A patient with primary metastatic rectal carcinoma with metastases in the liver

a case study

Abstract

Colorectal cancer (CC) is the most common cancer in Slovenia. According to the Cancer Registry of the Republic of Slovenia, a total of 1,450 people were diagnosed with colorectal cancer in Slovenia in 2008(1). The increasing incidence also means increasing morbidity, as in half of the patients, the disease is diagnosed when already at an advanced stage. Metastatic disease is incurable, but the prognosis and the survival of these patients have improved considerably, as in the last decade, with the use of new drugs, namely a combination of cytostatics (capecitabine, irinotecan, oxaliplatin) and target drugs (cetuximab, bevacizumab, panitumumab) we have achieved a median survival of more than 30 months(2). When combining systemic and surgical treatment in patients with liver metastases, in particular if these are solitary metastases, the 5-year survival can exceed 50%.
In this paper, we present a case of a patient with primary metastatic rectal carcinoma with metastases in the liver. Within the framework of a multidisciplinary approach with a combination of systemic therapy and multiple surgeries of liver metastases, and using also other therapeutic approaches, we have achieved a survival of more than 50 months.

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Povzetek

Rak debelega črevesa in danke (RDČD) je najpogostejši rak v Sloveniji. Po podatkih Registra raka Slovenije za leto 2008 je v Sloveniji zbolelo 1.450 ljudi(1). Z naraščajočo incidenco narašča tudi umrljivost bolnikov, saj bolezen pri polovici bolnikov še vedno ugotovimo v napredovali obliki. Razsejana bolezen je neozdravljiva bolezen, sta se pa prognoza in preživetje teh bolnikov močno izboljšala, saj zadnjih deset let z uporabo novih zdravil, to je kombinacijo citostatikov (kapecitabin, irinotekan, oksaliplatin) in tarčnih zdravil (cetuksimab, bevacizumab, panitumumab), dosegamo srednja preživetja, ki so daljša od 30 mesecev(2). Kadar kombiniramo sistemsko in kirurško zdravljenje pri bolnikih s samo jetrnimi zasevki, še posebej, če gre za solitarne zasevke, pa 5-letno preživetje lahko presega 50 %. V tem prispevku opisujemo primer bolnice s primarno razsejanim karcinomom danke z zasevki v jetrih, kjer smo v okviru multidisciplinarnega pristopa, s kombinacijo sistemske terapije in večkratne operacije jetrnih zasevkov ter tudi drugimi terapevtskimi pristopi dosegli preživetje, daljše od 50 mesecev.