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Colorectal Cancer Case Studies

Case Studies: Surgically Unresectable Metastatic Colorectal Cancer

In this case-based interview, Edward Chu, MD, discusses the diagnosis and treatment of patients with metastatic colorectal cancer.

Surgically Unresectable Metastatic Colorectal Cancer Case: 1

December 2014

  • A 51-year old Caucasian female presented with severe crampy right lower quadrant pain
    • She had a 4-month history of occult bleeding, and significant weight loss of over 10 pounds in the last 8 months
    • She sought medical treatment after experiencing severe cramping in the abdomen and bloody diarrhea
  • Past medical history included GERD, managed with a proton pump inhibitor and appendectomy at age 35
  • Laboratory evaluation showed grade 2 anemia (hemoglobin 8.7 g/dL) and carcinoembryonic antigen (CEA) level of 4.5 ng/mL
  • Colonoscopy revealed an obstructive lesion in the ascending colon, measuring approximately 15 cm
    • Pathological findings showed invasive and poorly differentiated adenocarcinoma with ulcer
    • 10 of 15 lymph nodes sampled were positive for tumor
    • CT scan revealed widespread lesions in both lobes of the liver, and she was diagnosed with stage IV disease
    • Mutation testing; KRAS-positive (G12D) and BRAF-negative
    • Her ECOG performance status was 0
  • She was treated with six cycles of FOLFOX + bevacizumab, and appeared to be responding well to treatment; follow-up imaging showed reduction in the size of the liver lesions

November 2015

  • Follow-up CT showed progression in the liver with new lesions and new small masses in the abdomen and pelvis
  • Her ECOG performance status was 1
  • She began therapy with FOLFIRI + bevacizumab

December 2015

  • The patient complained of severe fatigue
  • CT scan revealed progressive disease with no improvement in the size and number of the abdominal lesions and the presence of 3 pulmonary nodules in the right lung
  • She was then switched to trifluridine/tipiracil (TAS-102)
  • PET/CT at 3 months and 6 months showed stable disease
  • Her ECOG performance status improved (PS 0)
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