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Colorectal Cancer Case Studies

Case Studies: Progression of Left-Sided Metastatic Colorectal Cancer

In this case-based interview, Wells Messersmith, MD, discusses the case of a 66-year-old male patient diagnosed with left-sided metastatic colorectal cancer and the treatment options available, especially when the patient’s disease progresses.

Progression of Left-Sided Metastatic Colorectal Cancer

Progression of Left-Sided mCRC

February 2016

  • A 66-year-old man reported with constipation, bloating, abdominal pain and weight loss of 12 pounds in 2 months
  • PMH: mild hypertension, well-controlled on CCB
  • Lab evaluation: Grade 2 anemia (Hb 9.2 g/dL)
  • Colonoscopy revealed a7-cm mass in sigmoid colon
  • CEA, 80 ng/mL
  • The patient underwent sigmoid colectomy
  • Pathology: undifferentiated adenocarcinoma tumor invading through muscularis propria and extending into the pericolorectal tissue;
    • Biopsy: 7of 12 resected nodes positive
    • Molecular testing: KRAS mutation in codon 12 of exon 2; microsatellite stable
  • CT scan showed several lesions in both lobes of the liver, measuring up to 17 mm in diameter, and 3 small lesions (<6 mm) in the left lower pulmonary lobe
  • Diagnosis: Stage 4 colorectal cancer
  • The patient received systemic therapy with FOLFOX + bevacizumab; therapy was well-tolerated
  • The patient was continued on bevacizumab maintenance

February 2017

  • One year after starting therapy, the patient complained of nausea and fatigue
  • CT of the chest, abdomen, and pelvis showed progression in three of the liver lesions and one lesion in the right pulmonary lobe
  • The patient was started on FOLFIRI and continued bevacizumab

January 2018

  • Eleven months later, CEA level rose significantly
  • Follow-up CT showed progressive disease in the lung and liver
  • The patient is interested in knowing his options at this stage
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