Metachronous Arguably Resectable Liver-Only Disease at Presentation

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CASE 1: A 50-year-old woman status post sigmoid resection for Stage III colon cancer treated on protocol with adjuvant FOLFOX and bevacizumab now presents 18 months after initial diagnosis with increasing CEA and radiologic evidence of one 8.4-cm metastasis in the right lobe of the liver (segments VII and VIII). Left liver lobe appears normal in size and without evidence of metastases. (Presenter Dr. Axel Grothey, see other cases by Dr. Grothey)

CASE 2: A 59-year-old man underwent a left colectomy for a Stage II obstructing sigmoid tumor shortly following coronary bypass surgery. After a year of observation, surveillance CT revealed 4 hepatic metastases in the right lobe of the liver, somewhat peripherally located, the largest measuring 2.3 centimeters. Left liver lobe appears normal in size and without evidence of metastases. (Presenter Dr. Axel Grothey, see other cases by Dr. Grothey)

CASE 3: A 60-year-old patient presented with elevated CEA 3 years after resection for Stage II primary colorectal cancer (CRC) treated without adjuvant chemotherapy. Surveillance PET/CT showed a 2-cm lesion in the right liver lobe, centrally located with adequate radiologic margins, and a 0.5-cm accessible lesion in the medial left liver lobe. (Presenter Dr. Alan Venook, see other cases by Dr. Venook)

CASE 4: A 50-year-old man previously treated for Stage III primary CRC with adjuvant FOLFOX now presents 3 years after initial diagnosis with a solitary 3-cm metastasis in the right liver lobe (segment VI). He continues to experience mild residual treatment-related peripheral neuropathy. (Presenter Dr. Alan Venook, see other cases by Dr. Venook)

CASE 5: An otherwise healthy 63-year-old man who underwent a left hemicolectomy and adjuvant FOLFOX 3 years prior for lymph node-positive adenocarcinoma of the colon now presents with a serial rise in CEA levels. CT confirms a single 4-cm lesion within segment VI of the liver, with no identifiable extrahepatic disease. (Presenter Dr. Nicholas Petrelli, see other cases by Dr. Petrelli)

CASE 6: A 70-year-old man who is a smoker with a history of Stage II cecal adenocarcinoma was treated 4 years prior with hemicolectomy (no adjuvant therapy). Surveillance CT identifies 2 lesions in the liver, a 3-cm mass in segment III of the left lobe and a 4-cm mass in segment VII of the posterior right lobe, but no evidence of extrahepatic disease. (Presenter Dr. Nicholas Petrelli, see other cases by Dr. Petrelli)

CASE 7: An obese, insulin-dependent diabetic 55-year-old man presents 2 years after resection for Stage II sigmoid cancer. During routine follow-up, CT reveals 4 lesions scattered throughout all 4 segments of the right lobe of the liver, ranging in size from 2 to 4 centimeters. Left lobe of the liver appears to be of normal size and without metastases. (Presenter Dr. Nicholas Petrelli, see other cases by Dr. Petrelli)

CASE 8: A 65-year-old woman presents 4 years after undergoing a right hemicolectomy and receiving adjuvant FOLFOX for a Stage III adenocarcinoma in the ascending colon. Routine follow-up CT reveals a 3-cm lesion in segment V of the right liver, with no visible extrahepatic disease. (Presenter Dr. Nicholas Petrelli, see other cases by Dr. Petrelli)

CASE 9: A 54-year-old man initially presents with hemorrhoids and fatigue. Colonoscopy reveals a 5-cm mass in the midrectum. A poor-quality CT scan of the abdomen and pelvis is read as normal. Patient receives neoadjuvant chemoradiation therapy and undergoes a low anterior resection of a Grade III adenocarcinoma. Seven of 8 lymph nodes are positive, but surgical evaluation suggests the abdomen is otherwise normal. A follow-up CT scan obtained 6 weeks postoperatively shows a large mass occupying a substantial part of the peripheral right lobe of the liver. Left liver is of average size and without evidence of metastases. (Presenter Dr. Steven Alberts, see other cases by Dr. Alberts)

CASE 10: A 63-year-old woman underwent a left hemicolectomy and received adjuvant FOLFOX for Stage IIIB cancer of the left colon. Twenty-six months after the original diagnosis, routine surveillance now reveals CEA elevation from a nadir of 1.4 to a current value of 12. PET/CT reveals a solitary 7-cm lesion occupying the central liver (within segments IV, V and VIII). No extrahepatic disease is detected. (Presenter Dr. Michael Choti, see other cases by Dr. Choti)

CASE 11: A 62-year-old man underwent an extended right hemicolectomy for an obstructed carcinoma in the right transverse colon, and tumor deposit was discovered intraoperatively in the omentum, which was also resected. Postoperatively, the patient received 6 cycles of FOLFOX. One year after surgery, surveillance PET/CT reveals an isolated solitary 2.5-cm metastasis in the right liver. (Presenter Dr. John Primrose, see other cases by Dr. Primrose)

CASE 12: A 65-year-old woman diagnosed with T3N2 colon cancer was treated with resection and 10 cycles of adjuvant FOLFOX and switched to 5-FU/LV alone for the final 2 cycles secondary to Grade II neuropathy. Six months after surgery, a rising CEA level was linked to the discovery by CT of new small bilobar hepatic metastases, including a 2-cm lesion within segment VI and a 3-cm lesion within segment III. PET confirmed the findings but ruled out extrahepatic disease. (Presenter Dr. Daniel Haller, see other cases by Dr. Haller)

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