Synchronous double primary cancers of adenocarcinoma of the rectum and hepatocellular carcinoma

Abstract

        Synchronous double primary  cancers of the rectum and another have been hardly reported worldwide, so far. So, we additionally presented one patient who concurrently developed synchronous double cancers of the rectum and the hepatocellular carcinoma. He was a 65-year-old Thai who presented with hematochezia for a few days without fever or weight loss. His physical examination did not reveal any significant abnormality. The coloscopy found a rectal mass and multiple colonic polyps. The computerized tomography of the whole abdomen confirmed the rectal mass and also another mass in the liver with mild cirrhosis. His blood tests showed Hct 37.7%, elevated carcinoembryonic antigen (CEA), 22.04 ng/ml and normal alpha-fetoprotein (AFP) level, positive hepatitis B virus antigen, albumin 3.1 g%, globulin 3.6 g%. He underwent low anterior resection of the rectal mass, multiple colonic polypectomy, segmentectomy of the liver mass and colostomy and was further treated with radiation and adjuvant chemotherapy consisting of 5-fluoro uracil and leucovorin. The pathology of the rectal mass was adenocarcinoma whereas the liver mass was hepatocellular carcinoma. Nine months after treatment, the serum level of CEA appeared normal and the CT of the abdomen showed no recurrence of the liver or bowel wall carcinoma. He could still survive up to three years when this report was written. Although the primary colorectal cancer with liver metastasis is much more common than the synchronous double primary cancers of the colorectum and the liver, the liver mass biopsy must not be ignored even though the serum AFP level is not elevated, otherwise the double cancers can be overlooked and the appropriate management of the liver carcinoma will have never been accessed. The association between both cancers will be further discussed in detail.