Lower rectal cancer

23 yr old male came with h/o change in bowel habits with morning diarrhoea with feeling of incomplete evacuation for few months.h/oLOW.no comorbidities,no significant family history. On PRE-hard mass felt 4 cm from anal verge and t, Biopsy taken during proctoscopic examination(adenocarcinoma with mulinous differentiation) Colonoscopy done(involving lower rectum and anal canal)given in pic with tumour markers. 1.What sud be the surgical option,? APR (4cm from anal verge)I feel,will cause miserable life for this young man.neoadjuvant can be an option! 2. What can be cause in this young age(23 year) ?no family history of Cancer, sporadic rectal ca occurs in middle age,no polyps in colon(for FAP ca-age 36-39 years) Kindly give your valuable opinion



Both options are possible in this case APR And a low,anterior resection . The technique of ISR ( inter- sphincteric resection modifies the concept of sphincter-saving resection in the treatment of rectal cancer. The decision between a conservative procedure and APR is not related to the distance between the tumor and the anal verge or the anal ring; it becomes solely related to the infiltration of the external sphincter. Achievement of complete microscopic resection with a low local recurrence rate and without compromising survival after ISR for carcinomas at or below 4.5 cm from the anal verge supports this new concept.

Valuable opinion

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With such a low lying lesion, sphincter saving anterior resection is not possible, hence APR with permanent colostomy is the option.

Thank you doctor

Low rectal cancer - plan low anterior resection with proximal ileostomy Look for sexually transmitted disease, rule out, HIV, HbSAg, HCV

LAR is possible whn tumour distance is atleast 5 cm from anal verge,in this case its only 4 cm

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Tnx &wc Dr Diptanu Deb

APRWith permanent colostomy will be therteatment of choice cosidering the young age post op Chemo can be given based on the resected specimen Biopsy Report

Rectal malignancy Ref to Oncologist

1.APR with permanent colostomy will be a better option in this case.

Thank you doctor

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