[A case of recurrent colon cancer with improvement in prognosis and cancer pain after surgical intervention].
We report a case of recurrent colon cancer with improvement in prognosis and cancer pain after surgical intervention. A 47-year-old man underwent an emergency Hartmann procedure for colon obstruction from descending colon cancer. Histopathological findings confirmed adenocarcinoma (moderate to poor), pT4apN0cM0, pStage II, and Cur A. In October 2009, abdominal computed tomography examination detected a solitary intraperitoneal recurrent lesion. Multi-agent chemotherapy ( mFOLFOX6)was administered. A fentanyl patch was also placed for relieving cancer pain, but was removed 4 months later because the pain disappeared. From June 2010, multi-agent chemotherapy with FOLFIRI was replaced with bevacizumab because of the increase in recurrent lesion size. In August 2011, the recurrent lesion involving the abdominal wall, left side of the colon, iliopsoas muscle, and left side of the ureter was resected and the left ureter was reconstructed. No fentanyl patch was prescribed at this time. In October 2012, tumor relapse was detected along with lung metastasis, and multi-agent chemotherapy ( FOLFIRI+bevacizumab) was resumed. In January 2013, the cancer pain recurred, and a fentanyl patch was placed again. Since then, the fentanyl dosage has been gradually increased. In August 2013, the tumor in the abdominal wall was resected to manage the patients' pain in the left lower side of the abdomen. Histopathology revealed a tumor in the lymph nodes. In November 2013, multi-agent chemotherapy with FOLFIRI+cetuximab was initiated, but was ineffective. In January 2014, regorafenib was prescribed. The patient has survived for more than 6 years after the primary surgery. We conclude that a therapeutic strategy that combines surgical interventions and multi-agent chemotherapy needs to be considered for improving prognosis and cancer pain in recurrent colon cancer.
Dept. of Surgery, Fujisaki Hospital.
Shigeru
S
Fujisaki
Motoi
M
Takashina
Ryouichi
R
Tomita
Kenichi
K
Sakurai
Tadatoshi
T
Takayama
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D011379:Prognosis; D012008:Recurrence
D005283:Fentanyl