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Isolated metastasis of colon cancer to the scapula: is surgical resection warranted?

BACKGROUND: Distant metastases from colon cancer spread most frequently to the liver and the lung. Risk factors include positive lymph nodes and high grade tumors. Isolated metastases to the appendicular skeleton are very rare, particularly in the absence of identifiable risk factors. CASE REPORT: T...

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Autores principales: Onesti, Jill K, Mascarenhas, Christopher R, Chung, Mathew H, Davis, Alan T
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222610/
https://www.ncbi.nlm.nih.gov/pubmed/22029634
http://dx.doi.org/10.1186/1477-7819-9-137
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author Onesti, Jill K
Mascarenhas, Christopher R
Chung, Mathew H
Davis, Alan T
author_facet Onesti, Jill K
Mascarenhas, Christopher R
Chung, Mathew H
Davis, Alan T
author_sort Onesti, Jill K
collection PubMed
description BACKGROUND: Distant metastases from colon cancer spread most frequently to the liver and the lung. Risk factors include positive lymph nodes and high grade tumors. Isolated metastases to the appendicular skeleton are very rare, particularly in the absence of identifiable risk factors. CASE REPORT: The patient was a 55 year old male with no previous personal or family history of colon cancer. Routine screening revealed a sigmoid adenocarcinoma. He underwent resection with primary anastomosis and was found to have Stage IIA colon cancer. He declined chemotherapy as part of a clinical trial, and eight months later was found to have an isolated metastasis in his right scapula. This was treated medically, but grew to 12 × 15 cm. The patient underwent a curative forequarter amputation and is now more than four years from his original colon surgery. DISCUSSION: Stage IIA colon cancers are associated with a high five year survival rate, and chemotherapy is not automatically given. If metastases occur, they are likely to arise from local recurrence or follow lymphatic dissemination to the liver or lungs. Isolated skeletal metastases are quite rare and are usually confined to the axial skeleton. To our knowledge, this is the first reported case of an isolated scapular metastasis in a patient with node negative disease. The decision to treat the recurrence with radiation and chemotherapy did not reduce the tumor, and a forequarter amputation was eventually required. CONCLUSION: This case highlights the importance of adequately analyzing the stage of colon cancer and offering appropriate treatment. Equally important is the early involvement of a surgeon in discussing the timing of the treatment for recurrence. Perhaps if the patient had received chemotherapy or earlier resection, he could have been spared the forequarter amputation. The physician must also be aware of the remote possibility of an unusual presentation of metastasis in order to pursue timely work up.
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spelling pubmed-32226102011-11-23 Isolated metastasis of colon cancer to the scapula: is surgical resection warranted? Onesti, Jill K Mascarenhas, Christopher R Chung, Mathew H Davis, Alan T World J Surg Oncol Case Report BACKGROUND: Distant metastases from colon cancer spread most frequently to the liver and the lung. Risk factors include positive lymph nodes and high grade tumors. Isolated metastases to the appendicular skeleton are very rare, particularly in the absence of identifiable risk factors. CASE REPORT: The patient was a 55 year old male with no previous personal or family history of colon cancer. Routine screening revealed a sigmoid adenocarcinoma. He underwent resection with primary anastomosis and was found to have Stage IIA colon cancer. He declined chemotherapy as part of a clinical trial, and eight months later was found to have an isolated metastasis in his right scapula. This was treated medically, but grew to 12 × 15 cm. The patient underwent a curative forequarter amputation and is now more than four years from his original colon surgery. DISCUSSION: Stage IIA colon cancers are associated with a high five year survival rate, and chemotherapy is not automatically given. If metastases occur, they are likely to arise from local recurrence or follow lymphatic dissemination to the liver or lungs. Isolated skeletal metastases are quite rare and are usually confined to the axial skeleton. To our knowledge, this is the first reported case of an isolated scapular metastasis in a patient with node negative disease. The decision to treat the recurrence with radiation and chemotherapy did not reduce the tumor, and a forequarter amputation was eventually required. CONCLUSION: This case highlights the importance of adequately analyzing the stage of colon cancer and offering appropriate treatment. Equally important is the early involvement of a surgeon in discussing the timing of the treatment for recurrence. Perhaps if the patient had received chemotherapy or earlier resection, he could have been spared the forequarter amputation. The physician must also be aware of the remote possibility of an unusual presentation of metastasis in order to pursue timely work up. BioMed Central 2011-10-26 /pmc/articles/PMC3222610/ /pubmed/22029634 http://dx.doi.org/10.1186/1477-7819-9-137 Text en Copyright ©2011 Onesti et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Onesti, Jill K
Mascarenhas, Christopher R
Chung, Mathew H
Davis, Alan T
Isolated metastasis of colon cancer to the scapula: is surgical resection warranted?
title Isolated metastasis of colon cancer to the scapula: is surgical resection warranted?
title_full Isolated metastasis of colon cancer to the scapula: is surgical resection warranted?
title_fullStr Isolated metastasis of colon cancer to the scapula: is surgical resection warranted?
title_full_unstemmed Isolated metastasis of colon cancer to the scapula: is surgical resection warranted?
title_short Isolated metastasis of colon cancer to the scapula: is surgical resection warranted?
title_sort isolated metastasis of colon cancer to the scapula: is surgical resection warranted?
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222610/
https://www.ncbi.nlm.nih.gov/pubmed/22029634
http://dx.doi.org/10.1186/1477-7819-9-137
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