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A case of an enlarged rectal adenoma while achieving a clinical complete response with chemotherapy for advanced rectal cancer.
Clin J Gastroenterol. 2020 Jun 29 [Online ahead of print]CJ

Abstract

The effect of chemotherapeutic agents on concomitant colorectal adenomas in patients with advanced colorectal cancer is not clear. We report a case of an enlarged rectal adenoma while achieving a clinical complete response with chemotherapy for an advanced rectal adenocarcinoma. A 78-year-old man was referred to our hospital for evaluation of bloody stools. The clinical diagnosis was an advanced lower rectal adenocarcinoma with para-aortic lymph node metastases, and a sessile polyp on the proximal aspect of the rectal tumor. The rectal adenocarcinoma was treated with chemotherapy, including 1 cycle of capecitabin plus oxaliplatin (CapeOX), 22 cycles of tegafur/gimeracil/oteracil (S-1) plus irinotecan (IRIS), and 1 cycle of tegafur (UFT) plus calcium folinate (LV). One year after the last course of chemotherapy, colonoscopy showed a scar without visible rectal tumor; CT imaging confirmed no para-aortic lymphadenopathy. The patient had a clinical complete response to chemotherapy. In contrast, the polyp increased in size. The polyp was removed by endoscopic mucosal resection (EMR). The pathologic evaluation showed a well-differentiated tubular adenocarcinoma with adenoma localized in the mucosa. No recurrence of the advanced adenocarcinoma or intramucosal adenocarcinoma with adenoma occurred for 2 years after EMR. This case indicates the importance of careful surveillance for synchronous adenomas, even in patients with advanced colorectal cancer.

Authors+Show Affiliations

Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan. yappy0081@yahoo.co.jp.Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan. Department of Endoscopy, Nara Medical University Hospital, Nara, Japan.Department of Pathology, Nara Medical University, Nara, Japan.Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan.Department of Pathology, Nara Medical University, Nara, Japan.Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32602085

Citation

Nakamura, Yasuyuki, et al. "A Case of an Enlarged Rectal Adenoma While Achieving a Clinical Complete Response With Chemotherapy for Advanced Rectal Cancer." Clinical Journal of Gastroenterology, 2020.
Nakamura Y, Koyama F, Morita K, et al. A case of an enlarged rectal adenoma while achieving a clinical complete response with chemotherapy for advanced rectal cancer. Clin J Gastroenterol. 2020.
Nakamura, Y., Koyama, F., Morita, K., Kuge, H., Ohbayashi, C., & Sho, M. (2020). A case of an enlarged rectal adenoma while achieving a clinical complete response with chemotherapy for advanced rectal cancer. Clinical Journal of Gastroenterology. https://doi.org/10.1007/s12328-020-01169-6
Nakamura Y, et al. A Case of an Enlarged Rectal Adenoma While Achieving a Clinical Complete Response With Chemotherapy for Advanced Rectal Cancer. Clin J Gastroenterol. 2020 Jun 29; PubMed PMID: 32602085.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A case of an enlarged rectal adenoma while achieving a clinical complete response with chemotherapy for advanced rectal cancer. AU - Nakamura,Yasuyuki, AU - Koyama,Fumikazu, AU - Morita,Kohei, AU - Kuge,Hiroyuki, AU - Ohbayashi,Chiho, AU - Sho,Masayuki, Y1 - 2020/06/29/ PY - 2020/03/03/received PY - 2020/06/10/accepted PY - 2020/7/1/entrez KW - Chemotherapy KW - Colorectal cancer KW - Complete response KW - Synchronous adenoma JF - Clinical journal of gastroenterology JO - Clin J Gastroenterol N2 - The effect of chemotherapeutic agents on concomitant colorectal adenomas in patients with advanced colorectal cancer is not clear. We report a case of an enlarged rectal adenoma while achieving a clinical complete response with chemotherapy for an advanced rectal adenocarcinoma. A 78-year-old man was referred to our hospital for evaluation of bloody stools. The clinical diagnosis was an advanced lower rectal adenocarcinoma with para-aortic lymph node metastases, and a sessile polyp on the proximal aspect of the rectal tumor. The rectal adenocarcinoma was treated with chemotherapy, including 1 cycle of capecitabin plus oxaliplatin (CapeOX), 22 cycles of tegafur/gimeracil/oteracil (S-1) plus irinotecan (IRIS), and 1 cycle of tegafur (UFT) plus calcium folinate (LV). One year after the last course of chemotherapy, colonoscopy showed a scar without visible rectal tumor; CT imaging confirmed no para-aortic lymphadenopathy. The patient had a clinical complete response to chemotherapy. In contrast, the polyp increased in size. The polyp was removed by endoscopic mucosal resection (EMR). The pathologic evaluation showed a well-differentiated tubular adenocarcinoma with adenoma localized in the mucosa. No recurrence of the advanced adenocarcinoma or intramucosal adenocarcinoma with adenoma occurred for 2 years after EMR. This case indicates the importance of careful surveillance for synchronous adenomas, even in patients with advanced colorectal cancer. SN - 1865-7265 UR - https://www.unboundmedicine.com/medline/citation/32602085/A_case_of_an_enlarged_rectal_adenoma_while_achieving_a_clinical_complete_response_with_chemotherapy_for_advanced_rectal_cancer L2 - https://dx.doi.org/10.1007/s12328-020-01169-6 DB - PRIME DP - Unbound Medicine ER -
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