Cervical Node Metastasis as the First Sign of Cancer of the Caecum

literature, 33 (63.5%) had metastases to the cervical lymph
nodes, 3 (5.8%) to the thyroid gland, 6 (11.5%) to the
paranasal sinus, 3 (5.8%) to the tonsils, 3 (5.8%) to the
parotid gland, 2 (3.8%) to the ear, and 1 each (1.9%) to the
larynx and to the mandibula, respectively. Of the 33 patients
with metastases to the cervical lymph nodes, 17 (51.5%) had
secondaries from a primary in the gastrointestinal tract, but
only 2 out of 33 (6.1%) had primary abdominal digestive
neoplasms, one arising from the liver and one being a
carcinoid tumour of the terminal ileum (6, 7). In any case,
all of these advanced stage IV malignancies imply ominous
outcomes.
To our knowledge, this is the first reported case of
cervical node metastasis as the first sign of a caecal cancer.
It is not known how cancer cells could have reached the
neck from the large bowel, without grossly involving the
hepatic filter. Lymphatic spread through retrograde or
unusual flow should be considered, while haematogenous
dissemination can be ruled out due to the existence of
hepatic and pulmonary filters. Indeed, somewhat bizarre
secondaries can be the first sign of abdominal malignancies,
such as Sister Mary Joseph’s umbilical nodule, which,
however, is located at an abdominal level (8).
FDG-PET allows detection of the primary tumour in about
21% of cases located above the diaphragm (9), while it proves
more sensitive than CT and monitoring of CEA and CA 19-9
levels in detecting abdominal secondaries and/or recurrences
of colorectal cancer (10, 11). In the case we report, FDG-PET
proved critical in identifying the primary lesion, while CT had
initially been aimed only to the chest and neck, as they are the
common site of origin of these tumours.
In conclusion, distant metastases to the cervical, or
axillary lymph nodes from an unknown primary neoplasm
are rare and have a poor prognosis. When an
adenocarcinoma is found in these areas, even an
abdominal primary location such as the large bowel should
be taken into account and employment of FDG-PET
should be considered.
3592
ANTICANCER RESEARCH 27: 3589-3592 (2007)
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Received April 16, 2007
Revised July 12, 2007
Accepted July 24, 2007