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:RASandBRAFwild-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