Conservative management of anal leiomyosarcoma

Article Abstract:

Although cancers of the colon and rectum are common, the same is not true for cancers of the anus. Of the anal cancers that do occur, the majority are typed as squamous cell carcinomas. A leiomyosarcoma is a cancer that arises from smooth muscle, the type of muscle surrounding blood vessels, the stomach and intestines, and the uterus. Leiomyosarcoma of the anus is especially rare, and only six cases have ever been reported in the English language medical journals. Because this cancer is so rare, there has been no opportunity to determine the best form of treatment. The usual treatment is abdominoperineal resection, a radical procedure in which much tissue is removed and anal sphincter function is lost. A case of anal leiomyosarcoma that was treated more conservatively is presented. A 48-year-old woman was diagnosed with leiomyosarcoma of the anus. The small cancer was removed, but recurrent cancer was found in the original tumor site two years later during routine examination. This time, the cancer had invaded more of the surrounding tissue, and abdominoperineal resection was recommended to the patient. The patient chose not to undergo a procedure that would remove normal sphincter control. As a result, a program of brachytherapy was designed. Brachytherapy is the irradiation of a tumor by a radioactive source placed close to the tumor. The recurrent tumor was removed to the extent possible; catheters containing the radioactive isotope iridium 192 were then implanted. The rationale for such treatment is that the tumor site can be exposed to a high dose of radiation with minimal exposure to unaffected tissues. Irradiation by an external beam affects more tissues, but is desirable if the tumor has spread to lymph nodes in the abdomen. In the present case, the patient was alive with normal sphincter function 20 months after treatment. It is too soon to determine how successful this treatment will be in the long run. However, this report illustrates that, in some cases, more conservative management of anal leiomyosarcoma may be feasible. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Radiotherapy, Anal cancer, Leiomyosarcoma

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Transrectal ultrasonography of rectal carcinoma

Article Abstract:

The treatment of rectal cancer is determined largely by the stage of the disease, yet it is difficult to stage rectal cancer accurately at the time of diagnosis. While the digital rectal examination can be highly accurate, it is greatly dependent upon the skill and experience of the clinician. Attempts to apply computed tomography to the staging of rectal cancer have been disappointing. To establish a diagnostic technique that is more precise than the fundamentally subjective digital rectal examination, the use of transrectal ultrasonography was evaluated in the staging of 38 patients with confirmed adenocarcinoma of the rectum. Among the 32 patients who had not received radiation therapy prior to the transrectal ultrasonography, the staging was correctly assessed in 18 of 20 patients with disease limited to the rectum, and in 6 of 12 patients whose disease had spread beyond the rectal wall. Among the six patients who had received radiotherapy, it was possible to identify tumor shrinkage, but it was impossible to stage the tumor due to the presence of the edema (swelling) and fibrosis (formation of abnormal fibrous tissue) that accompanies radiotherapy. The staging obtained by transrectal ultrasonography was directly compared with digital rectal examination in 27 patients. The results were roughly comparable, but transrectal ultrasonography was more accurate in identifying positive lymph nodes. The results indicate that transrectal ultrasonography is superior to computed tomography for staging rectal cancer, and is perhaps slightly better than digital rectal examination. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Measurement, Colorectal cancer, Prognosis, Cancer invasiveness, Tumor staging, Cancer staging

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