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>> This was a lady from China
who had been diagnosed with presumed lung cancer in China,
and she was being treated as such.
She had received two courses of chemotherapy
at a hospital in Beijing for the treatment
of metastatic lung cancer.
She decided to seek an opinion here at Johns Hopkins,
and that's why we reviewed her along with colleagues,
and in reviewing the case,
there were a couple of things that stood out.
Her scans were not entirely consistent with lung cancer.
She had lymph nodes in the abdomen,
which we usually don't see with lung cancer,
and also, some of the findings,
when the sample of tumor was examined,
were more suggestive of another primary site,
perhaps in the colon.
So we then explored things further
and arranged a PET scan here in the United States,
and that PET scan suggested she did, indeed,
have lymph nodes in the abdomen and a mass
in the colon and the bowel.
So putting everything together
at that point strongly raised the question
was this really a colon cancer as opposed to a lung cancer.
>> The thoracic oncology group contacted me,
and we reviewed her images with our GI tumor board,
our gastrointestinal cancer tumor board,
and in a large collaborative group involving
medical oncology, radiation oncology, and GI surgery,
we all sort of agreed that the pattern didn't make sense
for primary lung cancer that had spread to the abdomen.
I saw the patient urgently the next several days later,
and we got her set up for a laparoscopy, which is about...
Every institution has their own protocols,
but here, it takes about half hour to about an hour
in the operating room under general anesthesia,
and using just three small incisions,
about five millimeters each,
we were able to put the camera in
and easily find this periaortic node.
We were able to excise it in full
and brought it to pathology,
where on frozen section analysis they felt it was consistent
with colon cancer
but needed more time with amino stains to be sure.
The patient recovered,
went back to her hotel uneventfully the same day,
and then we brought her back to clinic the next week,
when we had the amino stains that confirmed
that this was metastatic colon cancer.
We discussed her case in tumor board,
set her up to see a GI oncologist here, Dr. Katie Bever,
and Dr. Bever saw her shortly thereafter with a colonoscopy
by one of our GI doctors, and there,
we diagnosed metastatic colon cancer.
>> Unfortunately, this additional workup confirmed
that she had metastatic colorectal cancer,
which we manage primarily with chemotherapy.
So I recommended that she get chemotherapy,
which is our standard first line for metastatic disease,
and additionally, a biologic agent could be added
based on her molecular testing
that she had had done previously.
>> Multidisciplinary care, particularly for locally advanced
or metastatic cancers is critical for making sure
that we have the right diagnosis
and that we've sought all avenues of treatment,
whether it's chemotherapy, radiation, surgery,
or other therapies.
It's vital to have all stakeholders at the table
to discuss this in a thorough fashion.
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