A 70 year old lady is diagnosed with Low Rectal Cancer Stage III, with thyroid lobe enlargement with neck nodes. FNAC proves neck node Kochs & Thyroid swelling as colloid goitre. She was advised ATT along with NACTRT but defaulted, taking only RT and no chemo/ATT. On post-RT reassessment after 4 weeks, she is seen to have signs of progression of disease so repeat PET CT was done that showed multiple non specific small lesions in both lobes of liver ( low SUV) , with few lung lesions (favoring Koch's) with highly suspicious hilar LN mass.
How to proceed: 1) Transbronchial biopsy of hilar node only and decide the intent of treatment on the basis of that 2) Biopsy both hilar node & liver lesions 3) Biopsy confirmation of hilar node, lung lesions as well as liver lesions and then decide How to proceed? what are the rationale for each option chosen?
