Department of Internal Medicine, University of Kansas School of Medicine, 2817 N Tallgrass St, Wichita, KS, 67226, USA.
Department of Internal Medicine, University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA.
World J Surg Oncol. 2019 Apr 8;17(1):63. doi: 10.1186/s12957-019-1611-y.
Lung cancer is the most common cause of cancer-related deaths globally. Metastatic disease is often found at the time of initial diagnosis in the majority of lung cancer patients. However, colonic metastases are rare. This report describes an uncommon case of colonic metastasis from lung adenocarcinoma.
A 64-year-old female presented to her gastroenterologist for progressively worsening abdominal pain and constipation. Exploratory colonoscopy revealed a large rectosigmoid mass resulting in near total rectal occlusion. Her specialist recommended she immediately go to her regional hospital for further workup. On admission, she complained of continued abdominal pain and constipation. Notably, she had a past medical history of non-small cell lung cancer (T1bN3M0 stage IIIB), diagnosed 1 year prior. She was thought to be in remission following radiation and immunotherapy with pembrolizumab. Upon hospital admission, she underwent an urgent colostomy, ileocecectomy and anastomosis, and rectosigmoid mass resection with tissue sampling. Pathology confirmed the diagnosis of colonic metastasis from primary lung adenocarcinoma. Treatment was with systemic chemotherapy followed by localized radiation to the pelvic region was started. She did not respond well to these therapies. Subsequent imaging showed refractory tumor growth in the pelvic region. Treatment could not be completed due to the patient experiencing a debilitating stroke, and she was transitioned to hospice care.
Clinicians should have a low threshold for intestinal investigation and considerations for colonic metastasis when patients with a history of primary lung cancer have abdominal symptoms.
肺癌是全球癌症相关死亡的最常见原因。在大多数肺癌患者中，转移性疾病通常在初始诊断时就已发现。然而，结肠癌转移较为罕见。本报告描述了一例由肺腺癌引起的结肠转移的罕见病例。
一名 64 岁女性因进行性加重的腹痛和便秘就诊于胃肠病学家。结肠镜检查发现直肠乙状结肠交界处有一个大肿块，导致直肠几乎完全闭塞。她的专家建议她立即前往区域医院进行进一步检查。入院时，她主诉持续腹痛和便秘。值得注意的是，她有非小细胞肺癌（T1bN3M0 期 IIIB）的既往病史，该诊断于 1 年前确定。她在接受放疗和免疫治疗（帕博利珠单抗）后被认为处于缓解期。入院后，她接受了紧急结肠造口术、回肠-盲肠吻合术和直肠乙状结肠交界处肿块切除术，并进行了组织取样。病理证实了结肠转移来自原发性肺腺癌的诊断。她接受了全身化疗，随后开始对盆腔进行局部放疗。但她对这些治疗反应不佳。随后的影像学检查显示盆腔内肿瘤仍在不断生长。由于患者出现严重的中风，无法完成治疗，她被转至临终关怀。
当有原发性肺癌病史的患者出现腹部症状时，临床医生应降低对肠道检查和结肠癌转移的考虑门槛。
