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Early Detection of Krukenberg Tumors Utilizing ctDNA Testing and CEA Monitoring
Angela M DeRidder1, Corrine M Check1, Paul R Kunk2
1Department of Hematology and Oncology, Riverside Health System, Williamsburg, Virginia, USA.
Case Reports in Oncological Medicine
|March 3, 2025
Summary
Circulating tumor DNA (ctDNA) testing detected ovarian metastases missed by imaging in a colon cancer patient. This liquid biopsy approach aids in monitoring and managing rare Krukenberg tumors.
Area of Science:
- Oncology
- Molecular Diagnostics
- Gastroenterology
Background:
- Krukenberg tumors, originating from gastrointestinal cancers, present diagnostic challenges due to nonspecific symptoms and late detection.
- Traditional imaging (ultrasound, CT, MRI) has limitations in detecting early-stage or micrometastatic disease.
- Circulating tumor DNA (ctDNA) analysis offers a noninvasive method for early cancer detection and molecular profiling.
Observation:
- A patient with stage IV colon cancer showed positive ctDNA after initial treatment and surgery, despite negative imaging for residual disease.
- Radiology identified a small ovarian hypodensity, initially presumed to be a follicle, which later grew into bilateral ovarian masses.
- Rising carcinoembryonic antigen (CEA) levels, alongside persistent ctDNA positivity, indicated occult metastatic disease.
Findings:
- Post-treatment ctDNA levels initially improved with capecitabine, but rising CEA and subsequent imaging confirmed bilateral ovarian metastases.
- Pathological examination of surgically removed ovaries and uterus confirmed metastatic colon adenocarcinoma, consistent with Krukenberg tumors.
- Normalization of both CEA and ctDNA levels was observed after surgical resection of the ovarian masses.
Implications:
- ctDNA testing can complement traditional imaging for monitoring high-risk cancer patients, especially those with potential for occult metastases.
- Early detection of Krukenberg tumors through ctDNA can lead to timely therapeutic adjustments and improved patient management.
- This case highlights the utility of liquid biopsies in identifying and tracking rare metastatic cancers that may evade standard radiological surveillance.
