petincolorectalcancer-nebraskaadvancedradiology.pptVIP

PET in Colorectal CancerEarly detection of diseasePrecise Staging of Disease ProgressionAccurate Assessment of Therapy Colorectal Cancer Over 150,000 new colorectal cancers/yr, the second most common killer after lung cancer. A Malignant transformation of a polyp TNM staging is used to plan and assess therapy Complete surgical resection is generally required for a cure Resection of limited metastatic disease yields improved survival, unlike many cancers Colorectal Cancer Indications Diagnosis Staging Restaging Diagnosing Colorectal Cancer History 54 YOF Right Upper Quadrant abdominal pain CT reveals hepatic metastases without known primary PET Findings 3 Hyper-metabolic foci in the liver and 1 in the Left Upper Quadrant Outcome Splenic flexure colon cancer and 3 liver mets resected PET in Colorectal Cancer Diagnosis Staging Restaging Staging Colorectal Cancer History 63 YOM Large rectal cancer via pre-op evaluation CT suggest invaded lymph nodes near the primary PET Findings Rectal, multiple pelvic, right inguinal, and liver abnormalities Outcome Aggressive chemotherapy followed by pelvic XRT Followed by successful AP rectal and liver resection Pre-operative Staging of Primary Colorectal Carcinoma Study of 48 colorectal cancer patients Pre-op PET results compared to results at surgery and follow up PET CT Liver Mets Detected 88% 38% 4 liver mets were detected by PET, but ignored at time of initial surgery. Presence of mets was confirmed 3 months after surgery Abdel-Nabi Radiology 1998; 206:755. PET in Colorectal Cancer Diagnosis Staging Restaging Detecting recurrence Staging recurrence Assessing therapy Detecting Recurrence History 60 YOM Colon cancer 2 years ago Rising CEA Negative CT findings PET Findings Retroperitoneal abnormality Outcome Nodal metastasis resected to confirm PET findings Adjuvant chemotherapy Staging Recurrence History 56 YOF Rectal cancer 14 months ago Persistently elevated CEA never really dropped PET Fi