This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. This is a 73-year-old woman who underwent a right hemicolectomy for a stage three colon cancer about one year earlier and is now returning for a routine surveillance examination. When we are looking at that ileocolic anastomosis, you can see through the anastomosis there is small bowel mucosa and on the lower left part of the image, there is an ulcer. There's some exudate that is evident in the base of this ulcer. And so the question is, what is the nature of this lesion that is seen on this ileocolic anastomosis? This is recurrent colon cancer at the anastomosis. The tips here are the ulcer that has a ledge on it, and then looking in the ulcer, you see disrupted vasculature that's typical of NICE 3 or KUDO 5. The arrows are pointing to it there. So it means cancer in the same way here that it does in a patient who has it in a lateral spreading lesion. So having said this, recurrent cancer at the anastomosis is uncommon with colon cancer. It occurs only about 2% of the time. It was seen more often in the old days before appropriate neoadjuvant therapy with rectal cancers, but in the colon, it's always been uncommon. When it's present, oftentimes there is unresectable disease in the abdomen for cure. Nevertheless, we would, of course, biopsy this. We want to be able to recognize it and then get appropriate staging studies. And I think it's also important to know that in the surveillance situation, that the use of CEA and CT scans are the primary way that we look for recurrences. And with colonoscopy, the major goal is to prevent metacronous colon cancers from developing. And this is an unusual finding at colonoscopy.

video tip

Braintree

Cibela Pharmaceuticals

recurrent colon cancer

ileocolic anastomosis