CPC
Rectal Adenocarcinoma
By Dr Tayyab Malik
1st Year Surgical Resident
Shifa International Hospital
Facilitator : Dr Qamar Hafeez Kiani
, • 65 Year Old Male patient presented to
the OPD in September 2023 with
complaints of
1. Altered Bowel Habits
Case 2. Per Rectal Bleed
3. Weight Loss of more than 20 kilos
in a time period of 6 months
,Examination and Investigation
On Digital Rectal Examination there was Mass Palpable at 5
centimeters from the Anal verge
Referred for Colonoscopy – Semi circumferential ulcerated mass
in the rectum starting at 5 centimeters from the anal verge upto
10 centimeters.
Biopsy Report - Moderately Differentiated Adenocarcinoma
MRI Pelvis – Middle and Lower rectum reaching up to the anal
sphincter complex . cT4N2 – Positive Circumferential
Resection Margin
CT Chest Abdomen and Pelvis – No Distant metastasis
CEA – 1.6
, Neoadjuvant Chemotherapy
• MDT – Suggested to undergo Neoadjuvant Chemoradiation followed
Assessment for Surgery
• So Patient was started on 3 cycles of CAPOX
• Followed by Radiotherapy which he received as per protocol
Rectal Adenocarcinoma
By Dr Tayyab Malik
1st Year Surgical Resident
Shifa International Hospital
Facilitator : Dr Qamar Hafeez Kiani
, • 65 Year Old Male patient presented to
the OPD in September 2023 with
complaints of
1. Altered Bowel Habits
Case 2. Per Rectal Bleed
3. Weight Loss of more than 20 kilos
in a time period of 6 months
,Examination and Investigation
On Digital Rectal Examination there was Mass Palpable at 5
centimeters from the Anal verge
Referred for Colonoscopy – Semi circumferential ulcerated mass
in the rectum starting at 5 centimeters from the anal verge upto
10 centimeters.
Biopsy Report - Moderately Differentiated Adenocarcinoma
MRI Pelvis – Middle and Lower rectum reaching up to the anal
sphincter complex . cT4N2 – Positive Circumferential
Resection Margin
CT Chest Abdomen and Pelvis – No Distant metastasis
CEA – 1.6
, Neoadjuvant Chemotherapy
• MDT – Suggested to undergo Neoadjuvant Chemoradiation followed
Assessment for Surgery
• So Patient was started on 3 cycles of CAPOX
• Followed by Radiotherapy which he received as per protocol
