- Rectal case
- Introduction - Case Overview
- At this point would you...
- History and Physical Exam
- HPI
- History
- Physical Exam
- Within 12 hours, while still in the ER, TP's symptoms of obstruction resolved spontaneously. His symptoms and small bowel obstruction are attributed to adhesions from his abdominal aortic aneurysm repair. What would be your next step?
- Wrong Management
- Wrong Management
- Wrong Management
- Differential Diagnosis
- Right management
- CT Abdomen and Pelvis
- Family Physician
- It is now 1 week since TP presented at the ER. At the gastroenterologist's office, the doctor does a history and physical exam. TP continues to have some slight discomfort in the left lower quadrant, and some streaks of blood. His bowel movements have been regular today. He decides to do a sigmoidoscopy, due to suspicion of a rectal lesion. During the sigmoidoscopy, a circumferential, friable, ulcerative lesion is found. The distal edge of this lesion is estimated to be approximately 5 cm from the anal verge and the proximal edge is approximately 8 cm from the anal verge.
- Given that the mass on sigmoidoscopy is suspicious for a neoplasm, numerous biopsies are taken from the mass and the tissue samples are sent for histopathological analysis.
- Staging
- At this point, the diagnosis of rectal adenocarcinoma is definite. We need to assess the clinical stage of the rectal cancer. What lab tests and imaging modalities are used for clinical staging of rectal cancer?
- Further staging is performed with an MRI of the pelvis with gadolinium contrast. Click here to view the MRI Image. Click here to view the radiology report.
- Staging
- Performance status
- Which general approach do you think is more suitable for TP's cT3N0M0 rectal cancer, also accounting for his ECOG score of 0?
- Palliative Chemotherapy
- Epilogue
- pathology
- Adjuvant chemotherapy
- Epilogue
- Learning Review