The document details the case of a 53-year-old male diagnosed with stage IIIC rectal carcinoma, who underwent concurrent chemoradiotherapy. Post-treatment evaluations revealed significant tumor characteristics, including irregular wall thickening and mesorectal fat invasion. The final diagnosis is carcinoma of the rectum, classified as yct3b n1 m0, with a planned abdomino-perineal resection for management.

1. A CASE OF CARCINOMA
RECTUM
TUMOUR BOARD NO (223/23)
Prof Dr T Babu Antony Sir’s - Unit S6

2. • A 53 yrs old male, a K/C/O CA RECTUM - T3 N2 M0 STAGE IIIC
diagnosed on August 2023 and was presented in tumor board (TB.NO:
138/23).
• As per tumor board consensus, pt has now completed CCRT (25 cycles
RT with Tab.CAPECITABINE) and is admitted for reassessment and
further plan of management
CASE DETAILS :

3. CLINICAL PICTURE :
 Parasuraman
 53 years
 Male

4. ● ECOG-0
● Patient- afebrile, hydration fair
● Vitals stable
● Per abdomen:
● Soft, No tenderness, guarding or rigidity.
● No palpable mass or organomegaly
● Left supraclavicular fossa – free
● Other system examination- normal
ON EXAMINATION:

5. DIGITAL RECTAL EXAMINATION : (PRE CHEMO)
• Perianal region: Normal
• Anal tone: Normal
• Anal mucosa: A firm non friable irregular mass at 7O’Clock to 12
O’clock position about 4cm from the anal verge. Admitting one finger.
Unable to palpate the upper border.
• Normal fecal staining, no bleeding

6. DIGITAL RECTAL EXAMINATION : (POST CHEMO)
• Perianal region: Normal
• Anal tone: Normal
• Anal mucosa: An irregular ulceroproliferative growth at 4’o Clock to
8’o clock position about 5 cm from the anal verge. Admitting one
finger. Unable to palpate the upper border.
• Normal fecal staining, no bleeding.

7. CECT ABDOMEN : (30/07/2023)
• Irregular eccentric wall thickening noted for a length of 4.5 cm with
maximal wall thickening measuring 1 cm noted in mid and distal
rectum extending from 7 to 12 O’Clock position with surrounding peri
rectal fat stranding. Multiple (7-8) subcentimetric mesorectal lymph
nodes noted largest measuring 7*7 mm
• IMPRESSION: Possibly malignant rectal growth – suggested scopy or
HPE correlation

9. CT CHEST : (28/07/2023)
No evidence of metastasis.

10. COLONOSCOPY : (07/08/2023)
• Ulceroproliferative growth from 5cm from anal verge extending up to
12cm from anal verge (biopsy taken)

11. MRI PELVIS : (12/8/23) (PRE CHEMO)
• Irregular circumferential asymmetric wall thickening with diffuse restriction noted
involving mid and lower rectum for a length of 8.5 cm with maximum thickness
measuring 12mm, lower extend up to anal verge.
• Invasion of serosa noted from 8 to 11’O clock position for a length of 3.6 cm with
infiltration into mesorectal fat
• Mesorectal fascia appears involved 12-1 O’clock position
• No evidence of extramural vascular invasion noted
• Recto prostatic angle and neurovascular bundle of prostate appears to be spared
• Fat plane between the lesion and seminal vesicle, bladder appears spared
• Fat plane between the lesion and peritoneal reflection appears preserved
• Multiple (8-9) enlarged mesorectal lymph nodes largest measuring 7*6mm
• Few subcentimetric bilateral inhuman lymph nodes noted.
• Impression: F/S/O Rectal malignant growth – T3c N2b Mx, suggested HPE correlation

12. CCRT :
• Patient was started on concurrent chemoradiotherapy on 22/8/23
• 25 CYCLES OF RADIOTHERAPY + TAB. CAPECITABINE 500mg ON DAYS
OF RT
• CCRT completed on 20/09/23

13. MRI PELVIS : (28.10.23) (POST CHEMO)
• Irregular asymmetric circumferential T2/STIR hyperintense wall
thickening showing diffusion restriction for a length of 7.8cm,
maximum thickness measuring 13mm noted in the rectosigmoid
junction, with distal margin 2.7 cm from the anal verge.
• Lesion infiltrates the mesorectal fat for a depth of 3.5mm in the right
lateral aspect.
• Extramural vascular invasion noted.
• Few (5-6) tiny lymph nodes without diffusion restriction noted in the
mesorectum in right side largest measuring 3x2mm at 8’O clock
position.

14. • No evidence of enlarged lymph nodes in the obturator, internal iliac
level.
• No evidence of pelvic deposits noted.
• No evidence of abnormal signal intensities noted in the visualized
bones.
• IMPRESSION :
• K/C/O – CARCINOMA ANORECTUM POST CHEMORADIATON
• MALIGNANT GROWTH INOLVING ANORECTUM WITH MESORECTAL
FAT INVASION – T3b N1 Mx

15. HISTOPATHOLOGY : (4361/23) (14/8/23)
• INFILTRATING ADENOCARCINOMA - MODERATELY DIFFERENTIATED
GRADE II

16. DIAGNOSIS :
• CARCINOMA RECTUM ycT3b N1 M0 – STAGE IIIB

19. PLAN :
• Abdomino perineal resection (APR)

20. TUMOR BOARD CONSENSUS :

21. THANK YOU