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