Ovarian and uterine disease in women with colorectal cancer

Abstract

To identify the nature of adnexal and uterine disease in women with a history of colorectal adenocarcinoma who develop new pelvic masses or uterine cancers during follow-up. We conducted a retrospective chart review of the Memorial Hospital Gynecology Service database and identified 50 women, each with a history of colorectal carcinoma who underwent a hysterectomy or adnexectomy between January 1, 1977, and February 29, 1996. Subject characteristics, indications for re-operation, and findings at surgery were recorded. The mean age at re-operation was 66 years (range, 37-76), with a median interval from initial diagnosis to re-operation of 25 months (range, 3-444). Indications for re-operation were: 1) new pelvic mass in 35 women, and 2) cancer on endometrial or cervical biopsy in 15. Twenty-six of the 35 (74%) women who presented with a pelvic mass had a malignancy in the ovary, with metastatic colon cancer noted in 20 of 26 (77%) women, and epithelial ovarian cancer in six of 26 (23%). The mean ovarian tumor size for metastatic colorectal carcinoma, ovarian cancer, and benign tumors was 15, 8, and 6 cm, respectively. Fifteen women underwent hysterectomy for a newly diagnosed cancer in the uterus, with the majority, 11 (73%), having endometrial adenocarcinoma, followed by metastatic colon cancer to the endometrium or cervix in three (20%) women, and primary cervical carcinoma in one. Women with a history of colorectal cancer who underwent adnexectomy for a new pelvic mass had metastatic colon cancer to the ovary in 57%, benign ovarian neoplasm in 26%, and primary ovarian cancer in 17% of cases. Women who underwent hysterectomy for a newly diagnosed carcinoma in the uterus had primary endometrial adenocarcinoma in 73% and metastatic colon cancer in 20% of cases.