-Female 61 y.o
-Rectal prolapse and hematochezia for 6 months
-BSF Scale- type 6 for half a year
-Up on DRE a mass of identified -6 cm from the anal edge
-April 2018- Colonoscopy identified a cauliflower-like mass 6 cm from the Anal dentate line.
- Pathological diagnosis: poorly differentiated adenocarcinoma of the rectum.
►Immunohistochemistry: CK (+), P53 (+), Ki-67 (80%), CEA (-), CD20 (-)
►Pelvic Contrast-Enhanced CT- April 2018
-Thickening of the intestinal wall in the lower rectum, narrowing of the intestine and no obvious enlarged lymph nodes noted.
►Abdomen CT- Normal -CEA-17.31ng/ml,ECOG score 0
-liver and kidney function- Normal, normal ECG
-Poorly differentiated adenocarcinoma in the lower rectum. Clinical stage: T4N0M0, stage IIb
-Department of Radiology- The lower intestinal wall is thickened in the lower rectum, and the intestinal lumen is narrow.
-Gastrointestinal Surgery- Resectable - radical resection? Anal sphincter preservation?
-Department of Oncology-Neoadjuvant chemoradiotherapy + surgical treatment
-Radiotherapy- 50.4Gy/28 fractions/5.6 weeks
-Chemotherapy- (1-14 days) and(22-35 days)Tegafur 65 mg/m2
Review -June 2018 Colonoscopy
-Diagnosis: rectal mucosal chronic inflammation.
-Pathology CEA: 2.71ng/ml, liver and kidney function normal, ECOG score 0.
Pelvic CT-June 2018: thickening of the rectal wall, marginal irregularity- Evaluation of efficacy: cPR
►Surgery-July 2018:Laparoscopic radical resection of rectal cancer, sigmoid colon-rectal anastomosis
Review-6 months post-surgery: anterior sputum effusion. Carcinoembryonic antigen: 0.68 ng/ml-Efficacy: cCR
1.The best option for neoadjuvant therapy?
A.Combination chemotherapy Tegafur + oxaliplatin
2.If the patient reaches cCR after neoadjuvant therapy?
A. Watch and wait
B. Postoperative radiotherapy