Liver metastasis from sigmoid colon cancer with peritoneal dissemination showed a complete response to TS-1

A 64-year-old man with unresectable sigmoid adenocarcinoma due to peritoneal dissemination (P3) and liver metastasis (H2) treated with TS-1, showed a complete response. TS-1 is an oral anticancer drug that produces biochemical modulation. It is composed of tegafur, gimestat and ostat potassium in a molar ratio of 1:0.4:1 to increase the effect of 5-FU and to decrease toxicity in the digestive canal. Treatment with TS-1 requires no hospitalization and can enhance the quality of life of the patient. TS-1 is expected to be an effective agent for the treatment of colon cancer with liver metastasis and peritoneal dissemination.     

Isolated splenic metastasis of sigmoid colon cancer: a case report

We report the case of a 62-year-old man who developed isolated splenic metastasis of sigmoid colon cancer. The patient underwent left hemicolectomy for Dukes C sigmoid colon cancer in February 1997. In March 1999, an abdominal CT scan revealed a tumor 3 cm in size at the inferior pole of the spleen. The tumor was hyperechoic on ultrasonography. The serum carcinoembryonic antigen level was normal. Since no other site of recurrence was identified, a splenectomy was performed with a curative intent. At laparotomy, neither hepatic metastasis, peritoneal dissemination, lymph node metastasis nor local recurrence was detected. Histological findings of the splenic tumor were compatible with metastasis of the previously resected sigmoid colon adenocarcinoma. The patient has been disease-free for 19 postoperative months. Immunohistochemical staining for urokinase-type plasminogen activator was positive in primary sigmoid colon cancer and splenic metastasis, but negative in lymph node metastasis; results that possibly reflect the difference in progenitor cells between splenic metastasis and lymph node metastasis or the difference in the microenvironment of cancer cells between the spleen and lymph nodes. Based on the present case, we recommend that clinicians pay close attention to the spleen for the early diagnosis of isolated splenic metastasis when routinely evaluating abdominal CT scans and abdominal ultrasonography following curative resection of primary colorectal cancer.     

A case of peritoneal disseminated sigmoid colon cancer with liver metastasis responding to S-1

In October 2004, a 73-year-old man underwent loop ileostomy because of unresectable peritoneal disseminated sigmoid colon cancer with liver metastasis. The oral chemotherapy by S-1 was administered(80 mg/day for 4 weeks followed by a 2-week rest period). A half year later, the primary lesion was remarkably diminished on barium enema, and peritoneal dissemination and liver metastasis disappeared on CT. Because he was unwilling to have an ileostomy, we decided to resect the primary lesion and close the ileal stoma in May 2005. There was no obvious peritoneal dissemination, and operation was successful. He died without intestinal stoma one year after second operation. This therapy can be orally administered at home, and is considered to be useful from the viewpoint of QOL as well. S-1 is expected to be an effective agent for the treatment of colon cancer.     

Isolated splenic metastasis from colon cancer

Solid-tumor metastases of the spleen are rare and usually associated with disseminated disease. There are only seven reports in literature of isolated splenic metastases from colorectal carcinoma, which generally metastasize to regional lymphonodes, liver and abdominal peritoneum. We report a case of isolated splenic metastasis in a 55-year-old woman who had undergone left hemicolectomy, lymphadenectomy and chemotherapy 18 months earlier for adenocarcinoma of the sigmoid colon with positive pericolic and inter-aortocaval lymphonodes. This is the eighth documented case of isolated splenic metastasis from colon cancer. Previously reported cases of this type are reviewed along with the mechanism underlying neoplastic spread to the spleen.     

A case of metastasis to the diaphragm from ascending colon cancer

We reported a case of metastatic tumor to the diaphragm discovered by rising CEA after operation of ascending colon cancer. A 72-year-old female underwent right hemicolectomy on January 2005. After discharge, she received adjuvant chemotherapy by S-1, but a rise of CEA was shown. Based on exploratory findings, laparotomy was done with the diagnosis of metastasis to the liver(S7). A tumor was present in the right diaphragm, and contacted the liver(S7). Partial resection of the right diaphragm was performed. The removed specimen revealed the same histological findings of the last operated ascending colon. Metastasis to the diaphragm is very rare, especially a solitary one as in this case. Etiologically speaking, the tumor cells might be absorbed or have strayed into peritoneal stomata of the diaphragm.     

