Alyssa Imperatore, DO1, Linda Szczurek, DO, FACOS2, Alan J Shienbaum, DO2. 1Jefferson Health/Rowan University, 2Jefferson Health
Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States amongst cancers that affect both genders. A small entity of this common disease is synchronous colorectal carcinoma, defined as more than one primary detected on initial presentation. This accounts for 0.5-8% of all colorectal carcinomas. Prognostic implications appear to be similar to that of solitary CRC, however more investigation must be performed. Below is a case of synchronous colorectal carcinoma in which three separate colon masses were discovered on initial presentation.
This is a 78 year-old female who presented with shortness of breath on exertion for two weeks and intermittent black stools. Further workup revealed symptomatic anemia. The patient had never had a colonoscopy or EGD in the past. She was taken for endoscopy which demonstrated three polypoid lesions in the rectum and three separate colon masses: cecum, sigmoid colon and rectosigmoid. Preliminary pathology showed high grade dysplasia in the cecum and the patient was then taken for laparoscopic subtotal colectomy with rectal exam under anesthesia. Final pathology revealed moderately differentiated invasive adenocarcinoma arising from tubulovillous adenomas with lymphovascular and perineural invasion, five out of 12 lymph nodes involved. Patient had an uncomplicated post-operative course and was discharged home on post-op day four.
Synchronous colorectal cancer may be more prevalent than even documented secondary to not fully diagnosing or patients undergoing palliative surgery prior to complete diagnosis. This is a topic that could benefit from a large research experiment or meta-analysis to better answer the question as to how to effectively manage these patients.
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Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93170
Program Number: P314
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster