Surgical management of digestive neoplasia with genital invasion
Digestive neoplasia has a negative impact worldwide. Colorectal cancer is one of the most common types of cancer and the fourth cause of death [1,2]. The incidence of colorectal neoplasia is unusual in patients under 40, but in the last years, adolescents and young adults have shown an alarmingly increasing number of cases.
We present the case of a young woman, aged 22 years who presented to the Emergency Room for fetid vaginal discharge. During pelvic examination with a speculum, we noticed fetid secretion with necrotic epithelial fragments from the posterior vaginal wall. These fragments were sent to the histopathological exam. The vaginal examination revealed a tumour, seized 4/5 cm in the 1/3 middle of the vagina without infiltration, while the rectal examination revealed a tumour on the anterior rectal wall, sized 4/5 cm with no infiltration of the rectal mucous. The anatomopathological result showed a colorectal adenocarcinoma. Hence, the surgery team decided to perform proctosigmoidectomy (Figures 3 & 4). After this, the patient started chemo- and radiotherapy. Because of the genital invasion, the patient needed a second surgery which included a total hysterectomy with bilateral salpingo-oophorectomy (Figures 1 & 2). The images show the infiltrative sigmoid tumour which extended quickly to the posterior vaginal wall. Also, the recto-vaginal fistula can be observed.
The increased new cases of digestive neoplasia in young patients should be an alarm sign for every public health policy.
Wong, M. C., Huang, J., Huang, J. L., Pang, T. W., Choi, P., Wang, J., ... & Jiang, J. Y. (2020). Global prevalence of colorectal neoplasia: a systematic review and meta-analysis. Clinical Gastroenterology and Hepatology, 18(3), 553-561.
Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., ... & Bray, F. (2015). Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International journal of cancer, 136(5), E359-E386
You, Y. N., Lee, L. D., Deschner, B. W., & Shibata, D. (2020). Colorectal cancer in the adolescent and young adult population. JCO Oncology Practice, 16(1), 19-27.