[A Young Male Case of Rectosigmoid Adenocarcinoma with Diffuse Peritoneal Metastasis Managed with Palliative Care and Cell-Free and Concentrated Ascites Reinfusion Therapy to Initiate and Transit to Outpatient Systemic Chemotherapy].

Abstract

A 30s-year-old male complaining of abdominal distension and pain was referred to our hospital. The support by palliative care team was initiated soon after emergency admission. Colonoscopic examination revealed a circumferential ulcerated tumor of rectosigmoid and the tumor was diagnosed as an adenocarcinoma. Contrast-enhanced CT revealed multiple enlarged lymph nodes, diffuse peritoneal nodules and massive ascites, which led us to the diagnosis of advanced rectosigmoid cancer. Because bowel obstruction was not observed, early initiation of systemic therapy was planned. Although abdominal pain was alleviated with analgesics including opioids, discomfort from abdominal distension remained. So, we decided to perform cell-free and concentrated ascites reinfusion therapy(CART). To avoid the delay in the initiation of systemic chemotherapy due the adverse effects of CART, the first systemic chemotherapy was followed by CART. After single CART, the abdominal distention resolved without relapse, and seamless transition to outpatient treatment was made. Although the prognosis of colorectal cancer with diffuse peritoneal dissemination is poor, aggressive adoption of palliative therapy including CART may enable the introduction of systemic chemotherapy and the following alleviation of cancer-related symptoms.