Colorectal Cancer

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Case history of Mrs.Anupam.

I am Anupam, 30 years old lady having two children of aged 11 years and 6years.I belongs to Patna, India.On 09.05.05 severe pain started in my stomach and I rushed to doctor clinic. They prescribed me ODICEF, OFHIL, DROT AND PAN D for five days. On their queries I explained him that my stool colour is blackish. After his treatment I get relieved from pain. But again after one month it again started. This time doctor (gastroentologist) tested blood, stool, and urin and did colonoscopy. Whose report was as under:

ULCERERATED, FIRM MASS IN SIGMOID COLON.
Its proctosigmoidscopy report was Flexible scope passed up to 30 cms from anal verge where a firm friable ulcerated mass seen with narrow, rigid lumen.

Biopsy taken for HPE

Biopsy report: moderately differentiated adenocarcinoma.
CT scan done whose report was as under:
Evidence of increased circumferential wall thickening of descending colon with cranio-caudal extension of 7 cms with presence of eccentric mass lesion meas approx 4.8*3.8 cm narrowing its lumen. Fat planes are lost focally between adjacent bowels loops anteriouly.Fat planes between mass lesion and psoas muscle are well maintained. Proximal large bowel is dialated.Rest of the bowel loops including rectum and sigmoid colon are normal.
IMPRESSION: malignant mass lesion in the region of descending colon.
CEA 1.10 ng/ml
X ray chest PA view –normal study.

I undergone for surgery on 04.07.05.Procedure adopted was radical hemicolectomey+transverse colostomy+mucous frible.

Surgeon diognisis is carcinoma colon.

Biopsy report after surgery:
Done for sample consisting of 30 cms of colon with attached greater mentum within large amount of fat. There was 6*3.5*3 cms ulcero proliferative lesion with rolled out margin 10cms from one margin o resection.

Finding: section from tumor show mucess ulceration with islands of a moderately diff adinocarnoma infiltrating into muscular extema and focally into aeo serosa with a prominent desmoplastic reaction. No tumors perforation seen. NO peri neural spread/vascular emboli seen. No pre existing polyp/adenoma noted. Uninvolved colon is unremarkable.10 lymph nodes dissected which shows a reactive follicular hyper plasia with a sinu-hietjocyasis. All margin of resection are free from tumor.

Stage: 1 (T2, NO, MX)
I need your opinion in the light of above case history

· What should be my further course of action?
· Is chemotherapy must
· What should be prognosis
· What is recovery position for similar case?