CME INFORMATION

FACULTY AFFILIATIONS AND DISCLOSURES

Case Studies

Case 1 from the practice of Kert D Sabbath, MD: A 45-year-old man with a history of morbid obesity, diabetes and venous insufficiency who underwent resection of a 5-cm, poorly differentiated adenocarcinoma of the colon, associated with invasion of the muscularis, and 2/4 positive nodes (presented to Dr Richard M Goldberg and Dr Robert A Wolff).

Case 2 from the practice of Atif M Hussein, MD: A 65-year-old physician diagnosed with Dukes C colon cancer who underwent surgery and received adjuvant 5-FU/leucovorin. Five years later, he began FOLFOX6 with bevacizumab for liver metastases, resulting in a partial tumor response. The patient stopped chemotherapy after nine cycles due to neuropathy and continued on bevacizumab. Three months later, the liver lesions progressed and FOLFIRI with bevacizumab was started (presented to Dr Goldberg and Dr Wolff).

Case 3 from the practice of Michael A Schwartz, MD: A 63-year-old man diagnosed with primary sigmoid colon cancer with synchronous liver metastases and extensive pelvic disease who underwent a diverting colostomy and received FOLFOX with bevacizumab. After three cycles, his CEA level dropped by 80 percent, and after six cycles, no tumor could be visualized on sigmoidoscopy and then, at laparotomy. The colostomy was closed, and the patient began capecitabine (presented to Dr Jordan D Berlin and Dr Axel Grothey).

Case 4 from the practice of Philip Glynn, MD: A 72-year-old woman who underwent a left hemicolectomy for a 9.2-cm, Grade II adenocarcinoma with 42/47 positive lymph nodes. She completed six months of adjuvant FOLFOX. She was asymptomatic for 16 months until she recurred with a retroperitoneal mass. She then received five months of CAPOX and bevacizumab for progression (presented to Dr Berlin and Dr Grothey).

Case 5 from the practice of Sara M Garrido, MD: A 70-year-old woman who underwent a right hemicolectomy for a 3-cm, well- to moderately differentiated tumor with 3/15 positive nodes. She has a history of diabetes and laryngeal cancer, treated with cisplatin-based chemotherapy and radiation therapy, with residual neuropathy. The patient was treated with adjuvant capecitabine for the colon cancer (presented to Dr Berlin and Dr Grothey).

Case 6 from the practice of Noor M Merchant, MD: An 89-year-old man who underwent resection of a T4/N2 sigmoid colon cancer with a positive pelvic wall margin and 4/4 positive nodes and was then followed expectantly. His postoperative CEA level of 1.5 subsequently rose to 6.0. A PET scan revealed progression in the anterior abdominal wall. He received 5-FU/leucovorin and bevacizumab. His CEA level dropped after two cycles, and a PET scan was normal. Treatment ended after eight months, and the patient has subsequently done well for three years off treatment (presented to Dr Goldberg and Dr Wolff).

Case 7 from the practice of William G Reeves, MD: An 84-year-old man who underwent a right hemicolectomy for a 3-cm tumor with penetration of the muscularis and 1/15 positive nodes. The patient was the sole caretaker for his wife, who had suffered a stroke. He received six months of adjuvant capecitabine, continued to care for his wife and is doing well 12 months after initiation of treatment (presented to Dr Goldberg and Dr Wolff).

Case 8 from the practice of Daniel J Moriarty, MD: A 62-year-old woman who received neoadjuvant radiation therapy and 5-FU/mitomycin for squamous cell carcinoma three to four centimeters above the anal verge. After chemotherapy, the tumor was no longer visible or palpable but was still seen on ultrasound. An AP resection revealed submucosal disease, with 5/19 positive nodes (presented to Dr Goldberg and Dr Wolff).

Case 9 from the practice of Kapisthalam S Kumar, MD: A 66-year-old man who underwent resection of a 4-cm, moderately differentiated tumor in the descending colon with involvement of the subserosa and 20 negative nodes. No lymphovascular invasion was seen, but the pathologist noted multiple microabscesses adjacent to the tumor (presented to Dr Berlin and Dr Grothey).

Case 10 from the practice of Sushil Bhardwaj, MD: A 46-year-old mother of three who underwent a left hemicolectomy for a 2.5-cm, poorly differentiated adenocarcinoma with lymphovascular invasion and invasion into the subserosa, but 18 negative nodes. She received weekly 5-FU/leucovorin but had a history of a calcium “allergy,” and she consistently reacted with nausea, diarrhea and abdominal cramps, despite antiemetics. She was then switched to capecitabine, which she tolerated well (presented to Dr Berlin and Dr Grothey).

Case 11 from the practice of Dr Hussein: A 61-year-old man who underwent a colectomy for a 4-cm, poorly differentiated adenocarcinoma invading the subserosa. No lymphovascular invasion was detected, and all 17 nodes were negative. Enrolled on ECOG-E5202, the patient was classified as having “low-risk” disease and, therefore, did not receive adjuvant chemotherapy (presented to Dr Berlin and Dr Grothey).

Case 12 from the practice of Dr Reeves: A 54-year-old man in whom a colonoscopy revealed both rectal and transverse colon lesions. A PET-CT scan did not show any distant disease or nodal involvement (presented to Dr Berlin and Dr Grothey).

Case 13 from the practice of Dr Glynn: A 48-year-old woman who underwent resection of a 3-cm, moderately well-differentiated tumor extending into the subserosa with 4/7 positive nodes and two palpable liver lesions. Biopsy revealed metastatic disease. The patient received chemotherapy and then a wedge resection of the liver with cryotherapy. She subsequently received six months of 5-FU/ leucovorin and is doing well 12 years later (presented to Dr Berlin and Dr Grothey).