How Multidisciplinary Care Helped a 51-Year-Old Patient Conquer Stage IV Disease

In October 2015, a 51-year-old woman sought medical attention at Zhujiang Hospital for bowel habit changes lasting over six months. Investigations revealed a 3×3 cm rectal mass located 7 cm from the anus. Colonoscopy confirmed a cauliflower-like tumor at the rectosigmoid junction, with elevated CEA (85.2 μg/L) and CA199 (82.1 kU/L). Postoperative pathology identified a moderately differentiated adenocarcinoma that had infiltrated the entire intestinal wall, invaded vasculature and nerves, and spread to the right ovary and mesenteric lymph nodes. Genetic testing detected a KRAS G12D mutation, and the final staging was pT4bN2aM1b (stage IV).

Initially, laparoscopic radical surgery and right ovariectomy were performed, followed by six cycles of XELOX (oxaliplatin and capecitabine). However, 22 months later, imaging revealed metastases near the left iliac vessels. A second laparoscopic exploration removed the left ovary and the metastatic mass, and six cycles of FOLFIRI (irinotecan, 5-FU, calcium folinic acid) ensued. In 2019, additional recurrences required local radiotherapy, second-line chemotherapy (FOLFIRI plus bevacizumab), and ultimately a third laparoscopic surgery in March 2021, which included partial rectal resection and sigmoid colostomy.

When imaging in mid-2021 showed progression at the rectal stump, radiofrequency ablation and particle implantation were conducted, and regorafenib was started as third-line therapy. By July 2022, persistent tumor growth led to the decision for pelvic exenteration, a major procedure removing the rectum, anus, bladder, vagina, and part of the sacrum. Because of the extensive surgical wound, a free myocutaneous flap graft and debridement were performed in September 2022.

Remarkably, more than seven years after her initial diagnosis, this patient’s tumor markers remain within normal limits. She lives independently with a fistula bag but experiences little restriction in her daily activities. Follow-up assessment using the FACT-C questionnaire indicates a satisfactory quality of life and a hopeful outlook.