Metastatic Colon Cancer With Tumor Thrombus Extending Into the Right Atrium

What happened, in summary

A 46-year-old woman presented after 3 months of abdominal bloating, fatigue, nausea, vomiting, loss of appetite and about 10 pounds of weight loss. Imaging showed multiple liver lesions and a mass near the hepatic flexure of the colon. Biopsy of a liver lesion confirmed well-differentiated adenocarcinoma of colonic origin. Testing showed BRAF, KRAS and NRAS wild-type disease. Because the liver metastases were too extensive for complete surgical removal, she received palliative systemic treatment for about 18 months. She completed 12 cycles of FOLFOX with an excellent initial response, then 10 cycles of 5-FU alone after oxaliplatin caused neuropathy. When the cancer progressed, she received 12 cycles of FOLFIRI, with an early response followed by stable disease. She later developed a cerebellar metastasis that was surgically removed. Subsequent imaging found a mass extending from the inferior vena cava into the right atrium, later shown to contain colorectal tumor thrombus. Surgery for the thrombus was considered too risky, and she declined an interventional extraction procedure. Further FOLFOX and then panitumumab did not control the cancer. As her condition worsened, she and her medical team chose supportive care at home. She later died from multiorgan failure in the setting of widespread metastatic cancer.