A case of an enlarged rectal adenoma while achieving a clinical complete response with chemotherapy for advanced rectal cancer

Abstract

The effect of chemotherapeutic agents on concomitant colorectal adenomas in patients with advanced colorectal cancer is not clear. We report a case of an enlarged rectal adenoma while achieving a clinical complete response with chemotherapy for an advanced rectal adenocarcinoma. A 78-year-old man was referred to our hospital for evaluation of bloody stools. The clinical diagnosis was an advanced lower rectal adenocarcinoma with para-aortic lymph node metastases, and a sessile polyp on the proximal aspect of the rectal tumor. The rectal adenocarcinoma was treated with chemotherapy, including 1 cycle of capecitabin plus oxaliplatin (CapeOX), 22 cycles of tegafur/gimeracil/oteracil (S-1) plus irinotecan (IRIS), and 1 cycle of tegafur (UFT) plus calcium folinate (LV). One year after the last course of chemotherapy, colonoscopy showed a scar without visible rectal tumor; CT imaging confirmed no para-aortic lymphadenopathy. The patient had a clinical complete response to chemotherapy. In contrast, the polyp increased in size. The polyp was removed by endoscopic mucosal resection (EMR). The pathologic evaluation showed a well-differentiated tubular adenocarcinoma with adenoma localized in the mucosa. No recurrence of the advanced adenocarcinoma or intramucosal adenocarcinoma with adenoma occurred for 2 years after EMR. This case indicates the importance of careful surveillance for synchronous adenomas, even in patients with advanced colorectal cancer.

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References

  1. 1.

    Sano Y, Tanaka S, Kudo S, et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endos. 2016;28:526–33.

    Article  Google Scholar 

  2. 2.

    Crispin A, Mansmann U, Munte A, et al. A direct comparison of the prevalence of advanced adenoma and cancer between surveillance and screening colonoscopies. Digestion. 2013;87:170–5.

    Article  Google Scholar 

  3. 3.

    Kahl CJ, Boland CR, Dominitz JA, et al. Colonoscopy surveillance after colorectal cancer resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2016;150:758–68.

    Article  Google Scholar 

  4. 4.

    Joana MA, Diogo L, Pedro G, et al. Incidence and predictors of adenoma after surgery for colorectal cancer. Eur J Gastroenterol Hepatol. 2017;29:932–8.

    Article  Google Scholar 

  5. 5.

    Hee Seung Lee, Sung Bac Kim, Hyuu Jung Lee, et al. Postoperative adjuvant chemotherapy is associated with a lower incidence of colorectal adenomas in patients with previous colorectal cancer. Gastrointest Endosc. 2018;87:688–94.

  6. 6.

    Valeriote F, van Putten L. Proliferation-dependent cytotoxicity of anticancer agents: a review. Cancer Res. 1975;35:2619–30.

    CAS  PubMed  Google Scholar 

  7. 7.

    Stacey Ricci M, Zong W-X. Chemotherapeutic approaches for tageting cell death pathways. Oncologist. 2006;11:342–57.

    Article  Google Scholar 

  8. 8.

    Ohuchi M, Sakamoto Y, Tokunaga R, et al. Increased EZH2 expression during the adeno-carcinoma sequence in colorectal cancer. Oncology Letter. 2018;16:5275–81.

    Google Scholar 

  9. 9.

    Uehara K, Hiramatu K, Maeda A, et al. Neoaduvant oxaliplatin and capecitabine and bevacizumab without radiotherapy for poor-risk rectal cancer: N-SOG 03 phase II trial. Jpn J Clin Oncol. 2013;43:964–71.

    Article  Google Scholar 

  10. 10.

    Hasegawa J, Nishimura J, Mizushima T, et al. Neoadjuvant capecitabine and oxaliplatin (XELOX) combined with bevacizumab for high risk localized rectal cancer. Cancer Chemother Pharmacol. 2014;73:1079–87.

    CAS  Article  Google Scholar 

  11. 11.

    Rivera F, Karthaus M, Hecht JR, et al. Final analysis of the randomized PEAL trial: overall survival and tumor responses during first-line treatment with mFOLFOX6 plus either panitumumab or bevacizumab in patients with metastatic colorectal carcinoma. Int J Colorectal Dis. 2017;32:1179–90.

    Article  Google Scholar 

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Correspondence to Yasuyuki Nakamura.

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Yasuyuki Nakamura, Fumikazu Koyama, Kohei Morita, Hiroyuki Kuge, Chiho Ohbayashi and Masayuki Sho declare that they have no conflict of interest.

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Nakamura, Y., Koyama, F., Morita, K. et al. A case of an enlarged rectal adenoma while achieving a clinical complete response with chemotherapy for advanced rectal cancer. Clin J Gastroenterol (2020). https://doi.org/10.1007/s12328-020-01169-6

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Keywords

  • Colorectal cancer
  • Synchronous adenoma
  • Chemotherapy
  • Complete response