Colon carcinoma metastases with extension to chest wall and pericardium

Management of locally advanced colon cancer metastases is challenging and operation carries an increased risk of morbidity and mortality. The knowledge of exact sites of involvement can aid the surgeon to make a decision regarding complete resection or palliative therapy. PET/CT scan is an advantage in this setting because metabolic alterations often precede the anatomic changes; moreover, it can show unexpected metastases. In addition, PET/CT scan can differentiate adhesions and scar from local invasion of tumor.  We report a rare case of locally advanced colon cancer metastases to mesentery with extension to liver, chest wall and mediastinum depicted on PET/CT scan. The patient was treated with resection of the involved sites. The pathology report confirmed a poorly differentiated adenocarcinoma mainly involving the mesentery with extension to surrounding organs including the liver. Unfortunately, the patient’s condition deteriorated following surgical intervention. Although there is a trend toward complete resection of primary tumor and involved sites in patients with metastatic colon carcinoma to improve overall patient survival by eliminating any residual disease, in more advanced stages of the disease, palliative therapy might be the preferred approach. PET/CT has invaluable complimentary role to improve surgical planning in advanced oncological situations.