liver metastases
a 75yo icteric woman noted to have multiple lesions in her liver that on CT imaging are suspicious for metastatic CA. which of the following is the most likely source of the PRIMARY cancer?
(a) stomach (b) lung (c) colon (d) cervix (e) pancreas (f) gallbladder (g) eye
ANSWER:
traditionally i think i would answer (c) – colon. it is the most relevant answer to surgeons because of the possibility of resecting the mets and 5yr survival rates are about 50% even with met colon ca.
however, against my better judgement, a friend who responded to this facebook post, answered EYE. at first i thought it was ridiculous, but further pursuit revealed an emedicine article that suggests otherwise: http://emedicine.medscape.com/article/369936-overview
a 1982 study quoted
Analyzing the data from 9700 consecutive autopsies in patients with 10,736 primary cancers, Pickren et al found that liver metastases were present in 41%.[1,2] They found that the primary sites most commonly metastasizing to the liver are the eye (77.8%), pancreas (75.1%), breast (60.6%), gallbladder and extrahepatic bile ducts (60.5%), colon or rectum (56.8%), and stomach (48.9%).
- Pickren JW, Tsukada Y, Lane WW. Liver metastases. In: Weiss L, Gilbert HA. Liver Metastasis. Boston, Mass: GK Hall Medical Publishers; 1982:2-18.
- Pickren JW, Tsukada Y, Lane WW. Liver metastasis. In: Weiss L, Gilbert HA, eds. Analysis of Autopsy Data. Boston, Mass: GK Hall and Company;. 1982: 2-18.
Saying that eye primaries are the cancers that most commonly metastasise to the liver, is not the same as saying that a liver metastasis is most likely to have arisen from the eye.
Given that colon cancer and breast cancer are much more common than eye primaries in 75 year old women they would still be more likely as the origin.
Agree with precordialthump’s reasoning. And well, 1982 could be outdated, no? Interesting find, nonetheless.
thanks for sharing =)
I agree with precordialthump’s reasoning above. For example, choroid (eye) melanoma metastasises to the liver in 95% of cases, yet in a liver primary of unknown origin, you’d never think of that.
I too agree. If somebody had an eye cancer you’ll be like OMG what if it metastasize, where is it gonna go? But if you found cancer of the liver and realize that hey this is mets. The patient got cancer originally somewhere. Where does that come from? Very unlikely for it to be from the eye. That’s my two cents.
Goljan seems to say that lung is the answer followed by colon (because of portal venous drainage?. Did I wrongly interpret his materials?????