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Endoscopic Ultrasound Case 2
A 45 year old male presenting with rectal bleeding was found on colonoscopy with rectal cancer. Staging by PET/CT scan did not show any lymph adenopathy and he was orginally scheduled to undergo surgery. However, subsequent endoscopic ultrasound exam showed a 2.4mmx2.9mm peritumoral lymph node and tumor erosion through the muscularis propria consistent with stage T3N1 disease. His treatment plan was then changed to chemoradiation therapy before surgery which has been shown in multiple studies to decrease tumor recurrence by over 60% and possibly increase sphincter-preserving surgeries (decrease need for colostomy bags) as well as increase overall survival.
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| Fig 1. Rectal cancer on colonoscopy exam. | ||
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| Fig 2. EUS shows tumor invasion through the muscularis propria wall layer of the rectum. A small malignant lymph node at 2 o’clock position missed on PET/CT scan was also found on EUS. | ||