A 74-year-old woman was admitted to the hospital with abdominal pain, weight loss, fatigue, and change in bowel habits of 6 months’ duration. Her hemoglobin level was 7 g/dL; carcinoembryonic antigen, 672 ng/dL.
A colonoscopic examination revealed a nearly obstructing carcinoma of the colon in the cecum and 3 adenomatous polyps. The polyps were removed by snare polypectomy.
Exploratory surgery revealed that widespread metastases to the peritoneal surfaces—including multiple, hard, disseminated nodules—were scattered throughout the greater omentum. Dr Virendra Parikh of Fort Wayne, Ind, diagnosed carcinomatosis that resulted from colon cancer.
Colorectal cancer is the third most frequently diagnosed cancer in adults in the United States and the second leading cause of cancer deaths.1 The prognosis is poor for patients with weight loss, anorexia, and weakness; these symptoms suggest advanced, disseminated disease.
Peritoneal implats, which are found in about 10% of patients with colon cancer, can occur anywhere on the peritoneal surfaces or the omentum.2
Palliative resection of this patient’s colon cancer and a liver biopsy for detection of metastatic disease in that organ were performed. She and her family refused chemotherapy. The patient died 2 months after surgery.