Early distant relapse after optimal local control in locally advanced rectal cancer
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BioMed Central
Open Access
Case report
Early distant relapse after optimal local control in locally advanced rectal cancer Javier Gallego-Plazas*1, Francisco Menarguez-Pina2, Natividad MartinezBanaclocha1, Vanesa Pons-Sanz1, Fernando Mingol-Navarro3, Jose A RuizMacia4 and Sonia Macia-Escalante1 Address: 1Servicio de Oncología Médica, Hospital General Universitario de Elche, Elche, Alicante. Spain, 2Servicios de Cirugía, Hospital Vega Baja, Orihuela, Alicante, Spain, 3y Cirugía, Hospital General Universitario de Elche, Elche, Alicante, Spain and 4y Anatomía Patológica, Hospital Vega Baja, Orihuela, Alicante, Spain Email: Javier Gallego-Plazas* - [email protected]; Francisco Menarguez-Pina - [email protected]; Natividad MartinezBanaclocha - [email protected]; Vanesa Pons-Sanz - [email protected]; Fernando Mingol-Navarro - [email protected]; Jose A Ruiz-Macia - [email protected]; Sonia Macia-Escalante - [email protected] * Corresponding author
Published: 14 July 2008 International Seminars in Surgical Oncology 2008, 5:18
doi:10.1186/1477-7800-5-18
Received: 8 January 2008 Accepted: 14 July 2008
This article is available from: http://www.issoonline.com/content/5/1/18 © 2008 Gallego-Plazas et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract We present a case of locally advanced rectal cancer with initial optimal local control after neoadjuvant concurrent chemoradiotherapy followed by surgery; early liver recurrence then occurred and was treated again with curative intent with neoadjuvant combination chemotherapy followed by liver surgery. We reflect on this difficult problem and discuss relevant topics to this case report.
Clinical case A male of 56 years of age with clinical history of hyperuricemia and gout was hospitalised because of rectal bleeding. His symptoms had started two months prior, and he had been diagnosed with haemorrhoids. On admission, he had mild anemia. Blood chemistry and coagulation were normal. A full colonoscopy was performed, which detected a 5 cm long, non stenosing rectal tumour, starting after the dentate line, in addition to a sigmoid polyp. Biopsies revealed a rectal adenocarcinoma and a non dysplastic adenomatous polyp in sigmoid colon. Staging studies were completed with tumour markers (CEA and CA 19.9) measurement, echoendoscopy and a thoracic-abdominal-pelvic CT. Tumour markers values were within normal range, echoendoscopy showed a 6 cm long uT3N0 rectal cancer, and CT detected an eccentric
thickening of the rectal wall, compatible with a rectal cancer with no lymph node or visceral involvement. Final diagnosis was a rectal adenocarcinoma located in the middle-inferior thirds, clinical stage T3 N0 M0 (Figures. 1, 2). His clinical case was discussed shortly after in our Digestive Tumours Com
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