Advanced colon cancer before the age of 20 years: DISCUSSION (Part 1)
At laparotomy there was an obvious large tumour of the cecum extending halfway up the ascending colon and involving the terminal ileum and urinary bladder. There was mild evidence of ascites but there was no surface peritoneal tumour growth, nor were there any palpable liver metastases. He subsequently underwent a right hemicolectomy and partial cystectomy. Two of 17 sampled lymph nodes were positive for tumour.
Since then, he has received four cycles (of eight planned) of FOLFOX chemotherapy (consisting of 150 mg oxaliplatin, 600 mg folinic acid, and 5-fluorouracil 600 mg bolus and 2400 mg via continuous infusion administered over 4 h). He has tolerated this well with only transient diarrhea following each dose. His clinical condition has improved with impressive weight gain from 46 kg to 55 kg and an associated improved sense of well being. The diagnosis of HNPCC is based on guidelines known as the Amsterdam criteria , which includes the following:
• At least three relatives with colorectal cancer, one of
whom must be a first degree relative of the other two;
• Involvement of two or more generations;
• At least one case diagnosed before the age of 50 years; and
• Familial adenomatous polyposis has been excluded.
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