451 Metastatic Cervical Cancer to the Duodenum: A Learning Point

Background Carcinoma of the Cervix is the second most common gynaecological malignancy. It usually spreads in a predictable manner with most via direct extension to surrounding structures. When distant metastases present, they usually spread haematogenously and via the lymphatics to the liver, lung and bone marrow. Metastatic spread to the duodenum is rare with only 15 reported cases identifying spread to the bowel. Case Presentation An 81-year-old lady presented with signs and symptoms consistent with bowel obstruction with a background of renal cell carcinoma and cervical cancer. Investigations identified gastric outlet obstruction. Subsequent oesophago-gastroduodenoscopy showed structuring at D1/D2 and a enteric stent was inserted. Biopsies taken at the time showed lymphovascular permeation of the mucosa and submucosa by nests of tumour cells resembling squamous cells. The cells were P16 and P63 positive and FISH analysis detected Human papilloma virus 16. The tissue was identified as metastatic cervical cancer. The patient subsequently did not want further interventions and was referred to palliative care and subsequently passed away due to her illness. Conclusions Few reported cases of metastatic cervical cancer to the bowel have been reported. Of these, most commonly they have presented with obstructive bowel symptoms and metastasised to the duodenum such as in this case. The pathophysiology for this manner of transmission is poorly understood in literature. Obstructive bowel symptoms on the background of cervical cancer should raise the possibility of metastases in future practice.