Five metastasis, 4 surgery, colorectal cancer OS over 8 years!

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Colorectal cancer is the most common gastrointestinal tumor, and the chance of metastasis is higher. The patient had metastory of colorectal cancer, thyroid metastases, left and right adrenal metastases, and multiple metastases. The diagnosis and treatment process is very complicated. Although there are many distant metastasis, as long as reasonable treatment, patients can still get long -term survival.

In this issue, the "Classification of Cases" was shared by Xu Yan, Director of the Department of Earlier 1 of the Fudan Oncology Hospital, and shared a variety of rectal cancer after rectal cancer. While sharing cases with the experience of spreading with medicalists, I hope to bring confidence to patients who are still unremittingly treated.

Profile

Patient, male, 51 years old

CF: See a 4 cm rectum from the anus occupying a place

Pathological: Rectal fluffy glacocoma with severe heteroid hyperplasia cancer

2013.12.16 Rectal MRI: T4BN+

Figure 1 Rectal cancer MRI: T4BN+

2013.12.19-2014.1.23 New assisted chemotherapy

2014.01.22 Rectal cancer MRI: improved than before, T3BN0 may be possible

Tumor tumors were reduced by neo -assisted chemotherapy and no longer invading the surrounding organs. The chance of t3b anal aid surgery was very large.

1 year after rectal cancer

Lung metastasis (first time)

2015.07.27 Chest CT: The lumper of the left lung tongue section invades intercipate and lower lobe, and consider metastasis.

2015.08.03 PET-CT: The upper left lung 2.9*3.0cm lump, the FDG metabolism increases, consider transfer.

Figure 2 chest CT showing positional lesions

This case PET shows the transfer of pulmonary single hair, 2015.08.27 left lung partial destruction, pathological: bowel cancer lung metastasis. Due to the long time with the surgery for a long time, the operation was cleaned up and did not give chemotherapy.

discuss:

About 10%-15%of CRC patients will develop lung metastasis, with high probability, recommended surgery or local treatment of lung metastases, and consider whether surgery is performed according to tumor resection and patient tolerance.

The overall survival (OS) rate (OS) rate of colorectal cancer is 24%-82%, and the median OS is from 35 months to 70 months.

5YOS with liver metastasis and lung metastases at 32%-61.3%, and the median OS is 37 months-83 months.

The prognosis is related to the number of lung metastases, the size of the transfer nodule, the CEA level, the recurrence of the lung metastases, and the lymph node metastasis.

April after lung metastase

Thyroid metastases (second time)

2015.12.14 B ultrasound: The right thyroid nodule (Ti-Rads: 4B) on the right (Ti-Rads: 3)

2015.12.24 CT CT: Both sides of the thyroid occupying lesions, the right thyroid MT may

Figure 3 CT CT shows the diseased lesions on both sides

Preparatory diagnosis of primary thyroid cancer before surgery, 2016.01.15 Right nail standard+left thyroid partial division: conform to the metastasis of glandular cancer in the rectum. Considering the frequent metastasis of the patient, Folfiri chemotherapy began after surgery.

discuss:

Rectal cancer is very rare. The median OS after the metastasis of the thyroid gland is 11 months, 1Y: 2Y: 3y OS = 79%: 66%: 60%. Surgical surgery benefits better than symptomatic treatment.

March after thyroid metastases

Left adventure metastasis (third time)

2016.03.02 Abdominal MRI:

New lumps of left adrenal glands, 48*39*61mm, consider transfer

Give Folfiri+ERBITUX*5

Figure 4 abdomen MRI shows left adrenal mass

2016/05/17 Abdominal MRI: Aceneration of left adrenal masses compared to 40*28*25mm.

Figure 5 The abdomen MRI shows that the left adrenal mass is reduced

After the evaluation of chemotherapy is effective, the tumor shrinks. Multi -disciplinary discussion decide surgical resection, 2016.06.28 Abdominal laparoscopy left adrenal tumor resection, continuing Folfiri+ERBITUX treatment.

discuss:

Colorectal cancer adrenal metastases are rare, accounting for about 3.1%of tumor patients, and 9%of patients with colorectal cancer. R0 resection 56%: R1-2 resection 44%.

All patients with adoption metastasis: 1Y: 3Y: 5Y OS: about 72%: 31%: 16%

Patients with colorectal cancer adrenal metastases: 1Y: 3Y: 5Y OS: about 75%: 45%: 30%

March after left adrenal surgery

New hair lung metastases+right adrenal metastases (fourth time)

2016.10.17pet/ct:

1. The lower left lung -shaped dense shadow, FDG metabolism increases, m possible;

Figure 6 chest CT shows the left lower lung -shaped dense shadow

2. The metabolism of the right adrenal nodule fdg is increased, M may.

Figure 7 PET shows the right adrenal nodule

Because the left adrenal glands have been removed, the patient is not suitable for the treatment of right adrenal surgery, and local treatment+maintenance of chemotherapy. Local treatment includes lung tumor radio frequency ablation, adrenal HIFU and gamma knife treatment.

2016.12.26 Patients should be reduced by the patient's request to reduce chemotherapy+ERBITUX to maintain chemotherapy for 2 and a half years.

2019.09.25 Patients should once again request the reduction of therapy schemes, and give Koriocbine+Bevarzab. Stable, 3 and a half years. Figure 8 Chemotherapy regularly reviews internal lesions and adrenal lesions

After 4 years of stability

Obvious progress of lung metastases (fifth time)

1

2021.03 Review Progress

The chest CT prompts the lung metastases obvious progress, and the abdomen MRI indicates that the adrenal lesions are stable

Figure 9 The chest CT shows the obvious progress of the lung metastasis

Figure 10 The abdomen MRI shows the stabilization of adrenal lesions

Stranging to lung nodule gene test: all wild

Instead: Folfiri+ERBITUX high -strength chemotherapy;

2021.05 Review Progress

Figure 11 The chest CT shows that the lung metastasis has not made a significant progress

Folfiri+ERBITUX*1

Instead of using Elide Kang+ERBITUX low -intensity chemotherapy+Chinese medicine; personal reasons without regular consultation

2021.10 Death

Prognostic analysis

Director Xu Yan analyzed that the metastasis of intestinal cancer and dysfunction strived for local treatment: surgery, radiotherapy, radio frequency, etc.; Multiple metastasis to fight for NED (non -disease status): chemotherapy, targeted, immunity, etc.

Compared with the results of the May review and the results of the March review, the lung metastases did not progress significantly. The chance of patients due to colorectal cancer lung metastasis was relatively low. The patient's whole body was better. Survival.

Miracle cases need to work together to work together

As a leader in treating decision -making, on the right time, the correct technique is used to make the correct treatment at the right time. This tests the medical judgment and comprehensive application ability. And more importantly, how to clearly explain the advantages and disadvantages of various treatments to patients to help patients make the best choices.

As the decision to treat decision -making, patients with tumors choose the best treatment plan according to their actual situation, actively cooperate with treatment, maintain an optimistic attitude, and do not give up lightly.

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The first release of this article: the medical world tumor channel

Author of this article: Akai

Editor in charge: Sweet

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