Biliary metastasis in colorectal cancer confers a poor prognosis: case study of 5 consecutive patients.
The biliary duct is an extremely rare site for colon cancer metastasis. It often leads to a diagnostic dilemma, since primary cholangiocarcinoma (potentially treatable with surgery) has a similar presentation. This paper highlights our experience with 5 consecutive patients who had colon malignancy with biliary metastasis, and prognosis of their disease. Five patients, with a history of primary colon cancer since 2010, were identified to have biliary metastasis. Of these, 4 (80.0%) patients were male. The median time to diagnosis of biliary metastasis from diagnosis of colon cancer was 59.2 months (0-70.1 months), and all exhibited symptoms of biliary obstruction or its associated complications. Evaluation of the tumour samples revealed all specimens to be negative for CK7 but positive for CK20, suggestive of a colorectal primary. The median survival of the 5 patients was 23.5 months (1.8-44.5 months) from the diagnosis of biliary metastasis. However, none of their death was related to the direct complication of biliary obstruction. Biliary metastasis is a rare entity for metastatic colon malignancy. Diagnosis may be difficult radiologically, and immunohistochemical staining may help in identification. The overall survival for these patients is dismal.
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore.; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Frederick Hong-Xiang
FH
Koh
Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Wang
W
Shi
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore.; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Ker-Kan
KK
Tan
Bile Duct; Colorectal Cancer; Metastasis; Prognosis