Another potential approach will be to clinically observe the patient with periodic PET-CT scans and serum CEA levels and monitor

for signs of recurrence. However, it lacks evidence in the see more absence of a randomized controlled trial, with so few cases being reported. Despite that argument, we opted for the latter approach in our case after a thorough review of the available body of evidence and due discussion with the patient, of pros and cons of both the options. She has been followed clinically for a year and a half, with semi-annual PET-CT and MRI, and has not demonstrated any evidence of recurrent disease, locally or Inhibitors,research,lifescience,medical metastatic. Acknowledgements Disclosure: The authors declare no conflict of interest.
A 75 years-old active and healthy gentleman experienced new onset of bright Inhibitors,research,lifescience,medical red blood per rectum on defecation and constipation. Colonoscopy revealed a semi-circumferential lesion at about 13 cm from the anal verge. The posteriorly locating mass occupied at least 60% of the lumen. Biopsy showed invasive adenocarcinoma which was moderately differentiated, consistent with a primary rectal cancer. Chest X-ray was negative. CT of abdomen and pelvis with oral and intravenous contrast showed thickening mucosa with narrowing of the lumen by

the rectal Inhibitors,research,lifescience,medical lesion. The lesion measured 5 cm, locating just distal to rectosigmoid junction with peri-rectal fat stranding and minimal peri-rectal adenopathy, inflammatory versus potential nodal disease. There were also small retroperitoneal adenopathies. CBC and comprehensive metabolic Inhibitors,research,lifescience,medical panel values were within normal limits. Tumor marker CEA level was 1 ng/mL. Endorectal ultrasound was not applicable due to the proximal location. Patient’s past medical history consisted of dyslipidemia and coronary artery disease status post one cardiac stent placement. He remained active and continued to work full time in his own business. On examination, patient was well nourished, well developed and slightly overweight. On digital rectal examination, the rectal mass was Inhibitors,research,lifescience,medical not reachable. There was no palpable adenopathy in neck,

supraclavicular, axillary and inguinal areas. Remainder of the examination was normal. Karnofsky Performance crotamiton Status was rated at 90%. A PET-CT was also performed for evaluation of the adenopathies. PET-CT results showed the index rectal lesion with size of 5.4 cm without hypermetabolic peri-rectal adenopathy. The maximal standardized uptake value (suv) of the index lesion was 17.3 (Figure 1). Additionally, a 1.5 cm right inguinal lymph node with suv of 6.3 (Figure 2) were noted. Multiple small lymph nodes with mild PET-avidity in the para-aortic region measuring less than 1.2 cm with suv up to 4.8 (Figure 3) were also noted. No distant metastasis was suspected in the pelvic nodal chains, liver, lung or skeletal system. Although the pattern of potential nodal involvement was atypical for rectal cancer, differential diagnosis of metastatic disease needed to be ruled out.