PET in Colorectal Cancer Early detection of disease Precise Staging of Disease Progression Accurate 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
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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 mets primary
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 Large solitary met
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 Findings • Single liver abnormality Outcome • Liver met resection • No recurrence
Staging Recurrence History • 38 YOF • Sigmoid colon cancer 6 months ago • Persistent CEA elevation • Pre-op work-up was negative PET Findings • Single pulmonary, multiple liver and pericaval abnormalities Outcome • Biopsy of lung nodule confirmed mets • Chemotherapy Nodal met near the primary location
Detecting Recurrence in Patients with Increasing CEA Levels • Prospective study of 28 colorectal cancer patients • PET was compared to 2nd look surgery results • PET predicted correctly PET • Un-resectable Disease 90% • Resectable Disease 81% Libutti SK Ann Surg Onc 2001;8:779
Why PET? • Recurrent and metastatic colorectal cancer is common (35% within 2 years) • Early detection of localized disease is possible with PET , when the disease is still resectable • PET helps avoid surgery in patients with multi-focal and extra-hepatic metastases
PET in Colorectal Cancer • PET accurately detects local, hepatic and extra-hepatic disease • PET is superior to all imaging modalities in the restaging of colorectal cancer • Difficult patient management problems can be solved with the unique information PET provides