Colorectal Cancer: Managing Recurrent Disease - Episode 1
Tanios Bekaii-Saab, MD, FACP:Mr. Smith is a 62-year-old patient presenting with recurrent colorectal cancer. The patient initially was diagnosed at age 55 when he presented with near obstruction. The patient had a colonoscopy at the time, showed a right-sided tumor that was also ulcerated and somewhat obstructing. He went to the operating room, this was resected. It was found to be a T3N1, and no evidence of metastatic disease at the time. He received adjuvant FOLFOX, did well for a while, and then presented back at age 62 with elevated liver function tests. There was a concern that his cancer was recurrent. He got a PET/CT, which showed multiple lesions of the liver, nowhere else at the time. A biopsy of one of the liver lesions suggested that this was a poorly-differentiated adenocarcinoma very consistent with colon primary, so very consistent with his cancer that was diagnosed a few years prior.
Genomic analysis showed evidence ofKRAS,NRASwild-type, as well asBRAFwild-type, and this was a microsatellite-stable tumor. We went digging a little bit into his family history and his social history, the patient was a previous smoker. He was somewhat obese. His family didn’t carry any history of cancer that would put him at risk.
A discussion with the patient ensued. The patient had previously been exposed to FOLFOX and the decision was to start him on FOLFIRI and bevacizumab. Note that the patient had residual grade 1 neuropathy, which was very tolerable. But we decided anyways to proceed with FOLFIRI/bevacizumab.
The patient is somewhat in the younger category of patients. Although, above ages 50 and 55, we expect the risk of colorectal cancer to increase. In digging into the history of the patient, there’s not much that actually put him at a risk from the genetic or inherited risk factors. Of course, issues like obesity, perhaps smoking, processed meat consumption, and overconsumption, all these have somewhat been associated with an increase of colorectal cancer. But overall, I think given the age of the patient, he falls in what we call the low-risk category for developing colon cancer, and just looking at the risk factors, we think that there are very few identifiable other than loosely, again, obesity or history of smoking.
Transcript edited for clarity.
A 62-year-old African-American man presented with recurrent CRC