I was recently diagnosed with invasive squamous cell carcinoma arising from a 9mm polyp (villous lesion) at pouch-anal anastomosis after undergoing a screening pouchoscopy/coloscopy. (I am a patient with F.A.P Disease) The Pathology report showed the lesion to be squamous cell carcinoma arising and P16 positive. Also noted were fragments of a tubulovillous adenoma with focal high-grade dysplasia/intramucosal carcinoma.
Pet Scan showed impressions of the following:
1). Radiotracer activity showed the anal canal slightly distal to the region of the pouch anastomosis and to be non-specific with reflection areas of residual malignancy versus intense physiologic activity.
2). Prominent perirectal lymph nodes are indeterminate and suspicious for areas of nodal metastatic disease.
3). Scattered hypermetabolic lymph nodes, the cervical external iliac chains are indeterminate and may be reactive/inflammatory. However, lymphoproliferative disorder versus nodal metastatic disease is c to exclude—attention should be w/follow-up examinations.
The standard care for any anal or rectal patient I have been hearing is to do chemo/radiation therapy which the medical oncologist stated radiation therapy typically delivered f 6 weeks 5400 cGy at 180 centigrade per fraction, along with chemotherapy to be mitomycin and 5-FU. However, this treatment is already a J-Pouch holder of 39 years, and I am afraid of any damage that could potentially arise from it, meaning I would, at some point later, need to revert to an ileostomy or possibly I could revert to a Kock pouch (continental ileostomy). My other option was to do a transanal excision followed by observation, which may compromise the treatment of her cancer. I did choose to have the transanal excision o with a path report showing the endoscopic impression of a mass lesion being noted. Though things may not entirely represent the targeted lesion, possibility of invasive carcinoma in deeper or unsampled tissue, it cannot be excluded. Clinicopathologic correlation is recommended.
So I am wondering if just doing the option of surveillance every 3 months for 2 years followed by t more years of 6-month surveillance by then a one time the last year is worth it considering this could return compared to the just treat and be done in a 6-8 week with possible risk of needing a revert to ileostomy or new pouch if needed. I have been advised that I may not even need to have my current J-Pouch revised if it were to withhold and stand up to the treatment. Right now,d been through enough. I just jumped to option 1 to watch, but now I'm losing more ground as I wonder if it's the best option and quality of life.
Any thoughts and advice are beneficial.
