Asyntomatic synchronous brain metastasis of low rectal cancer; cancer report and review

The Authors report the case of a 68 year-old female with an unoccluding low rectal tumour. The tumour was evaluated by a double-contrast barium enema and sigmoidoscopy, confirmed on biopsy. CT scan for chest and abdomen was negative for metastases, lymph node or pelvis involvement. Post-surgery staging was: Dukes C, Astler Coller C2, Jass IV, T3 N2 MO. Patient had an unremarkable postoperative course until day 9, when she complained of general discomfort reported as weakness, anxiety and disorientation. A CT scan showed frontal lobe metastasis, which deterInined the decision to transfer her in a Neurosurgical Unit, where she was operated. Thereafter, the patient was discharged from the hospital with no neurological symptoms and without any other signs of recurrence; presently, she is undergoing adjuvant therapy. In general, brain metastases occur in 20-30% of patients with systemic cancer and represents the most common of intracranial tumours. It is relatively uncommon in colorectal cancer, and constitutes 1.8 to 4.5% of all metastatic lesions of the brain. Previous studies strongly suggest that an aggressive treatment in patients with colorectal cancer brain metastases can be beneficial. The concept that the presence of brain metastases is a terminal event without possibility of therapeutic option can be challenged. Furthermore, it seems appropriate to routinely include a brain MRI or CT scan, preoperatively and during follow-up of patients affected by low rectal cancer.