In case of suspicion or proven metastatic synchronous adenocarcinoma (any T or N, and M1) the diagnosis should be extended by determination of tumor gene status for KRAS and B-RAF mutation and/or HER2 amplifications, testing microsatellite instability (MSI) and mismatch repair (MMR) and consider PET-CT scan (skull base to mid-thigh) and MRI od liver [99,125]. This evidence concerns the gene KRAS and adenocarcinoma.