Case senerio
Completion requirements
A 54-year-old man presents to an oncology clinic in Ile-Ife with a 5-month history of fatigue, 8 kg weight loss, and dark stools. Physical exam reveals marked conjunctival pallor and a palpable, non-tender mass in the right iliac fossa.
- Labs: Hb 6.2 g/dL (microcytic hypochromic), Ferritin 8 ng/mL, CEA 18.5 ng/mL. LFTs and renal function are normal.
- Colonoscopy & Histology: Ulcerated mass in the cecum; invasive moderately differentiated adenocarcinoma.
- Staging CT (Chest/Abdomen/Pelvis): T3 lesion invading subserosa with 4 enlarged pericolic lymph nodes. No hepatic or pulmonary metastases. Stage: cT3 N2a M0 (Stage III).
- Surgical Outcome: Right hemicolectomy performed. Pathology confirms pT3 N2a (4/16 nodes positive), MSS/pMMR status, KRAS/NRAS wild-type.
Discussion Questions
- Surgical Staging & Quality MetricsWhat defines adequate lymphadenectomy in colon cancer resection, and how does node yield directly impact staging accuracy and adjuvant treatment decisions?
- Adjuvant Regimen Selection & LogisticsCompare 3 months of CAPOX versus 6 months of FOLFOX for this patient in terms of disease-free survival equivalence (IDEA collaboration findings), neurotoxicity risk, and cost-effectiveness in out-of-pocket settings.
- Biomarker Dynamics in Adjuvant vs. Metastatic SettingsDespite KRAS/NRAS wild-type status, why are anti-EGFR monoclonal antibodies (cetuximab/panitumumab) contraindicated in stage III adjuvant therapy? How would primary tumor sidedness alter your targeted therapy choice if he later develops synchronous liver metastases?
- dMMR/MSI-H Clinical ImplicationsIf pathology had instead demonstrated dMMR/MSI-H status, how would that alter prognosis, benefit from single-agent fluoropyrimidines, and potential response to immune checkpoint blockade across early versus advanced stages?
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