Management and Survivorship Considerations in Early-Onset Rectal Cancer

A 34-year-old premenopausal female presented with 9 months of progressive hematochezia and underwent diagnostic colonoscopy, where she had a friable rectal mass approximately 12 cm from the anal verge. Biopsy and staging imaging confirmed microsatellite stable stage IIIB (cT3N1M0) rectal adenocarcinoma without a threatened circumferential resection margin. Given her desire for future childbearing, she expressed concern regarding the effects of pelvic radiation on fertility. She was determined to be eligible for a radiation-sparing approach and underwent fertility preservation counseling prior to initiating neoadjuvant FOLFOX. After 6 cycles, restaging imaging and endoscopy demonstrated a 50% reduction in tumor size. She subsequently underwent low anterior resection with diverting loop ileostomy (DLI), with final pathology showing ypT2N0M0 disease and negative surgical margins.