Dr. Ram Abhinav. K
Medical oncology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My brother (asymptomatic, 32 years old) underwent a screening colonoscopy due to positive family history. During the procedure, a mass (4.5 cm) was found at the rectosigmoid junction along with three polyps. HPR on mass revealed mass as a well-differentiated adenocarcinoma confined to muscularis propria, and the polyps were hyperplastic, which were removed by polypectomy. The subsequent MRI pelvis, CT abdomen, chest showed no nodes and metastasis. CEA levels are < 0.5, 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?
Hello,
Welcome to icliniq.com.
I could see that the tumor is limited to muscular mucosa, and it is in the rectosigmoid junction.
One should have information on at what distance the tumor is located on colonoscopy. Secondly, on MRI, whether the tumor is located above the peritoneal reflection or below the peritoneal reflection. This is to differentiate whether it is a sigmoid or rectal tumor predominantly.
In spite of this, if the tumor is strictly limited to muscularis mucosa, I would consider surgery upfront for both rectal or 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.
Patient's Query
Thank you doctor,
But what if the final biopsy shows T3 or N +ve, how would the treatment change? To continue the previous question, if he needs adjuvant therapy, what are the regimes and what would be the duration of treatment and the associated side effects?
Hello,
Welcome back to icliniq.com.
We need to know whether it is rectal or sigmoid cancer, by what I have told. 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.
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