Carcinomatous peritonitis from metastatic colon cancer
A 52 year old man presented himself to the emergency room with an acute bowel obstruction. Evaluation revealed ascites and an obstructive mass at the ileocolic junction. CAT scan revealed extensive liver metastases. Emergency laparotomy confirmed an obstructing adenocarcinoma at the ileocolic juction and numerous 1 cm size nodules over the entire peritoneum. Intraoperative liver biopsy confirmed metastatic disease to the liver. The primary tumor was resected to temporarily restore bowel integrity. Postoperatively the patient was treated with 5Fu/Leucovorum and Oxaliplatin but progressed rapidly on this treatment. He was switched to an experimental regime but progressed on this as well and suffered a second acute bowel obstruction requiring laparotomy and diversion.
He then received Immunepheresis. Over the first two months of treatment, he became progressively better. His abdominal pains resolved. His appetite returned to normal and his ascites resolved. His CAT scan revealed resolution of his carcinomatous peritonitis and his liver metastases resolved. He agreed to a “second look laparotomy”. This confirmed a complete response. (This case has been submitted for publication)
Colon cancer with pulmonary metastases
A 64 year old man first developed a Duke’s C adenocarcinoma of the distal sigmoid colon 10 years ago. Initial treatment was sigmoidectomy. The tumor was transmural with positive pericolic lymph node involvement. The surgery was a primary end-to-end anastamosis. No adjuvant chemotherapy was taken.
The patient remained disease free for six years when the serum CEA began to rise and CAT scan revealed a right pulmonary infrahilar metastatic lesion. This was treated with RFA (Radio Frequency Ablation). Several months later CEA rose again and he received 5Fu/Leucovorum, Oxaloplatin chemotherapy. He had three cycles and stopped due to toxicity. The CEA continued to rise and PET revealed progression of the right lung mass. A right pulmonary lobectomy was performed. This was complicated by a postoperative Staph infection that required several months on oral antibiotics. CEA returned to normal one month postoperatively. One year later he developed a tumor recurrence in right middle lung which was treated again with RFA.
Within a year he developed a metastasis to the left adrenal gland. He had adrenalectomy laparoscopically. This was complicated by a Staph infection post op. Within six months he developed a 2.4 cm FTG avid mass in the right mid-lung field, a 2.2 cm right hilar node, and a faint area of increased activity in L-3. His laboratory evaluation was normal save a serum CEA of 9.8.
After one month of Immunepheresis a repeat PET/CT revealed complete resolution of the two pulmonary masses both by CAT and PET. His serum CEA fell to 3.0.