Portal vein thrombosis after cetuximab and 5-fluorouracil therapy in a patient with advanced colon cancer and decompensated cirrhosis - a case report and review of the literature

Sep 24, 2026

Treatment options for advanced colon cancer rely on chemotherapy and targeted drugs, yet poor physical condition and medication intolerance often restrict choices. Patients with colon cancer complicated by decompensated cirrhosis represent a high-challenge subgroup. A case describes a decompensated cirrhosis patient with advanced colon cancer presenting with Sister Mary Joseph’s nodule, later confirmed by biopsy and PET-CT. Cetuximab plus 5-fluorouracil at a below-guideline dose led to portal vein thrombosis and death within three months, highlighting treatment uncertainty and worse prognosis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Background

Case presentation

Conclusion

Background

Epidemiology and treatment stratification

Viral hepatitis, cirrhosis, and tumor-associated challenges

Case presentation

Patient history and diagnosis

Treatment course and outcome

Liu et al. World Journal of Surgical Oncology (2023) 21:302 [https://doi.org/10.1186/s12957-023-03175-7](https://doi.org/10.1186/s12957-023-03175-7) World Journal of Surgical Oncology CASE REPORT Open Access Portal vein thrombosis after cetuximab and 5-fluorouracil therapy in a patient with advanced colon cancer and decompensated cirrhosis: a case report and review of the literature Fangyu Liu1, Yongmei Xu1, Guowang Yang1, Yuhong Guo1* and Jiayun Nian 1* Abstract Background Treatment options for advanced colon cancer are mainly combinations of chemotherapy and targeted drugs. However, poor physical health and medication intolerance limit the choice of anticancer drugs. Colon cancer with cirrhosis is a particular patient group that poses a challenge to clinical treatment. Case presentation This article presents a case of a patient in the decompensated stage of cirrhosis who was diagnosed with advanced colon cancer. The initial presentation was a nodule on his navel named the Sister Mary Joseph’s nodule, which was later confirmed by biopsy and PET-CT as one of the metastases of colon cancer. The patient was treated with cetuximab and 5-fluorouracil at a below-guideline dose; however, portal vein thrombosis developed and led to death. This entire process, from diagnosis to death, occurred within a span of three months. Conclusion Cancers with cirrhosis are a special group that deserves more attention. There is no unified treatment guideline for these patients, especially those with extrahepatic primary tumors. We should be more cautious when choosing treatment for such patients in the future. Both chemotherapy and targeted treatment may potentially induce portal vein thrombosis, which appears to have a higher incidence and worse prognosis than cancers without cirrhosis. Keywords Advanced colon cancer, Decompensated cirrhosis, Cetuximab, 5-fluorouracil, Portal vein thrombosis Background Colon cancer is the fifth most common cancer in the world [1]. Due to the lack of specific clinical manifestations and screening tools, many cases of colon cancer are *Correspondence: Yuhong Guo [docgyh@163.com](docgyh@163.com)[ ](docgyh@163.com)Jiayun Nian[nianjiayun@126.com](nianjiayun@126.com) 1 Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China only diagnosed at an advanced stage. The 5-year survival rate of patients with advanced colon cancer is 14%[2]. Treatment options for advanced colon cancer should bestratified based on various factors, including the location of the primary lesion, microsatellite and mismatch repair status, and the presence of RAS and BRAF gene mutations [3]. However, the physical state of the patients may limit the available treatment options to some extent. Chronic hepatitis is a persistent global public health burden that can cause cirrhosis and cancer, including primary liver cancer and extrahepatic solid tumors [4, 5]. © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ()[. The Creative Commons Public Domain Dedication waiver (](http:/

FAQs

Why are treatment options for advanced colon cancer limited in patients with poor physical health or intolerance?

Advanced colon cancer treatment commonly depends on chemotherapy and targeted drugs, but patients’ medication intolerance and limited physical condition can restrict available options.

How did the patient’s initial presentation relate to colon cancer metastasis?

The first presentation was a Sister Mary Joseph’s nodule on the navel, later confirmed by biopsy and PET-CT as metastasis from colon cancer.

What treatment complication occurred after cetuximab and 5-fluorouracil therapy?

Portal vein thrombosis developed after below-guideline dose treatment with cetuximab and 5-fluorouracil, ultimately leading to death within three months of cancer diagnosis.

Sep 24, 2026

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