Practice Rational imaging

Minimally invasive treatment for liver and lung metastases in colorectal cancer

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39184.565532.80 (Published 17 May 2007) Cite this as: BMJ 2007;334:1056
  1. Alice Gillams, senior lecturer, honorary consultant
  1. The Royal Free and UCL Medical School and UCLH, London WCIE 6BT
  1. Correspondence to: A Gillams, Special Xray, UCH, London NW1 2BU a.gillams{at}medphys.ucl.ac.uk

    The patient

    A 59 year old woman had an anterior resection for primary Dukes's C rectal carcinoma in 2004 followed by adjuvant chemotherapy. Two years later, on routine computed tomography surveillance, she was found to have liver (fig 1) and lung (fig 2) metastases.

    Fig 1 Axial computed tomography of the liver showing two irregular hypoattenuating mass lesions, 4.0 cm and 4.3 cm in diameter (arrows). This is the typical appearance of colorectal liver metastases

    Fig 2 Axial computed tomography section through the lung showing a 3.8 cm tumour in the right upper lobe (arrow)

    Imaging for surveillance after resection of primary colorectal cancer

    Surveillance is indicated in patients with Dukes's B or Dukes's C colorectal carcinoma who are potential candidates for further therapeutic intervention. The optimal surveillance strategy is a matter of debate.1 2 3 An ongoing trial (FACS) is looking at the cost effectiveness of intensive follow-up or no follow-up in patients with successfully resected colorectal cancer (www.facs.soton.ac.uk/). Currently, most centres opt for computed tomography scans at six or 12 monthly intervals for the first two or three years, combined with regular measurements of serum carcinoembryonic antigen.

    Because the liver metastases were centrally located in our patient, surgery would have involved removal of three quarters of the liver, followed by pulmonary lobectomy for the lung metastasis. Liver resection and pulmonary resection are associated with a small increase in mortality—less than 5% for …

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