Breast cancer recurrence involving the bladder and bones

Patient Info: Anonymized, Female | Stage IV

Biomarkers: Initial breast cancer: ER-positive, PR-positive, HER2-negative. Bladder metastasis: ER-positive, PR-negative, HER2 1+.

Metastatic Site: bladder, bone, rectosigmoid region, anorectal region

She died in October 2016 from pulmonary haemorrhage, 47 months after metastatic disease was diagnosed.

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Gastric cancer diagnosed after pregnancy-related symptoms and gastric perforation

Patient Info: Anonymized, Female, Under 40 | Stage IV

CT after chemotherapy showed a good response, but her condition later deteriorated with multiple thromboses associated with metastatic disease. She died a few months after diagnosis.

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Lung cancer presenting with brain and leptomeningeal spread

Patient Info: Anonymized, Male, 70+ | Stage IV

Biomarkers: PD-L1 100%; EGFR negative; ALK rearrangement negative

Metastatic Site: brain, leptomeninges

His condition deteriorated within weeks of radiotherapy. He was readmitted with pneumonia and an acute right frontal brain haemorrhage and died within 1 week; metastatic lung adenocarcinoma was recorded as the cause of death.

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Small cell lung cancer presenting with spontaneous tumor lysis syndrome

Patient Info: Anonymized, Male | Stage IV

Metastatic Site: liver

He developed rapidly worsening encephalopathy, gastrointestinal bleeding, cyanosis and mottling and died before planned chemotherapy could be started.

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Rectal cancer first presenting as a mandibular metastasis

Patient Info: Anonymized, Male, 70+ | Stage IV

Metastatic Site: mandible, liver, L4 vertebra

He died 2 months after the metastatic rectal cancer diagnosis.

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Metastatic colon cancer in a woman later diagnosed with Lynch syndrome

Patient Info: Anonymized, Female, Under 40 | Stage IV

Biomarkers: Pathogenic germline MLH1 p. mutation; Lynch syndrome

Metastatic Site: liver

Twenty years after the metastatic colon cancer treatment, she presented with a separate small-bowel adenocarcinoma rather than recurrent colon cancer. Follow-up imaging 6 months after treatment of that later cancer showed no evidence of neoplastic disease.

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Breast cancer spreading to the colon, rectum and peritoneal surfaces

Patient Info: Anonymized, Female, 60s | Stage IV

Biomarkers: Primary tumor: ER >80% positive; PR 50–60% positive; HER2 negative; E-cadherin positive. Later colorectal metastases: ER positive; PR negative; HER2 negative; CK7 positive; CK20 negative; CDX2 negative.

Metastatic Site: colon, rectum, peritoneum, diaphragm, liver, bowel,…

Metastatic breast cancer was subsequently confirmed in the colon and rectum, with later laparoscopic biopsies showing peritoneal and additional intra-abdominal metastatic disease.

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Breast cancer recurrence presenting with numb chin syndrome

Patient Info: Anonymized, Female, 50s | Stage IV

Metastatic Site: sternum, left mandibular foramen

She was discharged ambulatory without lower-limb pain, although left mandibular numbness persisted, with monthly oncology follow-up planned.

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Stage IV EGFR Lung Cancer: Molly's Patient Story

Patient Info: Molly Golbon, Female, Under 40 | Stage IV

Biomarkers: EGFR mutation

Metastatic Site: Left hip; right shoulder; brain

Molly had a strong early response to Tarceva for Stage IV EGFR-mutated lung cancer, with about 50% tumor shrinkage after 2 months and metastatic disease described as almost undetectable; no later remission/NED status is provided in this record.

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Autoimmune hemolytic anemia after 39 cycles of nivolumab for metastatic lung cancer

Patient Info: Anonymized, Male, 70+ | Stage IV

Metastatic Site: liver, bone

While nivolumab remained on hold, his lung cancer was stable on imaging and clinically, and hemoglobin had recovered to 14.6 g/dL about 4 months after high-dose prednisone and rituximab began.

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Metastatic lung cancer causing recurrent small-bowel intussusception

Patient Info: Anonymized, Female, 50s | Stage IV

Biomarkers: EGFR mutation; exon 19 deletion in metastatic bowel lesions

Metastatic Site: small bowel

She recovered satisfactorily after bowel surgery, and care shifted to palliation with long-term nutritional support planned.

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Occult lobular breast cancer presenting as an orbital metastasis

Patient Info: Anonymized, Female, 60s | Stage IV

Biomarkers: ER positive; PR positive; HER2 negative; CK7 positive; CK CAM5.2 positive; E-cadherin negative

Metastatic Site: left orbit, bone

The orbital metastasis decreased with treatment and systemic disease remained controlled on hormonal therapy during 5 years of clinical follow-up.

