Lung Cancer with Gastrointestinal Metastasis - Review of Theories of Metastasis with Three Rare Case Descriptions

Abstract

Approximately 1 in 14 men and women during their lifetime will be diagnosed with lung cancer, which is the leading cause of cancer-related mortality in the world. As of January 1, 2008, there were about 373,500 men and women living with lung cancer in the United States. Fewer than 60,000 of these are estimated to be alive by January 2013, reflecting a poor overall 5-year relative survival rate of under 16 %. With metastatic cancer, the overall 5-year survival is meager 4 %. On the other hand, the overall five-year survival is over 50 % when the cancer is still in the localized stage. However, unfortunately, more than half of cases of lung cancer are diagnosed at an advanced stage Howlader et al. (2010). Cancer metastasis, the single most critical prognostic factor, is still poorly understood and a highly complex phenomenon. The most common sites of lung cancer metastasis are the lymph nodes, liver, adrenals, brain and bones. The gastrointestinal (GI) tract is an exceptionally rare site of metastasis; with only a handful of cases reported in the literature Centeno et al. (Lung Cancer, 18: 101-105, 1997); Hirasaki et al. (World J Gastroenterol, 14: 5481-5483, 2008); Carr and Boulos (Br J Surg, 83: 647, 1996); Otera et al. (Eur Respir Rev, 19: 248-252, 2010); Antler et al. (Cancer, 49: 170-172, 1982); Fujiwara et al. (Gen Thorac Cardiovasc Surg, 59: 748-752, 2011); Stinchcombe et al. (J Clin Oncol, 24: 4939-4940, 2006); John et al. (J Postgrad Med, 48: 199-200, 2002); Carroll and Rajesh (Eur J Cardiothorac Surg, 19: 719-720, 2001); Brown et al. (Dis Colon Rectum, 23: 343-345, 1980). We report three cases of non-small cell (squamous cell) lung cancer with GI tract metastasis-two in the colon and one in the jejunum. Then we present a review of literature exploring various theories of metastasis, as an attempt to understand the reason of preferential tumor metastasis.

Is Gastrointestinal Metastasis of Primary Lung Malignancy as Rare as Reported in the Literature? A Comparison Between Clinical Cases and Post-mortem Studies

“…Squamous cell carcinoma is known to be more aggressive with an associated poor prognosis. 3 This is supported by the fact that adenocarcinoma of the lung presents with fewer incidences of GI metastatic lesions in the study by Antler et al, at the same time as having more responsive treatment via erlotinib for cells mutated for epidermal growth factor receptor (EGFR) and crizotinib for cells mutated in anaplastic lymphoma kinase (ALK). 3 One concern with treating GI metastases from lung cancers is the risk of chemotherapy-induced perforation.…”

“…It has been estimated that there is a 4.6-14% incidence of GI metastasis found at autopsy (see Table 3). 11,31,34,39 Antler et al, 34 Yoshimoto et al, 41 and Burbige et al 40 42 This may due to the fact that this study was limited to the adenocarcinoma histology alone; it is known to be less aggressive than squamous cell carcinoma, 3 and constitutes a lower proportion of lung cancer patients demonstrating such metastatic disease and has shown a lower metastatic rate (see Table 1). Additionally, Stenbygaard's postmortem study only quantified the number of metastatic lesions to the small bowel without evaluating other parts of the GI tract.…”

“…Of note, squamous cell carcinoma of the lung is known to be the most difficult to treat, and is one of the most frequent causes of GI metastases. 3 Similarly, large-cell and small-cell carcinomas contribute to the most frequent GI metastases ( Table 1). Immunohistochemical staining is essential for the clarification between malignancies of pulmonary and GI origin.…”

Jejunal intestinal metastases, a form of presentation of pulmonary carcinoma

“…Las metástasis de intestino delgado en el carcinoma primitivo de pulmón son excepcionales y sus manifestaciones clí-nicas raras 2 . Cuando éstas se producen, pueden causar hemorragia, malabsorción, perforación intestinal, o incluso invaginación intestinal 3,4 aunque la forma más frecuente de presentación es la suboclusión-obstrucción intestinal 5 .…”

ecancermedicalscience

“…Sakai et al noted that only 12 lung cancer cases with metastases to the large intestine have been reported in published case reports as of 2012 [5, 6, 16–24]. In our literature review, we found four additional cases that had been recently published [1, 25, 26]. In the 17 documented cases, including these 16 previous cases and our case, the median age was 63 years (43–80 years), and there is a clear male predominance ( N = 15, 88.2%).…”