67 year old male with stage IIIA colon cancer, status post left hemicolectomy,
low anterior resection and 6 months of adjuvant chemotherapy presented with
rising CEA, an increase from 2.38 to 3.27 ng/ml. PET-CT showed a 8 mm non-
FDG avid right lower lobe lung nodule without any definite evidence of
recurrent or metastatic disease. The patient was otherwise asymptomatic and a
non-smoker.
low anterior resection and 6 months of adjuvant chemotherapy presented with
rising CEA, an increase from 2.38 to 3.27 ng/ml. PET-CT showed a 8 mm non-
FDG avid right lower lobe lung nodule without any definite evidence of
recurrent or metastatic disease. The patient was otherwise asymptomatic and a
non-smoker.
PET-CT case of the month (05/10): Recurrent Colon Cancer
PET-CT has been shown to be better than CT for the evaluation of recurrent
or distant metastatic disease, especially after recent surgical procedures that
distort local anatomy (1). Although colorectal cancer metastasizes to the liver
more commonly, isolated pulmonary metastasis can also occur. Aggressive
resection of pulmonary metastasis can prolong survival in these patients (2).
1. Flamen P; Hoekstra OSl Homans F. Unexplained rising carcinoembryonic
antigen (ECEA) in the postoperative surveillance of colorectal cancer; the
utility of positron emission tomography (PET). Eur J Cancer 2001 May;
37(7):862-9.
2. Lee WS, Yun SH, Chun HK. Pulmonary resection for metastases from
colorectal cancer: prognostic factors and survival. Int J Colorectal Dis. 2007
Jun;22(6):699-704.
This case was compiled by Dr. Saiyyeda Rahman, BCM
or distant metastatic disease, especially after recent surgical procedures that
distort local anatomy (1). Although colorectal cancer metastasizes to the liver
more commonly, isolated pulmonary metastasis can also occur. Aggressive
resection of pulmonary metastasis can prolong survival in these patients (2).
1. Flamen P; Hoekstra OSl Homans F. Unexplained rising carcinoembryonic
antigen (ECEA) in the postoperative surveillance of colorectal cancer; the
utility of positron emission tomography (PET). Eur J Cancer 2001 May;
37(7):862-9.
2. Lee WS, Yun SH, Chun HK. Pulmonary resection for metastases from
colorectal cancer: prognostic factors and survival. Int J Colorectal Dis. 2007
Jun;22(6):699-704.
This case was compiled by Dr. Saiyyeda Rahman, BCM
In the next 8-9 months the nodule slowly increased in size on follow up CT
scans and the CEA increased to 7.89 ng/ml. Repeat PET-CT showed focal
hypermetabolism in the right lower lung nodule with a maximum SUV of 4.0,
now measuring 1.6 x 1.0 cm. No other evidence of FDG avid neoplastic
disease was seen. FNA of the right lower lobe lung nodule showed poorly
differentiated adenocarcinoma from colon primary. Focal uptake (inflammatory)
is also seen in the cervical spine facet joint arthritis (on the left).
scans and the CEA increased to 7.89 ng/ml. Repeat PET-CT showed focal
hypermetabolism in the right lower lung nodule with a maximum SUV of 4.0,
now measuring 1.6 x 1.0 cm. No other evidence of FDG avid neoplastic
disease was seen. FNA of the right lower lobe lung nodule showed poorly
differentiated adenocarcinoma from colon primary. Focal uptake (inflammatory)
is also seen in the cervical spine facet joint arthritis (on the left).
