My wife, 57 years, underwent a successful surgery for adenocarcinoma of the colon in August 2013, followed by chemotherapy and regular check up every three months with no symptoms of reappearance of the problem. However, in mid December 2014, a cyst was detected in the pelvis region in the course of regular check up. On the doctor's advice PET CT scan was done from vertex to mid-thigh (Oral and IV contrast). The impressions of the PETCT are:
1. 2.8x1.1 cm mild wall thickening of the distal sigmoid colon
2. 5.8x66.6x4.9 cm heterogeneously enhancing solid cystic metabolically active mass in the midline pelvis, infiltrating the vaginal vault, bladder base, pelvic small bowel loops and anterior wall of sigmoid colon-pelvic deposit
3. Left external iliac, metabolically active para-iortic and iortocaval lymphadenopathy –likely metastatic
4. No evidence of hepatic, pulmonary and skeletal metastases
Following PET scan colonoscopy was done which show normal colon; biopsy of vaginal vault shows “tumour tissues made up of irregular complex glandular structures lined by columnar and pleomorphic cells having pleomorphic nuclei; most of the glands show epithelial stratification. Tumour is seen infiltrating into the underlying connective tissue. Features are of well differentiated adenocarcinoma”.
Please suggest the course of treatment to be followed