A case of anal metastasis from sigmoid colon cancer in a long-term survivor who had repeated local excisions

A 72-year-old man underwent sigmoidectomy for sigmoid colon cancer in January 1999. Histopathological examination revealed a moderately differentiated adenocarcinoma, tub 2, SS, ly2, v2, N1, H0, P0, M0, Stage IIIa, cur A. In March 2001, he complained of an anal bleeding and underwent colonoscopy. It showed a submucosal tumor 15 mm in diameter at the anal canal and the biopsy indicated a moderately differentiated adenocarcinoma. This tumor was suspected of metastasis from sigmoid colon cancer and transanal resection was performed in May 2001. Histopathological examination revealed a moderately differentiated adenocarcinoma, which was the same histological type as primary sigmoid colon cancer, tub 2, A, ly2, v2, RM0. The diagnosis of anal metastasis was made on the basis of three points. First, tumor was covered with anal epithelium. Secondly, there were severe lymphatic and venous involvements. Thirdly, there were no findings of other primary anal cancer. By removing anal canal metastases twice, inguinal lymph node metastases three times and lung metastases in each time, he survived for 11 years after a primary surgery. We reported here because it was a very interesting and rare case that the patient was cancer-free after surgeries as many as seven times.     

Locally disseminated cancer of the sigmoid colon]

The study discusses the experience of treatment of 207 patients with locally-advanced cancer of the sigmoid colon who made up 13.5% of the total number of cases of cancer of this site seen in the clinic in 1972-1990. Radical surgery was performed in 170 (82.1%) patients. Postoperative lethality rate was 5.8%, five-year survival rate--70.5 +/- 5.6%. The use of adjuvant preoperative radiotherapy assured a higher resection rate and had no adverse effect on immediate results.     

预防肝转移大肠癌术中静脉插管化疗体会

目的　大肠癌切除术中相应静脉插管化疗预防肝转移。方法　术中随机进行大肠癌相应部位静脉插管 ,术后立即开始 2 4小时持续静脉点滴 5 Fu 1克 +5 %葡萄糖 10 0 0ml,连用七天 ,化疗后 3～ 5天拔除此管。结果　完成此治疗且观察 3年以上插管组 44例病人及随机对照组的 44例病人 ,近期结果表明 ,插管组与对照组 3年生存率无明显差异 ,分别为 95 .1%( 39/ 41)、93.2 %( 4 1/ 44) ,而无瘤生存率两组有显著差异 ,分别为 85 .4%( 35 / 41)、6 1.4%( 2 7/ 44)。还有待长期随访观察。结论　本项研究是一种不失手术时机、立即对大肠癌术后病人进行预防复发肝转移的积极治疗方法。此方法能广泛应用于大肠癌晚期及未切除的腹腔其它脏器恶性肿瘤的预防及治疗。     

A case of esophageal cancer successfully treated by chemoradiotherapy after resection for multiple liver metastasis of sigmoid colon cancer

The patient was a 56-year-old man. Colonoscopic findings showed a cancerous lesion of the sigmoid colon and we performed curative sigmoidectomy. Four months after the operation, abdominal CT scan revealed multiple metastatic lesions in the liver. We performed lateral segmentectomy and partial resection of the S4, S6, S8 segments and cannulation for hepatic arterial infusion chemotherapy. Continuous hepatic arterial infusion chemotherapy with 5-FU (1,000 mg/body/day) was performed for two weeks as a postoperative adjuvant chemotherapy. Immediately after the therapy, endoscopic examination for upper digestive tract showed a 0-lpl type cancer lesion in the middle of the thoracic esophagus. Concurrent chemoradiotherapy with low-dose FP was efficacious and a complete response was obtained. The patient has survived for nine months after the operation without any sign of recurrence. It is suggested that concurrent chemoradiotherapy an effective treatment for esophageal cancer.     

