Introduction: The risk of colorectal cancer (CRC) is increased in survivors of numerous cancers including bone cancer, testicular cancer, and Hodgkin Lymphoma (HL). 1 In HL cancer survivors, the relative risk (RR) of CRC is estimated at 2 to 7 as compared to that of general population. 1 In the U.S., cancer survivorship guideline provided by the Children’s Oncology Group recommends initiation of CRC beginning 5 years after radiation or at age 30 years (whichever that occurs last) with either multitarget stool DNA every 3 years or colonoscopy every 5 years. 2
Methods: A 46-year-old female with history of childhood HL and presented to PCP with 4-month history of lower abdominal pain with bloating and loose stool. Family history was notable for colon cancer in maternal grandfather but otherwise noncontributory. Subsequent work up with CT abdomen revealed 3 cm diffuse wall thickening at the proximal transverse colon. Colonoscopy revealed ulcerated non-obstructing mass involving 1/3 of luminal circumference at the transverse colon at 55cm from anal verge. In addition, numerous sessile polyps were found throughout the GI tract from rectum to ascending colon. Pathology of biopsy specimen revealed moderately differentiated adenocarcinoma with multiple sessile serrated adenoma confirming serrated polyposis syndrome (SPS). Genetic panel was negative for pathogenic variant of MLH1, MSH2, MSH6, and PMS2. Subsequent PET CT showed confirmed intense FDG avidity at suspected proximal colon and mesenteric lymph node compatible with regional metastatic disease. Patient underwent extended right hemicolectomy with subsequent referral to medical oncology. Discussion: A recent population-based study reported increased risk of colorectal neoplasia, especially advanced serrated lesions and SPS, in HL survivors as compared to general population. 1 The risk is generally associated with exposure to abdominal radiotherapy and/or receipt of alkylating agent particularly procarbazine. Our patient reported receiving combination chemotherapy including doxorubicin, bleomycin, and cytosine arabinoside for treatment of HL and AML but had no exposure to procarbazine or abdominal radiation therapy. Currently, colonoscopy is recommended yearly in patients with SPS with the goal of performing resection of polyps greater than 5 mm in size.3 Given increased risk of CRC and higher prevalence of SPS, there is a need for a longitudinal multidisciplinary care to ensure appropriate colonoscopy surveillance program among HL survivors.
Polyp in ascending colon
Mass at transverse colon
Disclosures: Chansong Choi indicated no relevant financial relationships. Seth Sweetser indicated no relevant financial relationships.