3085 Delayed Diagnosis of Cecal Adenocarcinoma in a Premenopausal Female

Abstract

INTRODUCTION: Cecal adenocarcinomas can present with anemia and non-specific abdominal symptoms. It is a rare colon cancer associated with aggressive course and poor outcomes. In premenopausal women it can be masked by other gynecological pathologies, resulting in delayed diagnosis and poor outcomes. CASE DESCRIPTION/METHODS: A 48 yo Hispanic female presented with acute onset nausea, vomiting and epigastric pain radiating to the right lower abdominal quadrant (RLQ). Her past medical history included active smoking, overactive bladder syndrome, sickle cell trait, hirsutism, uterine fibroids with chronic menorrhagia, constipation, and chronic iron deficiency anemia (IDA). In addition, she had multiple visits to the emergency room with similar symptoms. Prior work up was remarkable for microcytic hypochromic anemia with Hgb of 7.4, Hct of 24 and MCV of 62, severe iron IDA with ferritin 6, total iron 26, TIBC 358, iron saturation 7.3, normal LDH and reticulocyte count. Stool occult was negative. Her usual symptoms were attributed to either gynecological etiologies or her chronic constipation. During this admission her CT abdomen was consistent with acute appendicitis. However, laparoscopy revealed a right colon mass requiring hemicolectomy. Pathology report confirmed grade II cecal adenocarcinoma stage pT3, pN2a. DISCUSSION: IDA in men prompts extensive workup for colon cancer. In contrast in women it is normally attributed to gynecological/benign gastrointestinal (GI) conditions resulting in delayed diagnosis. Most of the times IDA can be the only manifestation of right sided colon cancer. In the last years, our patient had persistent abdominal discomfort which were attributed to either uterine fibroids or iron supplement induced constipation. Stool occult test was negative correlating with its low sensitivity, especially in small amounts of bleeding. Many pelvic ultrasounds were done but no advanced investigation was considered to evaluate her GI symptoms. Her anemia was always assumed to be secondary to menorrhagia, which confounded the clinical judgment and underestimated the diagnosis of colorectal cancer. This case illustrates the need for low threshold in screening for colorectal malignancies especially in premenopausal women in which anemia can be overlooked as caused mainly by gynecological conditions.