Successfully resected an isolated extraperitoneal metastasis of sigmoid colon cancer--a case report

We herein report an extremely rare operative case of an isolated extraperitoneal metastasis of colon cancer. A female patient had undergone a sigmoidectomy for ileus due to sigmoid colon cancer when she was 40 years old. Peritoneal metastasis, 5 mm in diameter, was on the sigmoid colon mesentery and she was histologically diagnosed as Stage IV. She received fluorouracil-based adjuvant chemotherapy for 24 months. Serum CEA increased gradually from 36 months after the operation, and CT scan demonstrated bilateral ovarium tumors. Bilateral oophorectomy was performed at 44 months after the operation. Serum CEA decreased temporarily, but increased again. Serum CEA increased in spite of giving UFT/LV, so we changed to mFOLFOX6 therapy. Serum CEA decreased until it reached to a normal range after 9 courses, and stopped mFOLFOX6 therapy. Four months later, serum CEA increased again and PET-CT demonstrated a 3 cm mass with calcification in pelvic, and accumulation of FDP. Serum CEA decreased until it reached to a normal range after a resection of extraperitoneal mass. A histological examination of the tumor revealed a moderately differentiated adenocarcinoma similar to colon cancer. She has been well without recurrence 77 months after the first operation.     

Molecular determinants of colon cancer metastasis

Colon cancer metastasis is a tightly regulated process that requires a cancer cell to express genes that allow progression through various distinct steps. Aberrations in gene expression by cancer cells leads to transformation, growth, angiogenesis, invasion, dissemination and survival in the circulation, attachment in the organ of metastasis, and again invasion, growth, and angiogenesis. In addition to the genotype/phenotype of the tumor cell, for a tumor cell to become a clinically relevant metastasis, it must be able to respond appropriately to the environment. This includes being able to utilize growth factors and blood vessels from the organ of metastasis for the benefit of the tumor mass. Understanding the molecular and biologic mechanisms of colon cancer metastasis will allow the development of rationale therapeutic strategies that are more likely to impact the natural history of this disease than current therapies.     

A case report of thyroid gland metastasis associated with lung metastasis from colon cancer

Thyroid gland metastasis of malignant tumors is observed in 1.9% to 9.5% of histologically examined autopsy cases. Thyroid metastasis from colon cancer is extremely rare and the prognosis is poor. Here we report a case of lung metastasis and thyroid gland metastasis following sigmoid colon cancer surgery. In 2000, a 58-year-old woman underwent a sigmoid colectomy for sigmoid colon cancer. In 2005, a metastatic lung tumor was detected by chest CT. The patient underwent a partial thoracoscopic resection of the left lung in April 2005. On a CT scan taken 3 years and 4 months after the lung resection, a tumor mass was observed in the left lung and a low-absorption region with an unclear border was seen in the left lobe of the thyroid gland. Thyroid aspiration cytology showed adenocarcinoma, and a diagnosis of thyroid gland metastasis from sigmoid colon cancer was made. In April 2008 a subtotal thyroidectomy was performed. Following surgery, the patient underwent chemotherapy with mFOLFOX6 and bevacizumab. Nevertheless a number of lung metastases and expressions of lung metastasis were subsequently observed. Histopathological examination revealed a number of metastases of differentiated papillary adenocarcinoma in the thyroid gland from colon cancer.     

A case report of poorly-differentiated adenocarcinoma in sigmoid colon cancer with liver and pulmonary metastasis responding to TS-1 and CPT-11

A 66-year-old woman (156 cm, 58 kg) underwent sigmoid colectomy for cancer. She was found to have simultaneous liver and peritoneal metastases at operation, which had not been detected with CT examination before operation. After operation, CT showed multiple liver metastasis and a high level of CEA and CA19-9 . Pathological findings were type 3, 30 x 20 mm, poorly-differentiated adenocarcinoma, se, ly 2, v 2, n 2 (+), ow (-), aw(-), H 3, P 0 (stage IV). Treatment of the patient consisted of daily oral administration of 80 mg TS-1 for 21 days and 60 mg CPT-11 on 1 day and 15 day as one course.After 2 courses, tumor sizes of liver metastases and the level of tumor markers became reduced.The current case suggested that the administration of TS-1 and CPT-11 may have a potent therapeutic efficacy in advanced colorectal cancer.     

Organo-axial volvulus of the sigmoid colon

A 59 year old man presented with subacute abdominal distension. and diarrhea. Plain radiographs and barium enema demonstrated organoaxial volvulus of the sigmoid colon. The radiologic, surgical, and pathologic findings are presented. The radiologic differences between organoaxial volvulus and the common mesenteroaxial volvulus of the sigmoid colon are discussed.     

