Metastasis of untreated head and neck cancer to percutaneous gastrostomy tube exit sites

Abstract

BackgroundPercutaneous endoscopic gastrostomy (PEG) has become a mainstay in providing enteral access for patients with obstructive head and neck tumors. PEG tube placement is considered safe and complications are infrequent. MethodsA comprehensive review of the literature in MEDLINE (1962-2011) was performed. We report herein 3 new cases. ResultsThe literature search revealed 43 previous cases. The interval between PEG placement and diagnosis of metastasis ranged from 1 to 24 months. ConclusionsMetastatic cancer should be considered in patients with head and neck cancer that have persistent, unexplained skin changes at PEG site, anemia, or guaiac positive stools without a clear etiology. The direct implantation of tumor cells through instrumentation is the most likely explanation, although hematogenous and/or lymphatic seeding is also a possibility. Our review of the literature and clinical experience indicate that the “pull” technique of PEG placement may directly implant tumor cells at the gastrostomy site.