CONFIDENTIAL AND PROPRIETARY © 2014 Sarah Cannon. 1
MANAGING LIVER METASTASIS IN COLORECTAL CANCERS
FRANK SLOVICK, MD
JOE CATES, MD
THOMAS SWEENEY, MD
KAIDI MIKHITARIAN, MD
o 79 year old Indian female
o Past Medical History:• Type II Diabetes for 14 years• Hypertension• Hypothyroidism• Coronary Artery Disease
o Previous Surgeries:• Coronary stent placement in 2010• Cystocele repair in 2009• Vocal cord surgery in 2012
o Family History:• Sister with breast cancer (diagnosed under the age of 50)• Brother with bladder cancer (was a smoker)
Patient S.S.G.
o In 2012 she was seen by her Endocrinologist for management of Diabetes and routine labs indicated a decrease in hemoglobin.
o Iron studies were done:• Ferritin of 6• High TIBC consistent with iron deficiency• Stools were positive for blood
o Underwent Colonoscopy in September 2012 that showed a 1.7 cm mass at the ileocecal valve• Biopsy showed moderate differentiated adenocarcinoma of the colon.
o Imaging revealed suspicious lesions in the liver.
Patient Presentation
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Imaging Pre Trisegmentectomy
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Imaging Post Trisegmentectomy
Liver parenchyma involved by metastatic colorectal adenocarcinoma with extensive necrosis adenocarcinoma with extensive necrosis
Pathology
Pathology
Metastatic colorectal adenocarcinoma
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Imaging Post Folfiri Plus Avastin
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Imaging CT Ablation
o Diagnosis• Colorectal adenocarcinoma with hepatic metastasis.
o Treatment:• 9/10/12 Right and transverse colectomy • Chemotherapy with Folfox plus Avastin for 6 months• 5/16/13 Hepatic trisegmentectomy to include the entire right lobe and
medial segment of left lobe with placement of gold fiducial markers within the left lateral segment
• 1/14/14 Recurrent disease on PET/CT scan; additional chemotherapy with Folfiri plus Avastin through 8/2014
• 9/30/14 CT guided radiofrequency ablation of left lobe liver lesion• Currently on Capecitabine maintenance
Diagnosis and Treatment