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Stage IV Ovarian Cancer: Janelle's Patient Story

Patient Info: Janelle Kister, female | Stage IV

Treatment ended, and Janelle was still doing well 17 years after her Stage IV ovarian cancer diagnosis.

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Stage IV gastric cancer with peritoneal metastases responds to combined chemotherapy, surgery and HIPEC

Patient Info: Anonymized, Female, Under 40 | Stage IV

Metastatic Site: peritoneum

At last follow-up in January 2018, she was asymptomatic and examinations showed no evidence of disease.

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Stage IV signet-ring gastric cancer with peritoneal metastases treated with chemotherapy, surgery and HIPEC

Patient Info: Anonymized, Female, 50s | Stage IV

Metastatic Site: peritoneum

Developed peritoneal recurrence 3 months after postoperative chemotherapy and was receiving second-line chemotherapy at follow-up.

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Stage IV gastric adenocarcinoma progresses despite multiple chemotherapy approaches for peritoneal metastases

Patient Info: Anonymized, Male, Under 40 | Stage IV

Metastatic Site: peritoneum

The cancer progressed during second-line treatment, and he died from tumor-related complications in April 2017, about 16 months after his December 2015 admission.

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Stage IV signet-ring gastric cancer with peritoneal metastases treated with chemotherapy, gastrectomy and HIPEC

Patient Info: Anonymized, Male, 50s | Stage IV

Metastatic Site: peritoneum

At follow-up, he had no signs of recurrence.

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Stage IV ovarian cancer presenting as a persistent umbilical ulcer

Patient Info: Anonymized, Female, 40s | Stage IV

Metastatic Site: bilateral cardiophrenic lymph nodes

She recovered from extensive cytoreductive surgery without major abdominal or pulmonary complications and began adjuvant paclitaxel and carboplatin on postoperative day 25.

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Stage IV Breast Cancer With Long-Term Tumor Regression After Radiation Therapy

Patient Info: Anonymized, female, 60s | Stage IV

Biomarkers: HER2 positive

Metastatic Site: 8th thoracic vertebra

Follow-up showed near-complete regression of the breast tumor, resolution of the bone lesion, normal tumor markers, and a 2015 biopsy with no tumor cells. Follow-up showed no further recurrence, and she returned to work with good quality of life.

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Metastatic Breast Cancer With Brain, Bone, Lung and Liver Disease Responding During Eribulin Treatment

Patient Info: Anonymized, female, 40s | Stage IV

Biomarkers: Initial tumor: ER 90%, HER2 negative, Ki67 10%. Lung metastasis: ER 90%

Metastatic Site: lung, bone, brain, liver

Eribulin remained ongoing with reduced brain lesions, stable bone disease and continued shrinkage of liver metastases after prior systemic progression.

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Stage IV Ovarian Cancer With 20 Years of Tumor-Free Survival

Patient Info: Anonymized, female, 50s | Stage IV

Biomarkers: BRCA1 negative, BRCA2 negative

Metastatic Site: peritoneum, liver, right adrenal gland

Regular follow-up found no recurrence or other tumor, and at 20 years of follow-up she remained tumor-free with good health and quality of life.

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Metastatic Breast Cancer With Liver Progression Treated Through Multiple Chemotherapy Lines

Patient Info: Anonymized, female, 40s | Stage IV

Biomarkers: Initial tumor: ER 90%, HER2 3+, Ki67 15%. Liver metastasis: ER 30%

Metastatic Site: pleura, liver

After several periods of response and later liver progression, she remained on active treatment with pegylated liposomal doxorubicin.

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Metastatic Lobular Breast Cancer With Long-Term Disease Control Across Multiple Therapies

Patient Info: Anonymized, female, 40s | Stage IV

Biomarkers: Initial tumor: ER negative, HER2 negative, Ki67 17%. 2006 recurrence: ER 40%

Metastatic Site: pleura, liver, skin, bone

She was alive on ongoing metronomic vinorelbine with substantial disease stabilization at the most recent follow-up.

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Metastatic Breast Cancer With Bone and Liver Progression After Multiple Therapies

Patient Info: Anonymized, female, Under 40 | Stage IV

Biomarkers: Initial tumor: ER 80%, HER2 negative, Ki67 18%. Liver metastasis: ER 75%

Metastatic Site: bone, liver

After massive hepatic progression and liver failure, chemotherapy was stopped and she died on January 31, 2016.

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