Umblical metastasis in cervical cancer
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Objective cutaneous metastasis from carcinoma of the uterine cervix is an uncommon occurrence. The outcome of patients with skin metastasis is usually poor as they are often associated with locoregional recurrence. This metastasis impairs the quality of life and shortens survival. Consequently, physicians should be aware of the possible existence of skin metastasis in cervical cancer. Clinical suspicion should lead to a careful additional evaluation whenever a cutaneous nodule presents in the course of the disease.
We report a rare case of metastasis from squamous cell carcinoma of cervix to the umbilicus. The patient was diagnosed with stage IIB FIGO. Four months after chemoradiation patient presented with a nodule in the umbilical region. Biopsy performed and metastatic squamous cell carcinoma was diagnosed. Patient underwent salvage therapy with paclitaxel and carboplatin.
To the best of our knowledge, this is a rare reported occurrence of umbilical metastasis in cervical cancer without prior laparotomy or laparoscopy. This metastatic lesion has a grave prognosis and the mean survival is about 3 months like our case.
KeywordsCervical cancer Metastasis Umblical
Carcinoma of the cervix is the second most common neoplasm worldwide. Early detection and improved treatment techniques have resulted in better control of cancer and longer survival, however, invasive and metastatic disease still occurs.
Carcinoma of the cervix recurs most commonly locoregionally after surgery and/or radiotherapy. Distant metastases are rare and lungs, bone and liver are the main sites [1, 2]. Metastasis to the skin occurs rarely, regardless of the nature of the primary systemic neoplasm. Skin metastasis originating from cervical cancer is particularly unusual, even in the terminal stage of disease . The most common site of skin metastasis in carcinoma of cervix is the anterior abdominal wall (especially at the drain site), vulva, lower extremity and anterior chest wall [3, 4, 5]. We report a case of post-radiation carcinoma of cervix stage IIB who had an umbilical metastasis which is a very rare case of cutaneous metastasis, 4 months after completion of treatment.
The most common solid tumors metastasizing to the skin are breast, gastrointestinal, and ovarian cancers . Metastasis to the skin occurs rarely in gynecologic cancer, especially in cervical carcinoma . There has been no difference in the incidence of skin metastasis among the clinical stages . The incidence of skin metastasis seemed to be higher in patients with adenocarcinoma and undifferentiated carcinoma than in patients with squamous cell carcinoma . Our patient had stage IIB squamous cell cervical carcinoma. In uterine cervical cancer, skin metastasis has been reported in abdominal wall, vulva, anterior chest wall and lower extremity [4, 5]. This is consistent with other carcinomas in that the metastasis to the skin is commonly located near the site of the primary tumor . Skin metastases from cervical carcinoma occur predominantly in cases of tumor recurrences . A review of literature shows that most of skin metastases occurred after an interval less than 21 months except three cases reported by Behtash et al. , Selo-Ojema et al. , Srivastava et al.  although the second case was adenocarcinoma of the cervix. In the present case, the patient developed umbilical metastasis without prior laparascopy or laparotomy. Skin involvement was observed directly, so that deduction concerning its mechanism ought to be reliable and have applicability to the general question of the mode of spread of cervical cancer. The mechanism of involvement was thought to be retrograde lymphatic spread from the corresponding regional lymph nodes . This finding seemed important because it emphasized the predominant role of lymphatics in the spread of cervical carcinoma.
The prognosis associated with cutaneous metastasis of cervical carcinoma is poor. The mean reported survival of these patients is 3 months . These patients are not amenable to curative treatment because of locally advanced or metastatic disease. The intent of treatment remains palliation either by radiation, chemotherapy, surgery alone or in combinations . Cis-platinum is the single most active agent for controlling the symptoms , as we gave the patient carboplatin in combination with paclitaxel.
The present case is unusual in that case metastasis occurred to the normal skin (umbilical region) in squamous cell carcinoma, stage IIB 4 months after completion of the treatment and has a similar downhill course as reported in the literature
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