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Colorectal Cancer Case Studies

Case Studies: Clinical Approach for Left-Sided Metastatic Colorectal Cancer

In this case-based interview, Tanios Bekaii-Saab, MD, FACP, reviews the case of a 64-year-old female patient who is diagnosed with metastatic colorectal cancer that originates on the left side and discusses the treatment approach for this patient at diagnosis and disease progression.

Clinical Approach for Left-Sided Metastatic Colorectal Cancer

Metastatic Colorectal Cancer Originating on the Left Side

October 2016

  • A 64-year-old woman underwent left hemicolectomy for an obstructing mass at the rectosigmoid junction
    • PMH: atrial fibrillation, moderately controlled on a beta- blocker; patient is also on warfarin
    • CEA elevated; 23.3 ng/mL
  • Pathology:
    • Undifferentiated adenocarcinoma, invading through the muscularis mucosae up to the pericolic fat; 14 nodes were biopsied, 10 were involved
    • Molecular testing: RAS and BRAF wild-type, microsatellite stable
  • Imaging with PET/CT showed multiple lung lesions bilaterally, three measuring approximately 3.0 cm
  • Diagnosis: grade 3 colorectal adenocarcinoma, stage T4N2M1
  • The patient preferred to avoid rash and received systemic therapy with FOLFOX + bevacizumab; therapy was well-tolerated
  • Follow-up imaging at 2 months and 4 months showed significant response in the lung lesions
  • The patient was continued on bevacizumab maintenance

August 2017

  • The patient complained of nausea and fatigue
  • CT of the chest, abdomen, and pelvis showed marked progression in two of the lung lesions and development of 3 small liver lesions
  • The patient was switched to FOLFIRI and cetuximab; her heart rhythm was closely monitored and remained stable
  • Follow-up imaging at 2 months and 4 months showed stable disease in the lung and liver lesions; her symptoms improved
  • At 4 months, the patient complained of severe fatigue and was changed to maintenance therapy

January 2018

  • At 5 months, the patient reports reappearance of symptoms and states she requires frequent rest because of fatigue
  • CEA, 89.8 ng/mL
  • CT shows progressive disease in the lung and presence of several small boney lesions
  • The patient is motivated to try another therapy
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