Colorectal cancer presenting as ovarian metastasis

Loknatha Dasappa, KC Lakshmaiah, Govind Babu, Linu Jacob Abraham, Suresh Babu, Rekha V Kumar, KN Lokesh, LK Rajeev, AH Rudresha, Suparna Ajit Rao, Sunny Garg

Clinical Cancer Investigation Journal 2017 6(1):92-96

Background: Metastatic malignant tumors account for up to 7% of ovarian masses. Approximately 3.6% to 7.4% of patients with colon cancer have ovarian metastasis at the time of initial presentation, of which 45% are mistaken for primary ovarian tumors. Methods: Tumor registry was analyzed retrospectively for the cases of colorectal cancers diagnosed between 2008 and 2013. SPSS version 19 was used for statistical analysis. The survival curves were generated using the Kaplan–Meier method using log-rank test. Results: A total of twenty such patients were identified. Median age was 40 years (22–60 years). Seventeen (85%) patients were below 50 years. Most common symptom was abdominal pain (n = 11; 55). Carcinoembryonic antigen was elevated in 17 (85%) patients and CA-125 in 15 (75%) patients. Involvement of ovary was bilateral in almost half of the patients (n = 11; 55%). Median overall survival was 8 months. It was significantly higher in six patients with ovary-only metastasis as compared to extraovarian involvement, 24 versus 4 months, respectively (P = 0.001). Other factors such as extent of extraovarian metastasis, hepatic and peritoneal involvement, and administration of postoperative therapy did not have a significant survival implication. Conclusion: A female patient, especially in the premenopausal age, presenting with a pelvic mass should always be suspected for ovarian metastasis from colon cancer, and necessary evaluation should be carried out. Postoperative chemotherapy (5-fluorouracil-based or capecitabine-based) should be incorporated in suitable patients. However, further larger studies are required in this regard.

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