Imaging Metastatic Rectal Cancer Jack Temple, MS3 June 2013 Christian Malalis, MD
Dec 28, 2015
Imaging Metastatic Rectal Cancer
Jack Temple, MS3
June 2013
Christian Malalis, MD
• JS is a 77 year old man with a history of sigmoid colon cancer (s/p sigmoid resection w/o adjuvant therapy in 2009)
• Surveillance colonoscopy at OSH on 4/17/13 revealed large rectal mass referred to Rush GI and Colorectal surgery
• Rush GI performed:– Flexible Sigmoidoscopy (5/22/13)
– Transrectal Ultrasound (5/22/13)
• Rush Radiology consulted for:– Staging purposes
Clinical History / Physical Exam
Rush Endoscopy Images
Flexible Sigmoidoscopy Images, Courtesy of David Shapiro, MD; 5/22/13
Transrectal Ultrasound
Transrectal Ultrasound Images, Courtesy of David Shapiro, MD; 5/22/13
Colorectal Cancer Staging
Image Source:http://www.hopkinscoloncancercenter.org/
Rectal Cancer Metastasis
Image Source:http://www.elsevierimages.com/
• For pre-treatment staging of colorectal cancer (large lesion):
ACR Appropriateness Criteria
Procedure Rating RRL
CT chest, abdomen, pelvis with contrast
8
FDG-PET/CT whole body 8
X-Ray chest 8
MRI pelvis with and without contrast
8 0
MRI abdomen with and without contrast
7 0
Source: ACR appropriateness criteria
Pelvis (normal)
Axial CT
(No MRN)
Source: e-Anatomy(www.imaios.com)
Pelvis (our patient)
Axial CT from PET/CT
MRN-6557254
Pelvis (our patient)
Axial Fused PET/CT MRN-6557254
Pelvis (normal)
Axial CT
(No MRN)
Source: e-Anatomy(www.imaios.com)
Pelvis (our patient)
Axial CT From PET/CT
MRN-6557254
Pelvis (our patient)
Axial Fused PET/CT
MRN-6557254
Abdomen (normal)
Axial CT(No MRN)
Source: e-Anatomy(www.imaios.com)
Abdomen (our patient)
Axial CT from PET/CT
MRN-6557254
Abdomen (our patient)
Axial Fused PET/CT
MRN-6557254
Abdomen (our patient)
Diagnostic CT post contrast MRN-6557254
Axial
Coronal
• Treatment:–Most cases, treatment is palliative3
• Prolong survival and maintain quality of life
– Chemo options• Old: 5-Fluorouracil
• New: Irinotecan, Oxaliplatin
• Monoclonal Abs: Cetuximab, Panitumumab, Aflibercept4
– Surgical resection
• Follow up imaging:– Surveillance imaging
Treatment and Follow Up Imaging
Images:
• www.hopkinscoloncancercenter.org/
• www.elsevierimages.com
• www.imaios.com (e-Anatomy)
• www.gruntdoc.com
References:
1. Bipat S, Glas AS, et al. Rectal Cancer: Local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 2004 Sep; 232(3): 773-83.
2. American College of Radiology Appropriateness Criteria: Pretreatment Staging of Colorectal Cancer, 2011.
3. Weeks JC, Catalano PJ, et. al. Patients’ expectations about effects of chemotherapy for advanced cancer. New England Journal of Medicine 2012; 367: 1616-25.
4. Clark JW, Grothey A. Systemic chemotherapy for nonoperable metastatic colorectal cancer: treatment recommendations. UpToDate 2013.
5. Flamen P, Hoekstra OS, et al. Unexplained rising carcinoembryonic antigen (CEA) in the postoperative surveillance of colorectal cancer: the utility of positron emission tomography (PET). European
Journal of Cancer 2001; 37(7): 862.
References
Christian Malalis, MD, PGY IV
Rush Endoscopy
David Shapiro, MD
Thanks!
The End
Source:www.gruntdoc.com