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ESMO Preceptorship Programme
Locally advanced BRAF mutant positive
colon cancer
Dr.S.R.Muthuramalingam
Consultant Medical Oncologist
Portsmouth Oncology Centre
Queen Alexandra Hospital
United Kingdom
Locally advanced– Right side – 25/11/16
ESMO PRECEPTORSHIP PROGRAM
Case Presentation
� 38-yr old lady with with two young children aged 11 and 8
� Past medical history: Low BP, Transient collapse due to atrial flutter, low platelet counts during pregnancies
� Admitted in the hospital with fever and diarrhoeafollowing holiday in the Dominican Republic
� Readmission after a few months with fever, diarrhoea, backache and lump in the right abdomen
� Two stones of weight loss
� Clinically palpable lump in the right abdomen
ESMO PRECEPTORSHIP PROGRAM
Investigations
� CT scan: 6x5 cm mass in the hepatic flexure invading retroperitoneal space and extending to third part of duodenum with a 15 mm defect in the anterior wall of duodenum; enlarged local regional nodes.
� PET scan: SUV 15.4 hepatic flexure tumourextending to the duodenum with no distant metastases
� Colonoscopy and biopsy: Adenocarcinoma RAS wild type; BRAF (V600) and TP53 mutation positive
ESMO PRECEPTORSHIP PROGRAM
Treatment
� Discussed in the colorectal and hepatobiliary MDTs
� FOLFOX plus panitumumab – 6 cycles
� Post treatment CT: Significant reduction in the size of the hepatic flexure tumour from 53 to 28 mm but still remained adherent to the duodenum
� MRI of abdomen: No pancreatic involvement but distal part of the duodenum involved with the tumour
� Right hemicolectomy with enbloc wedge resection of duodenum
� Histology: T4 N1 Adenocarcinoma with 1 out 3 nodes positive
� 6 cycles of adjuvant FOLFOX chemotherapy
ESMO PRECEPTORSHIP PROGRAM
Post treatment
� Post treatment CT: No evidence of recurrence
� She has been referred to the regional genetic department
� She will be followed up in the colorectal follow-up programme
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