Anita Sultan

Treatment of Metastatic Colorectal Cancer in a Pregnant Woman with Lynch Syndrome- A Case Report

Colorectal carcinoma is the third most common cancer diagnosed in females in the United States [1]. It accounts for 8% of the new cancers diagnosed in women and an estimated 63,700 new cases of CRC expected in 2015. CRC diagnosed in pregnancy is not common with an incidence of 1 in 13,000 pregnancies [2-4]. Management of a pregnant woman with CRC is challenging due to various unknowns to guide the antineoplastic treatment decision. CRC cases during pregnancy and use of chemotherapy agents have reported in the past decade [5-12]. Reporting of management of such situations is helpful in assisting clinicians to further investigating the use of chemotherapy agents in pregnancy. We report an unusual, but the challenging case of 24-year-old pregnant women diagnosed with metastatic colon cancer as a consequence of lunch syndrome treated with FOLFOX chemo regimen with no apparent fetal harm.

Adenocarcinoma of Rectum with Brain Metastasis

Brain metastases are very uncommon in colorectal carcinoma. Only 2-3% of patients at time of diagnosis will have CNS involvement, and only 10% will develop brain lesions during the course of the disease. Patients with rectal carcinoma have brain involvement slightly more frequently than patients with colonic carcinoma; these metastasis are usually found concurrently with lung and/or liver metastasis. Factors associated with longer survival include age less than 65, a single CNS lesion, and the absence of bone metastasis or systemic disease. Our case demonstrates CNS involvement in a patient with known stage III adenocarcinoma of the rectum who presented with syncope and was found to have a brain mass on computed tomography (CT). Surgical management offers prolonged survival in brain metastasis of colorectal cancer. But tumor recurrence following surgery has been as high as 46%. Whole-brain radiotherapy (WBRT) improves outcome and remains the standard therapy. However, delivering this treatment over two weeks period can delay other therapy and is associated with acute and long-term toxicities. Stereotactic radiosurgery is associated with tumor control rates of 73-94% and less morbidity than WBRT. Brachytherapy, intraoperative application of (125I), has high response and control rates, a shorter treatment courses, and minimal toxicity.