Introduction:
This is a case study of a 36-year-old male who was diagnosed with Stage 4 Metastatic Colo-Rectal Cancer amid the Delta wave of Covid in June 2021. He was in significant pain and faced difficulty sitting, with nausea, vomiting, loss of appetite, and weight loss of 10 kg. He had a large mass at the Colo Rectal junction with metastases to the surrounding lymph nodes and the liver.
History:
The patient had developed lower abdominal pain four months prior, accompanied by occasional episodes of constipation, which had increased in intensity over the next three months. He had nausea, vomiting, and loss of appetite, and had lost 10 kg in the previous three months.
Investigations:
A CT scan and colonoscopy confirmed the diagnosis of an Adenocarcinoma of the Colo-Rectal area and a PET-CT scan revealed stage 4 metastatic disease. Biopsy samples were sent for molecular profiling and MMR & MSI/MSS testing to ascertain if any mutations could be targeted.
Concerns:
The patient had an incurable cancer where surgery was not a viable option and was anxious about his life-span. His immediate concern was the distressing pain he was experiencing and whether he would get any relief from it.
Treatment Offered:
The patient was admitted to the hospital, started on intravenous pain killers, and commenced chemotherapy with Modified FOLFOX 7 regimen. He obtained excellent disease control, as seen on scans performed following 3 months of treatment, and again at 6 months of treatment. The molecular profiling showed a mismatch repair deficiency with MSI-H status. The patient was diagnosed as suffering from a hereditary colon cancer syndrome- the Lynch Syndrome. Therefore, the Immunotherapy drug Pembrolizumab was added to the chemotherapy regimen. The patient tolerated the treatment well with no significant toxicities or side effects.
Long Term Care:
The patient will continue maintenance over the next 2 years with the immunotherapy every 21 days as a maintenance protocol. He understands that his cancer can relapse at any point and he will require another round of chemotherapy then. There are multiple targeted therapies and chemotherapy options available if he loses response to the immunotherapy. He currently enjoys an excellent quality of life with no pain and does not require any supportive care.
