Case report
A 54-year-old man was admitted to the Affiliated Hospital of Guangxi Medical University in August 2018, presenting with a 2-month history of hypodynamics accompanied by poor appetite and weight loss (15 kg). The patient had no significant medical history and no family history of cancer, and he was a non-smoker. A physical examination revealed no deep tenderness at the left lower quadrant of the abdomen and no rebound tenderness on palpation. Laboratory data revealed glandular tumor markers: (CEA) 7.3 ng/ml; (AFP) 1.74 ng/ml; (CA125) 12.3 U/ml; (CA15-3) 15.1 U/ml; and (CA19-9) 180.7 U/ml. Histopathology revealed hepatic curve ascending colon (5 points), tubular-villous adenoma, partial regional carcinogenesis, and highly differentiated intramucosal adenocarcinoma. Computed tomography (CT) of the abdomen revealed the possibility of colorectal cancer invading the liver, gall bladder, and pancreas/duodenum (Figure1). Colonoscopy identified a tumor located in the hepatic flexure of the colon (Figure 2). The diagnosis of colon cancer was confirmed by histopathological examination.
The patient underwent four rounds of chemotherapy, subsequent to 4 months of follow up examinations by CT and colonoscopy. The tumor exhibited stabilized disease (SD). However, an abdominal X-ray revealed an incomplete ileus (Figure 3).
Laboratory tests revealed the following blood and routine liver and kidney function data: (WBC) 3.02×109/L;* (RBC) 3.41×1012/L;* (HGB) 80 g/L; (HCT) 25.5%;* (MCV) 74.6 fL;* (MCH) 23.5 pg;* (MCHC) 315 g/L; (IBIL) 4.3 µmol/L; (TRF) 1.5 g/L;* (TP) 51 g/L;* (ALB) 29.9 g/L;* (GLO) 21.1 g/L; and (RBP) 15.3 mg/L. The following glandular tumor markers were detected: (CEA) 7.77 ng/ml; (AFP) 2.33 ng/ml; (CA125) 32.5 U/ml; (CA15-3) 15.2 U/ml; (CA19-9) 357.3 U/ml; and (PA): 108.9 mg/L. Preoperative examination showed that the patient had poor nutritional status and an intestinal obstruction. Preoperative supplementation with human serum albumin and parenteral nutrition improved the nutritional status of the patient, and he eventually underwent surgery.