Management of Locally Advanced Rectal Adenocarcinoma
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Nishi Kothari, MD
Assistant Member, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL

Khaldoun Almhanna, MD, MPH
Associate Member, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL

Question 1 of 5

A 52-year-old man with no significant past medical history presents to his primary care physician with bright red blood per rectum. His evaluation shows a blood pressure of 142/83 mm Hg, heart rate of 75 beats/min, and oxygen saturation of 97% on room air. On physical exam, he has no evidence of organomegaly. On rectal exam, a large rectal mass is felt at 2 cm from the dentate line extending to at least 6 cm on the posterior wall of the rectum. The mass is friable and fixed to the posterior wall. His laboratory values show hemoglobin of 10.5 g/dL, with a mean corpuscular volume of 78 fL and a carcinoembryonic antigen (CEA) level of 15 ng/mL. Biopsy confirms moderately differentiated adenocarcinoma.

What is the next most appropriate step in the management of this patient?

Colonoscopy, rectal ultrasound, and positron emission tomography scan

Rectal magnetic resonance imaging (MRI), computed tomography (CT) of thorax abdomen and pelvis (TAP) with contrast, and colonoscopy with tattooing of the lesion

Transrectal ultrasound (TRUS), CT TAP, and brain MRI

TRUS, CT TAP, and colonoscopy with tattooing of the lesion

B or D

Hospital Physician: Hematology/Oncology. 2015 September;11(5)

This quiz is not accredited for CME.

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