Dear Dr.Mahmoodzadeh

I wonder if I could ask you to get some more information  a bout your patient, such as age , performance , familial history , comorbidities , detailed location and stage of tumors , previous history of IBD , ect.

In  a such case I would start with FOLFOX and RT (with or without bevacizumab depending on KRAS/NRAS wild type) since you have already a N1 documented (probably MRI or endorectal US), then surgery, since both tumors are nonobstructing. Anyway the treatment should be individualised taking into account all other parameters mentioned by Dr. Maryam and not only(FAP, HNPCS, presence of other polips, etc.)

I suggest focusing on treatment of the rectal cancer with neoadjuvant chemoradiation (adapted from  , for example: Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Hofheinz RD, et al. Lancet Oncol. 2012). then surgery of both followed by 8-12 cycles of Folfox.

base on tumor board suggestion ,fast and short radiation hi dose in each fraction delivered to rectal ca as neoadjuvant ,it takes 10 days, then surgery for both sites

Sort for rectum and operate next week for both colon and rectum

crm not threatened, hence no need to wait for 8 weeks

good to rule out Hnpcc history

thanks Dr avanish

what do you mean sort for rectum?

Short course rt  for 5 days followed by surgery after 6 weeks, during which chemo is given

thanks again Dr Avanish

your plan also confirmed in our tumor board