SYNCHRONOUS COLON CANCER AND LARGE LST-G

A 74 year old man attended for a colonoscopy under the UK Bowel Cancer Screening Programme having been found to be FOB+ve using the FIT test. His past medical history included atrial fibrillation for which he was taking Apixaban.

The index colonoscopy (2 weeks ago) showed an adenocarcinoma in the distal descending colon (biopsy proven) but in addition there was a 7cm LST-G at hepatic flexure which was not removed or biopsied. Both the lesions were tattooed. A further 6 small (sub-centimetre) polyps were noted in the right colon. A subsequent CT scan staged the cancer as T2/3, N0, M0.

At the MDT meeting, the main question was wether to perform a total colectomy with ileo-rectal anastomosis or attempt to remove the LST-G endoscopically, together with the 6 small right sided polyps, and then perform a left hemi-colectomy. It was felt that the latter option would provide a better functional outcome. Hence the patient attended for a second colonoscopy to remove the LST-G at the hepatic flexure and the smaller right sided polyps (see video).

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