Primary gastrointestinal cancers presenting as gynecologic malignancies

The goal of this study was to characterize presenting symptoms, prognostic factors, and treatment outcome in patients diagnosed with primary gastrointestinal (GI) cancers initially presumed to be of gynecologic origin.

A retrospective review of all admissions to the gynecologic oncology service at Saint Luke's Hospital in Kansas City, Missouri, was performed between 1993 and 2003. Twenty-six patients with primary GI cancers who presented with presumed gynecologic malignancies were identified. Clinical and pathologic features were reviewed, methods of diagnosis were recorded, and survival was analyzed by the Kaplan-Meier method.

One percent of all gynecologic cancer referrals had a tumor of nongynecologic gastrointestinal origin. Seven subtypes of GI cancers were identified, most at stage 4 disease. Colon cancer was identified most commonly (26.9%). Abdominal pain was the most frequent symptom (57.6%), and an adnexal mass was diagnosed in the majority of patients (65.4%). Preoperative endoscopic evaluation provided a definitive diagnosis in only 3.8%. The median survival was 15 months with a 5-year survival of 35%. Ninety-six percent of patients had their GI tumor definitively diagnosed by exploratory laparotomy. Optimal cytoreduction provided a 7-month survival advantage.

Most patients required a major surgical procedure to establish the primary diagnosis of gastrointestinal cancer. The cancers encountered were almost always at advanced stage disease and were referred to the gynecologic oncologist due to the presence of an adnexal mass and a failed preoperative work-up. Surgical management should include removal of the primary or recurrent GI tumor and cytoreduction of all bulky disease, including adnexal metastases.