{"id":33788,"date":"2024-12-05T07:35:20","date_gmt":"2024-12-05T07:35:20","guid":{"rendered":"https:\/\/thomashosurgery.com\/?p=33788"},"modified":"2025-11-13T07:24:59","modified_gmt":"2025-11-13T07:24:59","slug":"unsuspecting-colon-cancer","status":"publish","type":"post","link":"https:\/\/thomashosurgery.com\/zh\/unsuspecting-colon-cancer\/","title":{"rendered":"Unsuspecting colon cancer"},"content":{"rendered":"
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Recently, a Gynaecologist colleague called me about a patient of his: a 60-year-old female who was referred by a GP for right iliac fossa pain (pain in the lower right quadrant of the abdomen).<\/p>

There are many diagnostic possibilities, but the commonest in a female is pain originating either from the ovary or appendix. The gynaecologist had ordered a pelvic ultrasound followed by a pelvic MRI when it became apparent that the ovaries were normal in appearance.<\/p>

The MRI showed a 5cm cystic mass<\/strong> adjacent to the sigmoid colon. The diagnostic possibility at this point is an abscess arising from a colonic perforation.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Inconclusive CT Scan<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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CT scan showing walled-off abscess<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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When I saw the patient, she was quite well and no longer in pain. Her abdomen was soft and non-tender and I couldn\u2019t feel any masses. What was worrisome was the fact that she was slightly anaemic and her colon cancer tumour marker<\/a> was raised.<\/p>

I arranged for her to come into the hospital, where a CT scan of the abdomen was promptly done. This was in the hope that this would provide more information about the cystic mass, the bowel and digestive organs.<\/p>

The CT scan, unfortunately, did not provide much more detail other than a slight thickening of the sigmoid colon suggestive of a malignancy. At this point, the lack of conclusive information was getting frustrating for the patient and me, so we agreed that a flexible sigmoidoscopy would be done.<\/p>

This is a small procedure where a scope is passed up the colon to the location of the abnormality for a better assessment.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Flexible Sigmoidoscopy<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Cut up specimen showing the area of perforation and abscess cavity wall behind the colon<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\u8fd9 flexible sigmoidoscopy<\/a> showed a narrowed and stiff colon in keeping with the expected pathology of inflammation from a perforation. Associated with it was heaped-up mucosa suggestive of a malignancy or severe inflammation. Multiple biopsies were taken.<\/p>

Back in the ward, I had a discussion with the patient and her family. We knew that there was certainly an abnormality in her colon, highly suspicious of a perforated cancer. In the end, we agreed that a surgery to explore the abdomen was warranted with the aim of removing the affected colon and mass.<\/p>

Surgery was done the next day. When I looked inside her abdomen, there was a large contained abscess (with a moderate amount of pus) arising from the side of the sigmoid colon and stuck down onto the uterus, ovaries and bladder.<\/p>

I was able to resect that segment of the colon with the adjacent infected mass, the uterus and ovaries so as to ensure a complete clearance of the inflammation and presumed cancer. In the end, an anastomosis was performed to ensure continuity of her bowel.<\/p>

The operation lasted under 3 hours and she recovered well in the ward.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Conclusion<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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The final histology of the specimen showed a perforated mucinous adenocarcinoma of the colon with several lymph nodes involved. Fortunately for her, the cancer is now completely removed.<\/strong> It is an aggressive cancer and she would now need to undergo chemotherapy to reduce the chances of a future recurrence.<\/p>

This case is interesting in that the colon cancer did not present in the usual manner, such as bleeding in the stools or a change in bowel habit. Other than a short episode of abdominal pain, she did not present with any alarming symptoms or signs.<\/p>

Despite the investigations that followed, the cancer remained elusive until the eventual surgery. The silver lining in the clouds is that she now has a good chance of a cure.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

A Gynaecologist colleague recently reached out about a 60-year-old female patient who was referred by her GP for right iliac fossa pain, presenting as discomfort in the lower right abdomen.<\/p>","protected":false},"author":1,"featured_media":33796,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[92],"tags":[],"class_list":["post-33788","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-colon-cancer"],"acf":[],"yoast_head":"\nUnsuspecting colon cancer - Thomas Ho Surgery<\/title>\n<meta name=\"description\" content=\"Dr Ho shares a patient's journey from discovering she had colon cancer and the surgical procedure to remove her cancerous colon tumours.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/thomashosurgery.com\/zh\/unsuspecting-colon-cancer\/\" \/>\n<meta property=\"og:locale\" content=\"zh_CN\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Unsuspecting colon cancer - 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