Breast cancer is the most common cancer in women but gastro- intestinal metastases of breast cancer are rare. They can occur years after the diagnosis or at the diagnosis of breast cancer. We report the case of a patient complaining of dyschesia, tenesmus and anal incontinence leading to the discovery of a rectal metastasis of an unknown breast neoplasia. Given the oligo-metastatic condition, multidisciplinary and aggressive management was the chosen therapy.
Breast Neoplasms , Carcinoma, Lobular , Rectal Neoplasms , Breast Neoplasms/pathology , Carcinoma, Lobular/secondary , Female , Humans , Rectal Neoplasms/secondary , Rectum
BACKGROUND: Preoperative radiotherapy has been shown to decrease the local recurrence rate of patients with locally advanced rectal cancer. Capecitabine and oxaliplatin are both active anticancer agents in the treatment of patients with advanced colorectal cancer and have radiosensitizing properties. Therefore, these drugs would be expected to improve effectiveness of preoperative radiotherapy in terms of local control and prevention of distant metastases. PATIENTS AND METHODS: Forty patients with rectal cancer (T3-T4 and/or N+) received radiotherapy (1.8 Gy, 5 days a week over 5 weeks, total dose 45 Gy, 3D conformational technique) in combination with intravenous oxaliplatin 50 mg/m2 once weekly for 5 weeks and oral capecitabine 825 mg/m2 twice daily on each day of radiation. Surgery was performed 6-8 weeks after completion of radiotherapy. The main end points were safety and efficacy as assessed by the pathological complete response (pCR). RESULTS: The most frequent grade 3/4 adverse event was diarrhea, occurring in 30% of patients. pCR was found in five (14%) patients. According to Dworak's classification, good regression was found in six (18%) additional patients. CONCLUSIONS: Combination of preoperative radiotherapy with capecitabine and oxaliplatin is feasible for downstaging rectal cancer.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Preoperative Care , Rectal Neoplasms/drug therapy , Rectal Neoplasms/radiotherapy , Adenocarcinoma/drug therapy , Adenocarcinoma/radiotherapy , Adenocarcinoma/surgery , Administration, Oral , Adult , Aged , Aged, 80 and over , Capecitabine , Combined Modality Therapy , Deoxycytidine/administration & dosage , Deoxycytidine/analogs & derivatives , Female , Fluorouracil/analogs & derivatives , Humans , Injections, Intravenous , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Male , Maximum Tolerated Dose , Middle Aged , Neoplasm Staging , Organoplatinum Compounds/administration & dosage , Oxaliplatin , Rectal Neoplasms/surgery , Treatment Outcome
From controlled studies only, the authors state the true position of medical therapeutics for the Crohn's disease when it attacks the small intestine and the colon. Sulfasalazine remains the first rate medicine, essentially when the ileum and colon, or colon alone, becomes affected. Metronidazole seems as effective, indeed slightly more so. Corticotherapy should be kept for patients who do not react to sulfasalazine or whose disease is, at the onset, particularly active. The duration of the corticotherapy should be the shortest possible. Immunosuppressors do not seem to be of any help in acute phase and their effect shows only after several months. Their main interest resides in the possibility of reducing or stopping the corticosteroids treatment. There is not enough information about the other medications that have been the tried to draw any conclusions. The use of pure 5-aminosalicylic acid or associated to another vector such as sulfapyridine, will probably be an important therapeutical progress.
Crohn Disease/drug therapy , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents/therapeutic use , Clinical Trials as Topic , Enteral Nutrition , Humans , Immunosuppressive Agents/therapeutic use , Parenteral Nutrition , Sulfasalazine/therapeutic use
