Does my brother, 32, need neoadjuvant for adenocarcinoma?

Question

Hello doctor,

My brother (asymptomatic, 32 years old) underwent a screening colonoscopy due to a positive family history. During the procedure, a mass (1.77 inches) was found at the rectosigmoid junction along with three polyps. HPR on mass revealed a well-differentiated adenocarcinoma confined to the muscularis propria, and the polyps were hyperplastic, which were removed by polypectomy.

The subsequent MRI of the pelvis, CT of the abdomen, and chest showed no nodes or metastasis. CEA levels are < 0.5, and IHC for MMR is also negative.

My questions are, does he need total neoadjuvant or neoadjuvant, or adjuvant CRT (chemoradiotherapy) along with the surgery LAR? If so, what are the regimes, and what would be the duration of treatment and the associated side effects?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

The tumor is limited to the muscular mucosa and is in the rectosigmoid junction.

During a colonoscopy, one should have information on the distance at which the tumor is located. Secondly, MRI (magnetic resonance imaging) determines whether the tumor is located above or below the peritoneal reflection. This is to differentiate whether it is predominantly a sigmoid or rectal tumor.

In spite of this, if the tumor is strictly limited to the muscularis mucosa, I would consider surgery upfront for both rectal and sigmoid cancer. By doing this, we would know the exact staging of the tumor. If he ends up as T2, N0, we could still consider observation after surgery.

Kind regards.

Answer 2

Hello,

Welcome back to icliniq.com.

We need to know whether it is rectal or sigmoid cancer, as I have told you. If it is rectal cancer T3 N+, he would require chemoradiation and adjuvant chemotherapy. If sigmoid cancer, only adjuvant chemotherapy.

Chemoradiation- Radiation 50Gy with concurrent Capecitabine.
Adjuvant chemotherapy- Capecitabine alone or Capecitabine-Oxaliplatin for six months.

I hope this helps you.

Thank you.