Imaging Metastatic Rectal Cancer Jack Temple, MS3 June 2013 Christian Malalis, MD.

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Presentation transcript:

Imaging Metastatic Rectal Cancer Jack Temple, MS3 June 2013 Christian Malalis, MD

JS is a 77 year old man with a history of sigmoid colon cancer (s/p sigmoid resection w/o adjuvant therapy in 2009) Surveillance colonoscopy at OSH on 4/17/13 revealed large rectal mass  referred to Rush GI and Colorectal surgery Rush GI performed: – Flexible Sigmoidoscopy (5/22/13) – Transrectal Ultrasound (5/22/13) Rush Radiology consulted for: – Staging purposes Clinical History / Physical Exam

Rush Endoscopy Images Flexible Sigmoidoscopy Images, Courtesy of David Shapiro, MD; 5/22/13

Transrectal Ultrasound Transrectal Ultrasound Images, Courtesy of David Shapiro, MD; 5/22/13

Colorectal Cancer Staging Image Source:

Rectal Cancer Metastasis Image Source:

For pre-treatment staging of colorectal cancer (large lesion): ACR Appropriateness Criteria ProcedureRatingRRL CT chest, abdomen, pelvis with contrast 8 FDG-PET/CT whole body 8 X-Ray chest 8 MRI pelvis with and without contrast 80 MRI abdomen with and without contrast 70 Source: ACR appropriateness criteria

Pelvis (normal) Axial CT (No MRN) Source: e-Anatomy (

Pelvis (our patient) Axial CT from PET/CT MRN

Pelvis (our patient) Axial Fused PET/CT MRN

Pelvis (normal) Axial CT (No MRN) Source: e-Anatomy (

Pelvis (our patient) Axial CT From PET/CT MRN

Pelvis (our patient) Axial Fused PET/CT MRN

Abdomen (normal) Axial CT (No MRN) Source: e-Anatomy (

Abdomen (our patient) Axial CT from PET/CT MRN

Abdomen (our patient) Axial Fused PET/CT MRN

Abdomen (our patient) Diagnostic CT post contrast MRN Axial Coronal

Treatment: – Most cases, treatment is palliative 3 Prolong survival and maintain quality of life – Chemo options Old: 5-Fluorouracil New: Irinotecan, Oxaliplatin Monoclonal Abs: Cetuximab, Panitumumab, Aflibercept 4 – Surgical resection Follow up imaging: – Surveillance imaging Treatment and Follow Up Imaging

Images: (e-Anatomy) References: 1.Bipat S, Glas AS, et al. Rectal Cancer: Local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 2004 Sep; 232(3): American College of Radiology Appropriateness Criteria: Pretreatment Staging of Colorectal Cancer, Weeks JC, Catalano PJ, et. al. Patients’ expectations about effects of chemotherapy for advanced cancer. New England Journal of Medicine 2012; 367: Clark JW, Grothey A. Systemic chemotherapy for nonoperable metastatic colorectal cancer: treatment recommendations. UpToDate Flamen P, Hoekstra OS, et al. Unexplained rising carcinoembryonic antigen (CEA) in the postoperative surveillance of colorectal cancer: the utility of positron emission tomography (PET). European Journal of Cancer 2001; 37(7): 862. References

Christian Malalis, MD, PGY IV Rush Endoscopy David Shapiro, MD Thanks!

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