Age- 57 years old PC- Change in bowel habit-7 months Gluteal pain-1 month HPC- He has been well until 7 months ago when he developed diarrhea with about 7 loose stools per day. This persisted over weeks and then started experiencing gluteal pain. He was seen at a peripheral clinic where a rectal mass was found on digital rectal examination

2. CLINICAL HISTORY Patient however defaulted on account of financial constraints He later noticed a mass around his anus and developed a perianal fistula Reported to the surgical department of KBTH where he had a diversion colostomy done on August,2022. He was then referred to Oncology in September,2022

3. CLINICAL HISTORY No family history of cancer No known chronic illness No previous surgeries or blood transfusions

4. CLINICAL EXAMINATION FINDINGS Middle aged male, Not pale or jaundiced ECOG 0 Cardiopulmonary stable Abdominal exam-functional colostomy Digital rectal exam revealed lax anal sphincter tone, a hard mass 2cm from the anal verge occupying almost 80% of the circumference of the rectum with a perianal fistula.

5. LABORATORY FINDINGS Blood workup done- normal Baseline CEA was 124ug/l Metastatic workup done with chest and abdominopelvic CT scan was negative for distant metastases. MRI of the pelvis was not affordable

6. ABDOMINOPELVIC CT SCAN

7. HISTOPATHOLOGY REPORT MODERATELY DIFFERENTIATED ADENOCARCINOMA OF THE RECTUM

8. DIAGNOSIS MODERATELY DIFFERENTIATED ADENOCARCINOMA OF THE RECTUM cT4b(perianal fistula)N1a(pelvic node)M0

9. TREATMENT PLAN Long course concurrent chemoradiation to 50.4Gy in 25 fractions with Capecitabine 825mg/m2 bd on treatment days This will be followed with adjuvant chemotherapy with XELOX (capecitabine and oxaliplatin) 3 weekly for 6 cycles. Then to have Abdominoperineal resection with a perineal colostomy

10. CONTOURS

11. CONTOURS

12. TREATMENT PLAN

13. ADJUVANT CHEMOTHERAPY/SURGERY Completed 6 cycles of adjuvant Xelox on 3/1/24 Patient had AP resection with a perineal colostomy done on 22/4/23 Histopathology report showed Pathological complete response pT0Nx

14. FOLLOW UP CEA done post adjuvant chemotherapy was 11.3g/dl Currently on 3 monthly reviews with CEA

15. Questions to the consultants: 1 2 3