Colon carcinoma with synchronous ovarian metastasis--report and discussion of five cases

A case of metachronous left ovarian metastasis 8 years after surgery for cecal cancer and right ovarian metastasis: Report of a case

Metachronous ovarian metastasis of colorectal adenocarcinoma is mostly identified within 3 years. Here we present a case of a 64-year-old woman with cecal cancer who underwent right oophorectomy for ovarian metastasis. Imaging was performed because of abdominal bloating; it detected a swollen right ovary with ascites. On laparotomy, a right ovarian tumor and cecal cancer were identified. After right oophorectomy, a diagnosis of unilateral ovarian metastasis from colon cancer was made. One month later, right hemicolectomy was performed. Eight years after initial surgery, the patient presented with vaginal bleeding. A computed tomography (CT) scan revealed a pelvic mass approximately 10 cm in diameter, but no mass was evident on a CT image taken 6 months before. The patient was diagnosed with left ovarian metastasis from colon cancer. A third laparotomy revealed a left ovarian tumor, but there was no evidence of other metastases or peritoneal dissemination. Left oophorectomy was performed. Oophorectomy is considered to be associated with a survival benefit in ovarian metastasis without other extensive metastasis. However, ovarian metastasis is often bilateral. Although complete resection was achieved in the present case, the findings support performing prophylactic bilateral oophorectomy if metastasis is identified in a unilateral ovary.

Metastatic ovarian carcinoma one year after surgical removal of colon carcinoma during pregnancy: a case report

Colorectal carcinoma during pregnancy is a very rare event. We presented a woman with metachronous metastatic ovarian tumor existing 1 year after surgical removal of perforated sigmoid colon carcinoma encountered during cesarean section of woman of 36-week gestation for fetal distress. Pregnant women with suspicious abdominal mass should be evaluated for a possible colorectal carcinoma even in the absence of any other gastrointestinal symptoms associated with it and undergo rectal examination and sigmoidoscopy. In addition, as synchronous and metachronous ovarian metastases are common in these patients, ovaries must be evaluated carefully by bisection during operation for possible metastasis, and in women who do not have a desire for fertility, prophylactic oophorectomy seems an appropriate treatment modality for resecting synchronous metastasis and preventing future metastasis.

Metastatic Gastrointestinal Tract Cancer Presenting as Ovarian Carcinoma

OBJECTIVES

(1) To assess if there has been an increase of metastatic gastrointestinal (GI) cancers presenting as ovarian cancer; (2) to determine from which areas of the GI tract malignancies are most frequently associated with ovarian metastasis; (3) to determine if a higher proportion of premenopausal women present with an ovarian tumour of GI tract origin.

METHODS

A retrospective chart review of women presenting to the Hôtel-Dieu de Québec Hospital from January 1993 to June 2002, searching for the diagnosis of ovarian metastasis of GI origin at the time of primary surgery.

RESULTS

Colon cancer accounted for 65% of the malignancies found to have ovarian metastases at the time of primary surgery, with an increased percentage of cases in recent years. Metastatic GI cancer mimicking ovarian primary was equally as frequent in pre- and postmenopausal women. The use of the cancer antigen (CA) 125/carcinoembryologic antigen (CEA) ratio may help to discriminate GI carcinoma from ovarian carcinoma.

CONCLUSION

Because GI tumours may present as advanced ovarian cancer, increased vigilance is required in order to make the right diagnosis and offer the best treatment.