What happened, in summary

An 84-year-old man came to the emergency department with several days of heavy rectal bleeding and one month of shortness of breath. His medical history included deep-vein thrombosis treated with warfarin, hypertension, diabetes, chronic kidney disease, and severe coronary disease. The bleeding colon cancer required treatment, but a multidisciplinary anesthesia conference concluded that immediate colectomy carried prohibitive cardiac risk.

Because he was not a chemotherapy candidate, he received external-beam radiation to 30 Gy in 10 fractions. The bleeding stopped without treatment complications. Cardiac evaluation then identified two-vessel disease, including an occluded proximal left anterior descending artery. A bare-metal coronary stent was placed, followed by four weeks of dual antiplatelet therapy and then aspirin alone.

Repeat staging CT showed improved colonic thickening and no metastatic disease. After his cardiac condition stabilized, the surgical, anesthesia, and cardiology teams agreed that resection was feasible. Six months after diagnosis, he underwent robotic-assisted right hemicolectomy with an intracorporeal ileocolic anastomosis. Recovery was uncomplicated, and he went home on postoperative day three.

Final pathology found no residual tumor and no cancer in 18 removed lymph nodes, establishing a complete pathologic response. Because the radiation-alone approach had controlled the cancer and the surgical specimen was clear, he did not require adjuvant chemotherapy.