The document outlines the clinical history of a 57-year-old male patient diagnosed with moderately differentiated adenocarcinoma of the rectum, who presented with changes in bowel habits and gluteal pain. After undergoing a diversion colostomy and treatment involving concurrent chemoradiation and adjuvant chemotherapy, the patient had a complete pathological response following surgery. Currently, the patient is under regular follow-up with reduced cancer markers.

1. CLINICAL HISTORY
• Age- 57 years old
• PC- Change in bowel habit-7 months
Gluteal pain-1 month
• HPC- He has been well until 7 months ago
when he developed diarrhea with about 7
loose stools per day. This persisted over weeks
and then started experiencing gluteal pain. He
was seen at a peripheral clinic where a rectal
mass was found on digital rectal examination

2. CLINICAL HISTORY
• Patient however defaulted on account of
financial constraints
• He later noticed a mass around his anus and
developed a perianal fistula
• Reported to the surgical department of KBTH
where he had a diversion colostomy done on
August,2022.
• He was then referred to Oncology in
September,2022

3. CLINICAL HISTORY
• No family history of cancer
• No known chronic illness
• No previous surgeries or blood transfusions

4. CLINICAL EXAMINATION FINDINGS
• Middle aged male, Not pale or jaundiced
• ECOG 0
• Cardiopulmonary stable
• Abdominal exam-functional colostomy
• Digital rectal exam revealed lax anal sphincter tone, a
hard mass 2cm from the anal verge occupying almost
80% of the circumference of the rectum with a
perianal fistula.

5. LABORATORY FINDINGS
• Blood workup done- normal
• Baseline CEA was 124ug/l
• Metastatic workup done with chest and
abdominopelvic CT scan was negative for
distant metastases.
• MRI of the pelvis was not affordable

6. ABDOMINOPELVIC CT SCAN

7. HISTOPATHOLOGY REPORT
• MODERATELY DIFFERENTIATED
ADENOCARCINOMA OF THE RECTUM

8. DIAGNOSIS
• MODERATELY DIFFERENTIATED ADENOCARCINOMA OF THE
RECTUM
• cT4b(perianal fistula)N1a(pelvic node)M0

9. TREATMENT PLAN
• Long course concurrent chemoradiation to 50.4Gy in 25
fractions with Capecitabine 825mg/m2 bd on treatment days
• This will be followed with adjuvant chemotherapy with XELOX
(capecitabine and oxaliplatin) 3 weekly for 6 cycles.
• Then to have Abdominoperineal resection with a perineal
colostomy

10. CONTOURS

11. CONTOURS

12. TREATMENT PLAN

13. ADJUVANT CHEMOTHERAPY/SURGERY
• Completed 6 cycles of adjuvant Xelox on
3/1/24
• Patient had AP resection with a perineal
colostomy done on 22/4/23
• Histopathology report showed
Pathological complete response
pT0Nx

14. FOLLOW UP
• CEA done post adjuvant chemotherapy was
11.3g/dl
• Currently on 3 monthly reviews with CEA

15. Questions to the consultants:
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