Case study of a patient diagnosed with rectal carcinoma with liver metastatis

Name of the Patient: Chandra Shekhar Choudhary

Sex: Male Age: 72 Yrs

Weight: 51 Kg Height: 5 ft. 8 Inches

The subject of the study noticed growth of mass in the anal canal for the first time in 2006. He ignored it
suspecting the recurrence of Hemorrhoid for which he was operated way back in 1984. The patient notices
rectal bleeding in June 2009. As the severity of rectal bleeding increased gradually and rectal obstruction
due to growing mass assumed alarming proportion patient consulted some homoeopathy practitioner in
his home town Supaul, Bihar. Bleeding and growth of mass continued unabated despited medication. In
December 2010, patient decides to consult a surgeon in his home town. The surgeon performed
proctoscopy and finds some abnormal growth and bleeding in perirectal region. The patient was referred
to gastroenterology department in AIIMS with impression “Polypoidal Growth and Bleeding in Rectum.”

Before visiting AIIMS, the patient visited Metro Superspeciality Hospital, Noida, and consulted
gastroenterologist Anurag Tandon on December 14, 2010. He performed proctoscopy and found some
abnormal growth and bleeding in the perirectal region. Tandon decided to perform sigmoidoscopy which
showed ulcerated polypoidal growth in the rectum just beyond the ano-rectal verge. Multiple samples
were collected from the site of growth and sent for biopsy. Biopsy report revealed “Well differentiated
adenocarcinoma rectum, invasive.”

Patient decides to visit the gastroenterology department in AIIMS on December 15, 2010. Doctor decides
to perform sigmoidoscopy again. Sigmoidoscopy performed on December 16, 2010, shows ulcerated,
infilterative growth at 5 cm from anal verge along with small sessile polyp at 15 cm from anal verge.
Synchronised lesion was confirmed. Multiple samples from the sites of growth were taken and sent for
biopsy. The biopsy report revealed the presence of two fragments of dysplatic glands but could not
definitively ascertain rectal carcinoma on the basis of available samples. Repeat biopsy was advised.

Repeat sigmoidoscopy for taking biopsy samples was conducted on 03/01/2011. This time biopsy report
revealed features of rectal adenocarcinoma.

Doctors at AIMMS then performed contrast enhanced CT scan (CECT) of whole abdomen and pelvis on
January 8, 2011. CECT report suggests “Concentric mural thickening of anal canal and distant segment of
rectum (6.5 cm) with liver metastasis.” Doctors suggested fine needle aspiration ctyopathlogy (FNAC) for
liver lesion. Ultrasound guided FNAC for Liver SOL was performed on 21/01/2011. Samples from lesion
sites of liver were sent for cytopathological findings. The report suggests the presence of metastatic
adenocarcinoma in liver. Doctors at AIIMS decide to avoid surgery and advise chemotherapy. Patient
decides not to go for chemo suspecting it will even deteriorate his physical conditions.

Present physical condition of the patient:(05/02/2011)

Patient is having obstruction in anal canal due to polypoidal growth. He is having difficulties in passing
stool though he is not frankly obstructed. Rectal bleeding has subsided after taking tranexamic acid
(Texid). Continuous secretion of unknown liquid substance in anal canal, perhaps from the site of
polypoidal growth, frequently causes urge for emptying stomach. Liquid secretion from anal canal
happens when gas forms and releases with vociferous sound. Perhaps the gas releasing process puts
pressure on site of growth resulting in secretion. Gas formation is frequent, more often after taking meal.
Patient frequently feels the urge for visiting toilet. One can hear some drum like sound from stomach,
something like irritable bowel syndrome. Appetie is perfect. Liver function test is normal.

Present Medication:

1. Texid to control bleeding. One daily at bed time (continuing from 15/01/2011)
2. Duphalac for softening stool. (15ml at bed time)
3. Alprovit Syrup for strength. (5ml once daily)

Past Medical History:

 Operated for tonsillitis (mildly ulcerated) in January 1960

 Cataract surgery for left eye in December 1978
 Operated for hemorrhoid in 1984.
 Operated for cataract (right eye) in 1985.
 Operated for removal of a mass in dental cavity in 1994. (Biopsy of mass negative for
carcinoma(benign).
 Operated for frequent boils at different parts of his body during June 2009 and July 2010. At least
five boils of different size were operated during the period. Only few times boils caused mild to high
fever.