An operated case of metastasis to the small intestine from lung cancer

We report a rare case of a 68-year-old man with long-term survival after a surgical treatment of solitary metachronous small intestinal metastasis from lung cancer. He underwent a right upper lobectomy for primary lung adenocarcinoma. Thirty -four months after the operation, a tumor of small bowel was detected by computed tomography. The tumor was resected and diagnosed as a metastasis from lung cancer. Eighteen months after resection of metastasis, a tumor located at mesentery of the jejunum was pointed out. The tumor was resected and also diagnosed as a metastasis from lung cancer. The postoperative course was uneventful, and the patient is still alive without recurrence for 3 years after the last operation. We reviewed of 222 Japanese cases that underwent a resection of small intestinal metastasis from lung cancer. Although the prognosis was extremely poor for those who underwent a resection of the primary lung cancer and who had no remnant metastatic lesion at the time of metastasectomy, they seem to have a longer survival time.     

A case of lymph node metastasis after 7 years from Hartmann's operation for stage IV sigmoid colon carcinoma

The case was a 49-year-old woman. In 1995, she underwent Hartmann's operation for sigmoid colon carcinoma. Histological stage was IV [se, n4(+), P0, H0, M(-)]. Adjuvant chemotherapy was performed by MMC and 5'-DFUR. After 7 years from the surgery, she had a lumbar pain. CT examination revealed a retroperitoneal tumor-like shadow and Para-aortic lymph nodes were swelling. In 2002, she underwent probe laparotomy. There were massive lymph nodes metastasis, and tumor resection was impossible. Following several systemic chemotherapies such as UFT/CPT-11 and TS-1, the tumor progressed and liver metastasis appeared. After 9 years from the first operation, she is still able to eat and her performance status is 1.     

Isolated splenic metastasis from colon cancer. Report of a case

Isolated splenic metastasis is an uncommon event, except in the case of secondary involvement by lymphoma. The most common sites of metastases of colorectal cancer are the regional lymph nodes, liver and peritoneum; lung and bone are rarely involved, the spleen exceptionally. In this paper we report a case of metachronous isolated splenic metastasis of transverse colon cancer in an 80-year-old woman who was successfully treated by splenectomy. The peculiar clinical-pathological aspects of this kind of metastasis are discussed on the basis of our clinical observation and a review is presented of similar cases reported in the literature. Only 14 reported cases of isolated splenic metastasis from colorectal cancer were found in Medline.     

A case of recurrent sigmoid colon cancer with adrenal and para-aortic lymph node metastasis successfully treated by operation and chemotherapy

We report a case of 57-year-old woman suffering from advanced sigmoid colon cancer with adrenal and para-aortic lymph node recurrence. Sigmoidectomy was performed for sigmoid colon cancer in January 2002. Pathological staging was Stage II (pT3, pN0, pM0, Cur A). She received a UFT + CPT-11 regimen as preoperative chemotherapy for liver metastasis (S2, S7) from December 2002. A partial liver resection (S2, S7) was performed for liver metastasis in July 2003, and the UFT + CPT-11 was introduced as adjuvant chemotherapy. However, adrenal and para-aortic lymph node recurrence was detected in February 2007, and mFOLFOX6 was performed as preoperative chemotherapy. Right adrenalectomy and para-aortic lymph node dissection was performed in July 2007. mFOLFOX6 as postoperative chemotherapy was done, mFOLFOX6 + bevacizumab was started because of CEA increase. The chemotherapy was performed for 23 courses and temporarily stopped due to adverse reactions, such as peripheral neuropathy (grade 2), general fatigue (grade 1), and nausea (grade 1). She had no recurrence for almost 3 years after a resection of adrenal and para-aortic lymph node metastasis.     

A case of sigmoid colon cancer with multiple liver metastases responding to S-1

A 74-year-old woman was referred to our hospital with complaints of constipation and abdominal distention caused by a sigmoid colon tumor. After examination, she was diagnosed as sigmoid colon cancer with multiple liver metastases. To prevent bowel obstruction, a sigmoid colon resection was performed. On postoperative days 15, S-1 was started, and she was discharged on postoperative day 26. Each course consisted of daily oral administration S-1 for 4 weeks followed by 2 drug-free weeks. However, because of grade 2 anorexia in the 1st course, the treatment plan was changed to administration for 2 weeks and withdrawal for 1 week. After 7 courses of treatment, computed tomography revealed that the liver metastases were remarkably reduced. Although she experienced an adverse event involving a cutaneous symptom of grade 2, the treatment was continued under ambulatory management. After eight courses, elevation of tumor marker and metastasis at the right femur were found, and she died of the cancer 12 months after the operation. S-1 is expected to be an effective agent for the treatment of advanced colorectal cancer.