转移性直肠癌综合治疗病例报告
投票已结束 |  参与人数:24
A 49-year-old male patient; admitted in July 2012 due to hematochezia in the last 2 months,  difficult defecation in the last 2 weeks; with a previous history of left femur fracture caused by accident 1 years ago; no family tumor history; CEA:4.76 CA-199:49.17; Chest X-ray: normal; Abdominal CT: an occupying lesion of upper and middle part of rectum; Pelvic MR imaging: an occupying lesion of rectum, directly invades, enlarged lymph nodes in mesorectum; Colonoscopy found that a lesion located in rectum within 8-15 cm of the anal verge, occupied all the rectal circumference and the endoscope was unable to pass through; Histologic report showed moderately differentiated adenocarcinoma; The preoperative clinical stage: T4N1?M0; Treatment options:Underwent radical resection of rectal carcinoma (LAR) Postoperative pathology showed moderately or poorly differentiated tubular adenocarcinoma, infiltrated through adventitia, tumor deposits in the mesentery, lymphatic invasion (+), vascular invasion (-), perineural invasion (+) , upper and lower incisor edges (-), lymph nodes (+) 6/21, superior mesenteric artery lymph nodes (+) 1/5;stage was pT4N2M0,ⅢB a week after  operation:CEA:1.57 CA199:13.64 pT4N2M0,ⅢB. after radical resection (R0),next treatment:mFOLFOX6; From August 14. 2012, mFOLFOX6 4 cycles; After 4 circles of mFOLFOX6, pulmonary metastasis ; Elevated tumour markers, lung metastasis, the next treatment: FOLFIRI regimen for 1 cycles, CEA, CA-199 decreased (CEA:4.32---4.21; CA-199:85.58---67.99), but the patient was intolerant, diarrhea, anorexia, vomiting, weight loss, refused treatment. Gene detection: K-RAS, B-RAF was wild type; A cycle of mFOLFOX6 plus Erbitux, CEA, CA199 increased (CEA:4.21--7.61; CA-199:67.99--96.39, a cycle of FOLFIRI plus Erbitux, CEA decreased; CA199 increased (CEA:7.61--6.30; CA-199:96.39—147.68) ; CEA:4.66 , CA-199:147.68 ; Enhanced CT:liver metastasis, the right lobe, 1.7*1.5cm; 4 cycle of FOLFIRI plus Erbitux, CEA , CA199 decreased (CEA:4.66-2.62 ; CA199:147.68-33.88); 2 cycle of Erbitux, CEA , CA199 increased (CEA:2.62 –11.14; CA199:33.88-248.48);2 cycle of FOLFIRI plus Erbitux, , CEA , CA199 increased (CEA:2.62 –11.14; CA199:33.88-248.48);
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