SYNCHRONOUS PRIMARY CERVICAL AND COLORECTAL CANCERS IN A 25-YEAR-OLD WOMAN

Introduction: Synchronous cancer refers to two or more malignancies co-existing in a patient at the time of diagnosis or within 6 months of diagnosing the first. Cervical cancer is the commonest gynecological malignancy in Nigeria, while colorectal cancer the 4^th commonest malignancy in Nigeria.

Case Presentation: We present a 25-year-old grand multi-para who presented the hospital with a 20-month history of recurrent bleeding per rectum and a 4-month history of persistent foul smelling watery vaginal discharge. Physical examination at presentation revealed a mildly pale young woman with multiple discrete inguinal lymphadenopathies, with a Karnofsky performance status (KPS) of 90. Abdominopelvic ultrasound scan showed a rectal mass measuring 12 x 11.4 cm that was clearly delineated from the uterus, cervix and urinary bladder. There was also a hypo echoic mass in the region of the cervix uteri. These findings were further confirmed with a pelvic MRI scan. She had a colonoscopy done with the findings of a near obstructing irregular luminal rectal mass about 3-4 cm in vertical extent and extending up to about 5 cm above the anal verge, while the other aspects of the colon were normal. Separate biopsies were taken for the rectal and cervical masses. The reports of histology were well differentiated mucinous adenocarcinoma and Squamous Cell Carcinoma Large Cell Non-keratinizing for the rectal and cervical masses respectively.

Conclusion: Synchronous primary cervical and colorectal cancers are extremely rare. The risk factors for each of the malignancies may overlap with that of the other, thereby increasing the chances of synchronicity in an individual. More routine screening for cancer predisposing conditions like Li-Fraumeni syndrome is advocated in resource-constrained countries