Colon Cancer with Lymph Node & Liver Metastases
3D maximum intensity projection (MIP) whole body diffusion weighted magnetic resonance imaging (DWI) image cropped to the torso.
Red Circle: Primary colon cancer mass.
Blue Circle: Suspected lymph node metastases.
Green Circle: Hepatic metastases.
Case overview
Unlike colonoscopy, which focuses solely on detecting cancer within the colon, whole body MRI (WB-MRI) can identify asymptomatic colon cancer and simultaneously detect distant metastases. This allows for more effective triaging of the next critical steps in clinical management, potentially improving the prognosis before the disease progresses further.
Patient History
A 72-year-old male opted for a WB-MRI screening as part of a renewed commitment to his health before embarking on a six-month work trip abroad. He had no previous participation in standard preventative healthcare or screenings.
Findings
- His scan showed multiple liver metastases from an adenocarcinoma of the colon (primary/original cancer site) with regional spread to the lymph nodes that drain towards the liver. (Figure 2, 3, & 4).
- No disease was detected beyond the liver, a finding associated with improved prognosis and available treatment potential in metastatic colorectal cancer.
Axial DWI image at the mid abdomen. Green circle: Colon diffusion restricting hypercellular mass. Red circle: Adjacent focal abnormal diffusion restricting lymph nodes, suspicious for metastases.
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Axial T2 image at the mid abdomen. Green circle: Primary colon cancer mass.
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Axial T2 image at the upper abdomen. Green circles show multiple hepatic soft tissue masses compatible with metastases.
Follow-up care
The patient was recommended an expedited oncology consultation for further evaluation and management of their disease. This consultation provided an opportunity for improved survival through life-prolonging strategies, including surgical resection.
How the Prenuvo scan impacted patient care:
- Colorectal cancer (CRC) is the third most common cancer worldwide; approximately 25-50% of these patients develop cancer in the liver.1 Screening colonoscopy is the gold-standard for earliest possible colon cancer detection, as well as prevention by removal of precancerous polyps. In this case, for a patient who had previously not adhered to standard preventive health screening recommendations, WB-MRI played a pivotal role in this patient's care by uncovering potentially treatable colorectal cancer with liver metastases, at advanced stage but one still potentially amenable to life-prolonging treatment options.
- Early detection beyond symptoms: Unlike colonoscopy, which focuses solely on detecting cancer within the colon, the opportunistic detection of the still asymptomatic colon cancer by the WB-MRI enabled simultaneous identification of distant metastases and triaging of the next most important steps in clinical management towards a potentially improved prognosis prior to further progression of disease.
- Prognostic clarity: By identifying metastatic disease confined to the liver and regional lymph nodes, the scan provided critical prognostic information, emphasizing the potential for successful intervention with specialized advanced care.
- Improved treatment timeline: Pre-symptomatic identification facilitated timely transition to oncologic care, enabling discussions around cutting-edge treatment options.
References
- Martin J, Petrillo A, Smyth EC, et al. Colorectal liver metastases: current management and future perspectives. World J Clin Oncol. 2020;11(10):761-808. doi:10.5306/wjco.v11.i10.761.
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