case Andrea LUCIANI 1 C R Man 86 years old Widower Lived alone just near his son PS ECOG 1 Non smoker GA ADLs independent Need some help for transportations Non significant weight loss No depression MMSE 2330 ID: 779619
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C. R.
Advanced colon cancer caseAndrea LUCIANI
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Slide2C. R.
Man86 years old Widower. Lived alone just near his son. PS ECOG 1Non smoker
GA: ADLs independent. Need some help for transportations. Non significant weight loss. No depression. MMSE 23/30
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Slide3HISTORYMyocardial infarction in 2012Dilatative cardiomyopathy Previous hip replacement surgeryUrolithiasis Hypercholesterolemia 3
Slide4HISTORY2010: subtotal gastrectomyHysto: adenocarcinoma pT2bN1 (3/18) G22014: During follow-up CA 19.9 increaseColonscopy (16/09/14): Huge rectal vegetating lesion with ulcer at 8 cm from the anal border.Hysto: adenocarcinoma
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Slide5STAGINGEchoendoscopy: rectal neoplasia uT3 uN0Pelvic MRI : huge vegetating lesion at the proximal rectum with a longitudinal extension of 70 mm; the lower border is at 40 mm since the external anal border. Pathologic adenopathies in the mesorectum;. Staging: cT3cN1CT thorax-abdomen: negative for distant metastasisPET FDG: pathological uptake at the rectal lesion. Hepatic metastais at 7° segment.
Liver ultrasoud with contrast: 13 mm lesion at 7° segment. 5
Slide6MDT: RT short-course and after 8 weeks surgery on T and MJanuary2015: pelvic RT (25Gy in 5 fractions)RestagingCT thorax-abdomen: partial response on TPelvic MRI: Reduction of the rectal lesion; no change of adenopathies diameters6
Slide719/03/15: surgical resection of the rectal lesion; protection ileostomy; Surgical resection fo hepatic lesionHysto: rectal adenocarcinoma ypT3 ypN0 (0/16) M1; hepatic metastasis epatica da adenocarcinoma con margini di resezione indenni
da neoplasia The patient has not received adjuvant therapy due to comorbidities and ageStarting follow-up7
Slide8September 2015CEA 71, CA 19-9 888CT thorax-abdomen: NegativePET FDG: pathological uptake in the liver MDT : no locoregional therapies
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Slide9Slide1017/11/15-28/01/16: CT with capecitabine for 4 cyclesCT Thorax-abdomen (09/03/16): small lung nodules; centimetric lesion at 6° hepatic segmentStarting follow upCT thorax-abdomen
(14/10/16): increase of the lung nodulesate the LRL and LLL; increase of hepatic metastases at segments 8, 4, 6. 10
Slide11Slide1213/12/16-02/05/17: CT with capecitabine-bevacizumab for 6 cyclesDiarrhea G2, Fatigue G2. HFS G1. Impairments in most IADLs CT thorax-abdomen (26/05/17): SD; in the hearth at the left ventricle two thrombotic lesions (1 cm) at the apex and at the
interventricular sept. 12
Slide13Slide1426/05/17: referred to ERCardiac ultrasound: severe reduction in the left ventricular ejection fraction (<35%). Lesion at the interventricular sept. Cardiologic evaluation: starting antithrombotic therapy
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Slide15MDT: stop Bevacizumab. Continuing Capecitabine with metronomic schedule (3cp every day). 2 months of treatment were completed15
Slide16September 2017: worsening of dispneaCardiac ultrasound: severe cardica disfunction, EF 20%Stop chemotherapy
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Slide17CT thorax-abdomen (24/10/17): Stability of the lung nodules. Bilateral pleural effusion. Persisting thrombus at the left ventricle. Progressive hepatic disease. Starting home palliative care.17