Tumor clinically staged as T4bN1M1

[LL2006]

Sister with Stage IV (T4bN1M1) rectal CA.  Differential dx includes ovarian CA.  FHx includes mother - breast CA, maternal aunt - ovarian CA.  Ovarian metasteses noted on staging scans.  Local extension of primary tumor into ovary, vagina and cervix.  What are the means for determining definitively whether or not there is a second primary tumor (that of the ovary).  Only one ovary was removed at the time of surgery.

[Annekathryn Goodman, M.D.]

Hi There,

I agree with the consideration of a exenteration. Yes your poor sister is most likely dealing with just a rectal cancer.
I hope all goes wells
take care

[LL2006]

Thank you Dr. Goodman.  My sister underwent sx for a diverting sigmoid colostomy and small bowel resection for impending small bowel obstruction from peritoneal metastases. She was also noted to have peritoneal metastases studding, small bowel metastases distant from the tumor and local extension of the tumor into the ovary, vagina and cervix. They were unable to remove her large obstructing tumor. Colostomy was performed for palliative purposes. She responded amazingly well to FOLFIRI plus bevacizumab chemo and now a pelvic exenteration has been proposed.

I understand the histopathological findings. The one ovary that was removed appears to be a met from the rectal CA. The radiologist on most recent diagnostic MRI suggests they cannot rule out another primary tumor of the ovary.

Is it safe then to assume that b/c the one ovary is a metastases from the rectal CA, then the other (not removed) is a metastases as well?

[Annekathryn Goodman, M.D.]

Hi There,

It is very common for colon cancer to spread to the ovaries.  Under the microscope, ovarian cancer has a very different look than rectal cancer. If your sister had one of her ovaries removed and she has a biopsy or removal of her rectal cancer, then these two biopsies can be analyzed and compared.

You should ask your sister's doctor about this.

I hope all goes well
take care