[Multimodal therapy for juvenile advanced rectal carcinoma]

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Locally advanced rectal carcinoma with liver metastasis presents a complex treatment challenge, particularly in younger patients.
• Multimodal therapy is often required to manage advanced stages of colorectal cancer.
• Early diagnosis is crucial for improving outcomes in young colorectal cancer patients.

Observation:

• A 37-year-old male with advanced rectal cancer and liver metastasis underwent sigmoid colostomy due to anemia and perineal abscess.
• The patient received systemic chemotherapy (mFOLFOX6) and whole pelvic irradiation, resulting in tumor size reduction.
• Surgical intervention included total pelvic evisceration with ileal conduit and rectus abdominis myocutaneous (RAM) flap reconstruction.

Findings:

• Post-operative chemotherapy with mFOLFOX6 and bevacizumab, followed by partial hepatic resection and FOLFIRI with bevacizumab, was administered.
• The patient was managed as an outpatient for further systemic chemotherapy.
• Recent studies suggest late diagnosis, rather than inherent tumor aggressiveness, contributes to poor prognosis in young colorectal cancer patients.

Implications:

• This case highlights the complex management of advanced rectal cancer in a young patient, involving neoadjuvant therapy, extensive surgery, and adjuvant chemotherapy.
• The findings underscore the importance of timely diagnosis in improving survival rates for young individuals diagnosed with colorectal cancer.
• Further research into the specific challenges and optimal treatment strategies for young colorectal cancer patients is warranted.