Vaginal metastases from colorectal cancer

Abstract

Vaginal metastasis of colorectal cancer should be included in the differential diagnosis of a vaginal swelling. There is no proposed standard treatment for vaginal metastases but surgical resection is an appropriate approach for local control when no disseminated metastatic disease is documented.

Vaginal metastasis presenting as postmenopausal bleeding

“…(7)(8)(9)11) Chemotherapy is often used as an adjunct in patients with multiple metastatic sites. (13) Our case demonstrated the importance of performing a thorough gynaecological examination during follow-up for patients with a history of malignancies, gynaecological or not, so as to detect recurrences early. The prognosis for vaginal metastasis is poor, as it is often associated with disseminated disease.…”

“…Adjuvant therapy can potentially improve survival outcomes but its role requires further study. (13) Currently, the therapeutic approach is via surgical resection for single vaginal lesion and radiotherapy, in the form of combined external beam therapy and interstitial brachytherapy. (7)(8)(9)11) Chemotherapy is often used as an adjunct in patients with multiple metastatic sites.…”

“…Chemotherapy is offered to patients with multiple metastatic sites, while surgical resection is the option for local control. (13) Hence, chemotherapy was not offered to this patient, who had a single metastatic site. In view of the patient's advanced age and her significant history of two previous cerebrovascular accidents, she was a poor surgical candidate and the decision was made for conservative management in the form of radiotherapy.…”

Uterine colorectal metastatic disease: a rare occurrence

“…Given that the serosal margin was unaffected, direct spread can clearly be excluded; in addition, the primary tumour and local recurrence were resected some years previously. Ovarian and uterine vascular channels are linked which may also provide a route of spread, given that it is known that colorectal cancer can metastasize to the ovaries . Although pelvic lymphatics drain away from the pelvis, it is postulated that, if these channels become blocked from surgery or lymph node metastasis, retrograde flow to the uterus may occur .…”

“…Ovarian and uterine vascular channels are linked which may also provide a route of spread, given that it is known that colorectal cancer can metastasize to the ovaries . Although pelvic lymphatics drain away from the pelvis, it is postulated that, if these channels become blocked from surgery or lymph node metastasis, retrograde flow to the uterus may occur . However, notably, histopathological examination of the previous resections did not reveal any lymphatic invasion, nor was there evidence of vascular involvement, which further confounds the mechanism of spread.…”