1、Case report,Case Report,Harbin Medical University cancer hospital,A case consultation : Liver metastasis after resection of rectal cancer,HeiLongJiang tumor hospital.China,Harbin Medical University cancer hospital,Name:Xing XXGender:maleAge:63 years oldECOG:0,Personal profile,Harbin Medical Universi
2、ty cancer hospital,Chief complaint,Resection of rectal cancer before 6 years ,with liver metastasis for 1 month.,Harbin Medical University cancer hospital,Present history,Extended radical resection for rectal cancer (Miles ) was performed before 6 years in this hospital. The tumor was located under
3、the peritoneal fold ,with a size of 6*5*7cm, invading wall of intestine.,Harbin Medical University cancer hospital,Present history,The pathologic diagnosis Rectal: moderately differentiated adenocarcinoma and mucinous adenocarcinoma with disc protrude type Invading wall of intestine A negative upper
4、 margin of resection Number of positive lymph nodes 0/22,Harbin Medical University cancer hospital,Present history,Clinical diagnosis based on the pathologic stage Rectal adenocarcinoma after resection pT4aN0M0 B,Harbin Medical University cancer hospital,Present history,Adjuvant Chemotherapy after s
5、urgery FOLFOX *8 Cycles Oxaliplatin 200mg d1 ivgtt; Leucovorin 300mg d1-5 ivgtt; 5-Fu 1g d1-5 ivgtt; Repeated every 2weeks,Harbin Medical University cancer hospital,Present history,Follow up2009.08-2014.05 CEA and CA199 monitoring and routine CT scanning were conducted every 3 month within 2 years a
6、nd 6 months within 5 years after the surgery. Colonoscopy was performed every year.,Harbin Medical University cancer hospital,Present history,Recurrence2015-05-23 Upper Abdominal Enhancement CT : Liver Metastasis .,Harbin Medical University cancer hospital,肝转移病灶,Harbin Medical University cancer hosp
7、ital,A metastases with a maximum diameter of 14 cm diameter) was observed in the left lobe of the liver,2015.05.23Plain CT,Portal Phase,Hepatic arterial phase,Present history,RecurrenceTumor markers： CEA 113.2ng/ml(0-5) CA199 135.3U/ml(0-37) NSE 23.77ng/ml(0-15.2) AFP 4.24ng/ml(0-7),Harbin Medical U
8、niversity cancer hospital,Present history,Recurrence2015-06-01 Left liver lesion biopsy: Poorly differentiated carcinoma, consistent with metastatic carcinoma.,Harbin Medical University cancer hospital,Present history,Recurrence 2015-06-01 Colonoscopy and Chest CT was Tumor Free.,Harbin Medical Univ
9、ersity cancer hospital,Chest CT,Chest CT,2015.05.28 Pelvic CT,2015.05.28 Pelvic CT,Present diagnosis,Rectal cancer after resection pT4aN0M0 B Liver metastasis,Harbin Medical University cancer hospital,RAS Gene Test,2015-6-11 KRAS/NRAS WT,Harbin Medical University cancer hospital,临床诊断： 直肠癌术后pT4N0M0 B
10、期 肝转移,Present history,Chemotherapy after RecurrenceXELOX *1 Cycles Oxaliplatin 200mg d1 ivgtt; Capecitabine 1500mg am 2000mg pm d1-14 po; Repeated every 3 weeks,Harbin Medical University cancer hospital,Present history,Tumor marker after Chemotherapy,Harbin Medical University cancer hospital,CEA：0-5ng/mlCA199:0-37U/ml,Following treatment,Resection?Chemotherapy ？Portal vein embolization therapy？Chemotherapy combination with HAI (Hepatic Arterial infusion)？,Harbin Medical University cancer hospital,Harbin Medical University cancer hospital,THANKS FOR YOUR ATTENTION,
